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Scarselli A, Corfiati M, DI Marzio D, Marinaccio A. Occupational carcinogens in Italy: an overview on exposure to cadmium and its compounds. Ind Health 2023:2023-0128. [PMID: 38148027 DOI: 10.2486/indhealth.2023-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Given the recognized carcinogenicity of cadmium, several regulatory interventions have been carried out over the years to protect exposed workers. The aim of the study is to investigate the prevalence and extent of exposure to cadmium among Italian workers. Data was collected from a nation-wide occupational exposure registry (SIREP, 1996-2022). Gender-specific statistical analysis was carried out for some exposure-related variables (cadmium compound, activity sector, occupational group, firm size). Potentially exposed workers were estimated for some industrial sectors. Concurrent exposures were investigated using cluster analysis. Overall 4,264 measurements were analyzed. Four industrial sectors were found to be most involved by cadmium exposure: base metal manufacturing, fabricated metal products, machinery and equipment, and other transport equipment (55% of measurements). Jewellery/precious-metal workers, and glass/ceramic plant operators were found to be most at exposure risk. A total of 26,470 workers potentially exposed was estimated (69% men). Concurrent exposures to other occupational carcinogens were detected quite frequently (52% of workers). Several situations of exposure and co-exposure to cadmium deserve attention and awareness in order to minimize the risks associated with workers' health. Recognition of potentially hazardous exposure conditions is an important step in prevention strategies to better protect workers against cancer-causing agents.
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Affiliation(s)
- Alberto Scarselli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, National Institute for Insurance against Accidents at Work (INAIL), Italy
| | - Marisa Corfiati
- Department of Prevention, Occupational Health and Safety Unit (SPeSAL), Local Health Authority of Bari, Italy
| | - Davide DI Marzio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, National Institute for Insurance against Accidents at Work (INAIL), Italy
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, National Institute for Insurance against Accidents at Work (INAIL), Italy
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Scarselli A, Corfiati M, Marinaccio A. Benzene and cause-specific mortality in an Italian national cohort of exposed workers through a proportions analysis. Epidemiol Prev 2023; 47:172-180. [PMID: 37387299 DOI: 10.19191/ep23.3.a518.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND occupational exposure to benzene represents a threat for the health of a still relevant number of workers. An increased risk of leukaemias has been demonstrated among exposed workers, while a weaker association has been found for other malignancies. OBJECTIVES to evaluate mortality risk among workers exposed to benzene across economic sectors in Italy. DESIGN proportionate mortality ratios (PMRs) were calculated linking exposure occupational information to national mortality statistics (2005-2018), assuming a Poisson distribution of the data. SETTING AND PARTICIPANTS data from the Italian national registry on occupational exposure to carcinogens (SIREP) in the period 1996-2018 were selected. MAIN OUTCOMES MEASURES PMRs by cause of death were reported. Specific analyses by cancer site and activity sector, profession, and cumulative exposure were performed. RESULTS a total of 858 deaths (97% in men) were identified among 38,704 exposed workers (91% men). An excess of deaths from malignant neoplasm of the lung was found among exposed workers, in both genders (PMR 1.27 in men; PMR 3.00 in women). An increased proportion of deaths was also found from leukaemias (leukaemia of unspecified cell type: PMR in men 2.99; 95%CI 1.24-7.19), and multiple myeloma in the chemical industry (PMR in men 2.27; 95%CI 1.08-4.76). CONCLUSIONS the risk of leukaemia in the petrochemical industry has been confirmed, while an excess risk of lung cancer mortality was highlighted in the retail sale of automotive fuels. Epidemiological surveillance and air and biological monitoring are recommended for workers exposed to benzene to ensure compliance with regulatory requirements and reduce exposure-related deaths.
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Affiliation(s)
- Alberto Scarselli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (Inail), Rome (Italy);
| | - Marisa Corfiati
- Department of Prevention, Occupational Health and Safety Unit (SPeSAL), Local Health Authority of Bari (Italy)
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (Inail), Rome (Italy)
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Scarselli A, Corfiati M, Marinaccio A. Proportionate mortality among workers exposed to hardwood dust in Italy. Ann Ist Super Sanita 2022; 58:197-203. [PMID: 36128969 DOI: 10.4415/ann_22_03_09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIMS The main aim of this study is to estimate the impact on workers' health caused by hardwood dust exposure in selected industrial sectors in Italy. METHODS Proportionate mortality ratios (PMR) by cancer site were calculated by linking the information on occupational exposure to carcinogens from the Italian national registry (SIREP, 1996-2018) to the national mortality archives (ISTAT, 2005-2018), assuming a Poisson distribution of the data. RESULTS An elevated proportion of deaths from sino-nasal cancer was found in male exposed workers (PMR=4.25, CI 95%=1.37-13.23). Increased proportions of deaths were also found from stomach cancer in both genders (PMR=3.14, CI 95%=1.41-7.00 women; PMR=1.64, CI 95%=1.22-2.19 men). CONCLUSIONS Although hardwood dust is a known human carcinogen, there are still many high-risk occupational exposure settings. Epidemiological surveillance and continuous monitoring of workers is highly recommended in order to ensure compliance with regulatory obligations and limit the burden of associated mortality causes.
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Affiliation(s)
- Alberto Scarselli
- Dipartimento di Medicina, Epidemiologia, Igiene del Lavoro ed Ambientale, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro, Rome, Italy
| | | | - Alessandro Marinaccio
- Dipartimento di Medicina, Epidemiologia, Igiene del Lavoro ed Ambientale, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro, Rome, Italy
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Napolano F, Corfiati M, Vaira A, Giangaspero G, D'Ongia M, Di Leone G, Trani G, Longo F, Marcuccio P. [Campaign of labour inspections on the implementation of protection measures against carcinogenic agents in fuel station workers]. G Ital Med Lav Ergon 2021; 43:328-333. [PMID: 35049156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 06/14/2023]
Abstract
Following the reduction in levels of exposure to benzene over the last few decades, the cancer risk of refuelers currently represents an occupational hygiene issue potentially underestimated by employers and workers themselves. Based on the literature data, the occurrence of adverse effects of neoplastic nature can not actually be excluded in this professional category, since it is not possible to define a threshold dose. In the period 2016 - 2019, an extensive focused campaign of labour inspections was conducted in the province of Bari by the OSH inspection services of the Health Local Authority in order to verify the compliance with the legislation on the workers' protection from carcinogenic agents at fuel stations. In particular, the obligations referring risk assessment, workplace hygiene, environmental monitoring, personal protective equipment (PPE), health surveillance, biological monitoring and recording of exposure to carcinogens were verified. Although these obligations were documentarily fulfilled by almost all the 162 plants inspected in the province of Bari, several critical issues were found in the approach to carcinogenic risk, including, more frequently, the lack of suitable changing rooms with relative lockers for clothing, the scarce use of gloves when dispensing fuel, the absence or incompleteness of the carcinogenic risk assessment documents, the failed or incorrect execution of biological monitoring. Data of the environmental monitoring carried out by the companies confirm that the current exposures to benzene of fuel distributors are considerably below the limit values set by the Italian legislation. The most frequently used biological exposure indicator was trans, trans-muconic urinary acid (TTMA-U). In order to reduce as much as possible the health risks for refuelers, it is needed that employers, workers and occupational physicians pay more attention to their respective duties, ensuring corrective or ameliorative interventions focused on assessment of the risk of carcinogens, supply and use of PPE, design of workplaces, health surveillance and biological monitoring of workers. The poor value of the end-of-shift TTMA-U as a biological indicator of exposure to low-dose benzene is also confirmed.
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Affiliation(s)
- Flavio Napolano
- Azienda Sanitaria Locale di Bari, Dipartimento di Prevenzione, Servizio Prevenzione e Sicurezza degli Ambienti di Lavoro
| | - Marisa Corfiati
- Azienda Sanitaria Locale di Bari, Dipartimento di Prevenzione, Servizio Prevenzione e Sicurezza degli Ambienti di Lavoro
| | - Alessandro Vaira
- Azienda Sanitaria Locale di Bari, Dipartimento di Prevenzione, Servizio Prevenzione e Sicurezza degli Ambienti di Lavoro
| | - Girolamo Giangaspero
- Azienda Sanitaria Locale di Bari, Dipartimento di Prevenzione, Servizio Prevenzione e Sicurezza degli Ambienti di Lavoro
| | - Marino D'Ongia
- Azienda Sanitaria Locale di Bari, Dipartimento di Prevenzione, Servizio Prevenzione e Sicurezza degli Ambienti di Lavoro
| | - Giorgio Di Leone
- Azienda Sanitaria Locale di Bari, Dipartimento di Prevenzione, Servizio Prevenzione e Sicurezza degli Ambienti di Lavoro
| | - Giuseppe Trani
- Azienda Sanitaria Locale di Bari, Dipartimento di Prevenzione, Servizio Prevenzione e Sicurezza degli Ambienti di Lavoro
| | - Fulvio Longo
- Azienda Sanitaria Locale di Bari, Dipartimento di Prevenzione, Servizio Prevenzione e Sicurezza degli Ambienti di Lavoro
| | - Paolo Marcuccio
- Azienda Sanitaria Locale di Bari, Dipartimento di Prevenzione, Servizio Prevenzione e Sicurezza degli Ambienti di Lavoro
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Scarselli A, Corfiati M, Di Marzio D, Massari S, Marinaccio A, Iavicoli S. The impact of vinyl chloride exposure on the health of Italian workers: an evaluation from SIREP compliance data. Arch Environ Occup Health 2021; 77:372-381. [PMID: 33739244 DOI: 10.1080/19338244.2021.1900045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The aim of the study is to investigate exposures to vinyl chloride monomer (VCM) at workplace in Italy and the related burden of diseases. Measurements data was collected from a nation-wide occupational exposure registry (SIREP, 1996-2016). Potentially exposed workers were estimated for some industrial sectors. Concurrent exposures were investigated using cluster analysis. Proportionate mortality ratios were calculated linking data to national mortality statistics (2005-2015). Overall 8,460 measurements were analyzed. Most exposures occurred in the manufacture of chemicals and plastic products. A total of 12,148 workers potentially exposed was estimated (64% male). Concurrent exposures were detected frequently (83%). An elevated proportion of deaths for liver cancer was found in male exposed workers. Although VCM is a known carcinogen for humans, there are still many exposure situations, albeit at low doses, in the chemical and plastic industries.
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Affiliation(s)
- Alberto Scarselli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Marisa Corfiati
- Department of Prevention, Occupational Health and Safety Unit (SPeSAL), Local Health Authority of Bari, Bari, Italy
| | - Davide Di Marzio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Stefania Massari
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Sergio Iavicoli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy
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Scarselli A, Marinaccio A, Corfiati M, Di Marzio D, Iavicoli S. Occupational asbestos exposure after the ban: a job exposure matrix developed in Italy. Eur J Public Health 2020; 30:936-941. [DOI: 10.1093/eurpub/ckaa118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Abstract
Background
Asbestos is a well-known carcinogen for humans. The aim of this study is to develop a tool to estimate occupational asbestos exposure in Italy after the ban using information collected in a national dataset.
Methods
Data were collected from firm registries of workers exposed to asbestos in the period 1996–2016. Descriptive statistics (arithmetic mean, standard deviation, geometric mean and geometric standard deviation) were calculated for the main exposure-related variables (activity sector, occupational group and exposure period). An estimate of workers potentially exposed to asbestos was also performed.
Results
A total of 19 704 airborne measurements of asbestos exposure was selected from the national database of occupational exposures in the sectors of asbestos abatement. Overall, a geometric mean of 7.93 f l−1 was found, and chrysotile was the asbestos type that had more exposures (41%). A total of 46 422 workers was estimated to be potentially at asbestos exposure risk. Exposure data were summarized by calendar period, activity sector and occupational group.
Conclusions
The construction of a job exposure matrix for different occupation/industry combinations may allow the assessment of occupational exposure to asbestos in several removal and disposal activities, and the estimate of the risks associated with asbestos-related diseases in epidemiological studies.
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Affiliation(s)
- Alberto Scarselli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Marisa Corfiati
- Department of Prevention, Occupational Health and Safety Unit (SPeSAL), Local Health Authority of Bari, Italy
| | - Davide Di Marzio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Sergio Iavicoli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
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Marinaccio A, Corfiati M, Binazzi A, Di Marzio D, Bonafede M, Verardo M, Migliore E, Gennaro V, Mensi C, Schallemberg G, Mazzoleni G, Fedeli U, Negro C, Romanelli A, Chellini E, Grappasonni I, Pascucci C, Madeo G, Romeo E, Trafficante L, Carrozza F, Angelillo IF, Cavone D, Cauzillo G, Tallarigo F, Tumino R, Melis M. The epidemiological surveillance of malignant mesothelioma in Italy (1993-2015): methods, findings, and research perspectives. Epidemiol Prev 2020; 44:23-30. [PMID: 32374111 DOI: 10.19191/ep20.1.p023.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND as a legacy of the large asbestos consumption until the definitive ban in 1992, Italy had to tackle a real epidemic of asbestos related diseases. The Italian National Registry of Malignant Mesotheliomas (ReNaM) is a permanent surveillance system of mesothelioma incidence, with a regional structure. Aims, assignments and territorial network of ReNaM are described, as well as data collection, recording and coding procedures. OBJECTIVES to describe the Italian epidemiological surveillance system of mesothelioma incidence, to provide updated data about occurrence of malignant mesothelioma in Italy, and to discuss goals, attainments, and expectations of registering occupational cancer. DESIGN analysis of data by malignant mesothelioma incident cases surveillance system. SETTING AND PARTICIPANTS Italy, network of regional surveillance system, all Italian regions. MAIN OUTCOME MEASURES a Regional Operating Centre (COR) is currently established in all the Italian regions, actively searching incident malignant mesothelioma cases from health care institutions. Occupational history, lifestyle habits, and residential history are obtained using a standardized questionnaire, administered to the subject or to the next of kin by a trained interviewer. The extent of dataset, epidemiological parameters, and occupations involved are reported updated at 31.12.2016, and standardized incidence rates are calculated. RESULTS at December 2016, ReNaM has collected 27,356 malignant mesothelioma cases, referring to the period of incidence between 1993 and 2015. The modalities of exposure to asbestos have been investigated for 21,387 (78%) and an occupational exposure has been defined for around 70% of defined cases (14,818). CONCLUSIONS the Italian experience shows that epidemiological systematic surveillance of asbestos related diseases incidence has a key importance for assessing and monitoring the public health impact of occupational and/or environmental hazards, programming preventive interventions, including remediation plans and information campaigns, and supporting the efficiency of insurance and welfare system. Monitoring the incidence of malignant mesothelioma through a specialized cancer registry is essential to follow-up the health effects of changing modalities and extent of occupational exposures over years and of environmental contamination. Such consolidated surveillance system is recommended also for occupational cancers with low aetiological fraction.
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Affiliation(s)
- Alessandro Marinaccio
- Department of occupational and environmental medicine, epidemiology and hygiene, Italian Workers Compensation Authority (Inail), Roma (Italy);
| | - Marisa Corfiati
- Department of occupational and environmental medicine, epidemiology and hygiene, Italian Workers Compensation Authority (Inail), Roma (Italy)
| | - Alessandra Binazzi
- Department of occupational and environmental medicine, epidemiology and hygiene, Italian Workers Compensation Authority (Inail), Roma (Italy)
| | - Davide Di Marzio
- Department of occupational and environmental medicine, epidemiology and hygiene, Italian Workers Compensation Authority (Inail), Roma (Italy)
| | - Michela Bonafede
- Department of occupational and environmental medicine, epidemiology and hygiene, Italian Workers Compensation Authority (Inail), Roma (Italy)
| | - Marina Verardo
- Regional Operating Center of Valle d'Aosta, Valle d'Aosta Local Health Unit, Aosta (Italy)
| | - Enrica Migliore
- Regional Operating Center of Piedmont, Unit of Cancer Prevention, University of Turin and CPO-Piemonte, Turin (Italy)
| | - Valerio Gennaro
- Regional Operating Center of Liguria, Operative unit of Epidemiology, IRCCS University Hospital San Martino, National Cancer Research Institute (IST), Genoa (Italy)
| | - Carolina Mensi
- Regional Operating Center of Lombrady, IRCCS Ca' Granda Foundation, Ospedale Maggiore Policlinico and University of Milan, Milan (Italy)
| | - Gert Schallemberg
- Regional Operating Center of the Province of Trento, Provincial Unit of Health, hygiene and occupational medicine, Trento (Italy)
| | - Guido Mazzoleni
- Regional Operating Center of the Province of Bolzano, Alto Adige Local Health Unit, Bolzano (Italy)
| | - Ugo Fedeli
- Regional Operating Center of Veneto, Epidemiological Department, Azienda Zero, Padua (Italy)
| | - Corrado Negro
- Regional Operating Center of Friuli Venezia Giulia, University of Trieste, Clinical Unit of Occupational Medicine, Trieste General Hospitals, Trieste (Italy)
| | - Antonio Romanelli
- Regional Operating Center of Emilia-Romagna, Public Health Department, Local Health Unit, Reggio Emilia (Italy)
| | - Elisabetta Chellini
- Regional Operating Center of Tuscany, Unit of Environmental and Occupational Epidemiology, Cancer Prevention and Research Institute, Florence (Italy)
| | - Iolanda Grappasonni
- Regional Operating Center of Marche, Hygienistic, Environmental and Health Sciences Department, School of Sciences of the drug and the products of health, University of Camerino, Camerino (Italy)
| | - Cristiana Pascucci
- Regional Operating Center of Marche, Hygienistic, Environmental and Health Sciences Department, School of Sciences of the drug and the products of health, University of Camerino, Camerino (Italy)
| | - Gabriella Madeo
- Regional Operating Center of Umbria, Department of Experimental Medicine, Public Health section, University of Perugia, Perugia (Italy)
| | - Elisa Romeo
- Regional Operating Center of Lazio, Department of Epidemiology, Lazio Region, Rome (Italy)
| | - Luana Trafficante
- Regional Operating Center of Abruzzo, Occupational Medicine Unit, Local Health Unit, Pescara (Italy)
| | - Francesco Carrozza
- Regional Operating Center of Molise, Oncology Unit, Cardarelli Hospital, Campobasso (Italy)
| | - Italo Francesco Angelillo
- Regional Operating Center of Campania, Department of Experimental Medicine, Second University of Naples, Naples (Italy)
| | - Domenica Cavone
- Regional Operating Center of Puglia, Department of Interdisciplinary Medicine, Section of Occupational Medicine "B. Ramazzini", University of Bari, Bari (Italy)
| | - Gabriella Cauzillo
- Regional Operating Center of Basilicata, Epidemiological Regional Center, Potenza (Italy)
| | - Federico Tallarigo
- Regional Operating Center of Calabria, Public Health Unit, Crotone (Italy)
| | - Rosario Tumino
- Regional Operating Center of Sicily, Cancer Registry, Provincial Health Department of Ragusa and Sicily Regional Epidemiological Observatory, Ragusa (Italy)
| | - Massimo Melis
- Regional Operating Center of Sardegna, Regional Epidemiological Center, Cagliari (Italy)
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Marinaccio A, Corfiati M, Binazzi A, Di Marzio D, Scarselli A, Ferrante P, Bonafede M, Verardo M, Mirabelli D, Gennaro V, Mensi C, Schallemberg G, Mazzoleni G, Merler E, Girardi P, Negro C, D'Agostin F, Romanelli A, Chellini E, Silvestri S, Pascucci C, Calisti R, Stracci F, Romeo E, Ascoli V, Trafficante L, Carrozza F, Angelillo I, Cavone D, Cauzillo G, Tallarigo F, Tumino R, Melis M, Iavicoli S. Letter concerning: 'Response to: 'The epidemiology of malignant mesothelioma in women: gender differences and modalities of asbestos exposure' by Marinaccio et al'. Occup Environ Med 2018; 75:844-845. [PMID: 30209209 DOI: 10.1136/oemed-2018-105362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/10/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Alessandro Marinaccio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Marisa Corfiati
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Alessandra Binazzi
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Davide Di Marzio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Alberto Scarselli
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Pierpaolo Ferrante
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Michela Bonafede
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Marina Verardo
- Valle d'Aosta Health Local Unit, Regional Operating Center of Valle d'Aosta (COR Valle d'Aosta), Aosta, Italy
| | - Dario Mirabelli
- COR Piedmont, Unit of Cancer Prevention, University of Turin and CPO-Piemonte, Torino, Italy
| | - Valerio Gennaro
- COR Liguria, UO Epidemiology, IRCCS Az Ospedaliera Universitaria San Martino, National Cancer Research Institute (IST), Genova, Italy
| | - Carolina Mensi
- COR Lombardy, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan, Milano, Italy
| | - Gert Schallemberg
- Provincial Unit of Health, Hygiene and Occupational Medicine, COR Province of Trento, Trento, Italy
| | - Guido Mazzoleni
- Alto Adige Health Local Unit, COR Province of Bolzano, Bolzano, Italy
| | - Enzo Merler
- Occupational Health Unit, Department of Prevention, COR Veneto, Padua, Italy
| | - Paolo Girardi
- Occupational Health Unit, Department of Prevention, COR Veneto, Padua, Italy
| | - Corrado Negro
- Clinical Unit of Occupational Medicine, COR Friuli-Venezia Giulia, University of Trieste -Trieste General Hospitals, Trieste, Italy
| | - Flavia D'Agostin
- Clinical Unit of Occupational Medicine, COR Friuli-Venezia Giulia, University of Trieste -Trieste General Hospitals, Trieste, Italy
| | - Antonio Romanelli
- Health Local Unit, Public Health Department, COR Emilia-Romagna, Reggio Emilia, Italy
| | - Elisabetta Chellini
- Unit of Environmental and Occupational Epidemiology, COR Tuscany, Cancer Prevention and Research Institute, Firenze, Italy
| | | | - Cristiana Pascucci
- School of Medicinal and Health Products, Center for Hygiene and Public Health Research, COR Marche, University of Camerino, Bolzano, Italy
| | - Roberto Calisti
- School of Medicinal and Health Products, Center for Hygiene and Public Health Research, COR Marche, University of Camerino, Bolzano, Italy
| | - Fabrizio Stracci
- Section of Public Health, Department of Experimental Medicine, COR Umbria, University of Perugia, Perugia, Italy
| | - Elisa Romeo
- Department of Epidemiology, COR Lazio, Lazio Region, Rome, Italy
| | - Valeria Ascoli
- Department of Radiological, Oncological and Anatomopathological Sciences, COR Lazio, La Sapienza University, Rome, Italy
| | - Luana Trafficante
- Health Local Unit, Occupational Medicine Unit, COR Abruzzo, Pescara, Italy
| | | | - Italo Angelillo
- Department of Experimental Medicine, COR Campania, Second University of Naples, Napoli, Italy
| | - Domenica Cavone
- Department of Interdisciplinary Medicine, Section of Occupational Medicine 'B Ramazzini', COR Puglia, University of Bari, Bari, Italy
| | | | | | - Rosario Tumino
- Cancer Registry ASP Ragusa and Sicily Regional Epidemiological Observatory, COR Sicily, Syracuse, Italy
| | - Massimo Melis
- Regional Epidemiological Center, COR Sardegna, Cagliari, Italy
| | - Sergio Iavicoli
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Rome, Italy
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Marinaccio A, Binazzi A, Bonafede M, Altimari A, Boscioni R, Corfiati M, Clemente M, Brusco A. Occupational diseases in Italian national priority contaminated sites. Am J Ind Med 2018; 61:582-591. [PMID: 29888799 DOI: 10.1002/ajim.22866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/16/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the occupational health risks in the Italian National Priority Contaminated Sites (NPCSs). METHODS Established cases of occupational diseases in 2010-2014 were extracted from the Italian National Institute for Insurance against Accidents at Work (INAIL) archives. Standardized incidence ratios with 95% confidence intervals were estimated by site and by disease group separately for genders. RESULTS In the 44 NPCSs evaluated, 11 015 cases of occupational diseases (8877 in men and 2138 in women) were ascertained. Overall, an excess of occupational diseases with respect to expected cases of 24.2% was found in men residing in NPCSs. An increased occurrence was detected in 21 NPCSs for men and in eight for women. CONCLUSIONS The findings suggest a role of occupational diseases in the health profile of NPCSs, reinforcing the need for a permanent surveillance system.
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Affiliation(s)
- Alessandro Marinaccio
- Department of Occupational and Environmental Medicine; Epidemiology; Hygiene, National Institute for Insurance against Accidents at Work (INAIL); Rome Italy
| | - Alessandra Binazzi
- Department of Occupational and Environmental Medicine; Epidemiology; Hygiene, National Institute for Insurance against Accidents at Work (INAIL); Rome Italy
| | - Michela Bonafede
- Department of Occupational and Environmental Medicine; Epidemiology; Hygiene, National Institute for Insurance against Accidents at Work (INAIL); Rome Italy
| | - Antonella Altimari
- Statistical and Actuarial Department; National Institute for Insurance against Accidents at Work (INAIL); Rome Italy
| | - Roberto Boscioni
- Statistical and Actuarial Department; National Institute for Insurance against Accidents at Work (INAIL); Rome Italy
| | - Marisa Corfiati
- Department of Occupational and Environmental Medicine; Epidemiology; Hygiene, National Institute for Insurance against Accidents at Work (INAIL); Rome Italy
| | - Marta Clemente
- General Medical Department; National Institute for Insurance against Accidents at Work (INAIL); Rome Italy
| | - Adelina Brusco
- Statistical and Actuarial Department; National Institute for Insurance against Accidents at Work (INAIL); Rome Italy
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10
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Bonafede M, Ghelli M, Corfiati M, Rosa V, Guglielmucci F, Granieri A, Branchi C, Iavicoli S, Marinaccio A. The psychological distress and care needs of mesothelioma patients and asbestos-exposed subjects: A systematic review of published studies. Am J Ind Med 2018; 61:400-412. [PMID: 29575036 DOI: 10.1002/ajim.22831] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND The purpose of this study is to present the results of a systematic review of published research that focuses on psychological aspects of malignant mesothelioma patients and asbestos-exposed people. METHODS Our research includes primary studies published between 1980 and 2016, using information from the Cochrane Library, the Psychology Behavioral Sciences Collection, PsychINFO, PubMed, PubGet, PubPsych, and Scopus, in compliance with PRISMA guidelines. RESULTS We identified 12 papers that investigated the psychological distress and care needs of mesothelioma patients, and nine papers for asbestos-exposed subjects. CONCLUSIONS This paper highlights the paucity of studies on the psychological distress and care needs of mesothelioma patients and asbestos-exposed subjects. It confirms that malignant mesothelioma is associated with the physical, emotional, and social functioning of patients, while also suggesting that the risk of developing asbestos-related diseases among asbestos-exposed subjects is associated with high levels of psychological distress, despair, and mental health difficulties.
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Affiliation(s)
- Michela Bonafede
- Department of Occupational and Environmental Medicine; Epidemiology and Hygiene; Italian Workers’ Compensation Authority (INAIL); Rome Italy
| | - Monica Ghelli
- Department of Occupational and Environmental Medicine; Epidemiology and Hygiene; Italian Workers’ Compensation Authority (INAIL); Rome Italy
| | - Marisa Corfiati
- Department of Occupational and Environmental Medicine; Epidemiology and Hygiene; Italian Workers’ Compensation Authority (INAIL); Rome Italy
| | - Valentina Rosa
- Department of Occupational and Environmental Medicine; Epidemiology and Hygiene; Italian Workers’ Compensation Authority (INAIL); Rome Italy
| | | | | | - Claudia Branchi
- Department of Occupational and Environmental Medicine; Epidemiology and Hygiene; Italian Workers’ Compensation Authority (INAIL); Rome Italy
| | - Sergio Iavicoli
- Department of Occupational and Environmental Medicine; Epidemiology and Hygiene; Italian Workers’ Compensation Authority (INAIL); Rome Italy
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine; Epidemiology and Hygiene; Italian Workers’ Compensation Authority (INAIL); Rome Italy
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11
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Marinaccio A, Corfiati M, Binazzi A, Di Marzio D, Scarselli A, Ferrante P, Bonafede M, Verardo M, Mirabelli D, Gennaro V, Mensi C, Schallemberg G, Mazzoleni G, Merler E, Girardi P, Negro C, D’Agostin F, Romanelli A, Chellini E, Silvestri S, Pascucci C, Calisti R, Stracci F, Romeo E, Ascoli V, Trafficante L, Carrozza F, Angelillo IF, Cavone D, Cauzillo G, Tallarigo F, Tumino R, Melis M, Iavicoli S. The epidemiology of malignant mesothelioma in women: gender differences and modalities of asbestos exposure. Occup Environ Med 2018; 75:254-262. [PMID: 29269563 PMCID: PMC5878657 DOI: 10.1136/oemed-2016-104119] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 09/04/2017] [Accepted: 10/05/2017] [Indexed: 12/04/2022]
Abstract
INTRODUCTION The epidemiology of gender differences for mesothelioma incidence has been rarely discussed in national case lists. In Italy an epidemiological surveillance system (ReNaM) is working by the means of a national register. METHODS Incident malignant mesothelioma (MM) cases in the period 1993 to 2012 were retrieved from ReNaM. Gender ratio by age class, period of diagnosis, diagnostic certainty, morphology and modalities of asbestos exposure has been analysed using exact tests for proportion. Economic activity sectors, jobs and territorial distribution of mesothelioma cases in women have been described and discussed. To perform international comparative analyses, the gender ratio of mesothelioma deaths was calculated by country from the WHO database and the correlation with the mortality rates estimated. RESULTS In the period of study a case list of 21 463 MMs has been registered and the modalities of asbestos exposure have been investigated for 16 458 (76.7%) of them. The gender ratio (F/M) was 0.38 and 0.70 (0.14 and 0.30 for occupationally exposed subjects only) for pleural and peritoneal cases respectively. Occupational exposures for female MM cases occurred in the chemical and plastic industry, and mainly in the non-asbestos textile sector. Gender ratio proved to be inversely correlated with mortality rate among countries. CONCLUSIONS The consistent proportion of mesothelioma cases in women in Italy is mainly due to the relevant role of non-occupational asbestos exposures and the historical presence of the female workforce in several industrial settings. Enhancing the awareness of mesothelioma aetiology in women could support the effectiveness of welfare system and prevention policies.
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Affiliation(s)
- Alessandro Marinaccio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Marisa Corfiati
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Alessandra Binazzi
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Davide Di Marzio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Alberto Scarselli
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Pierpaolo Ferrante
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Michela Bonafede
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Marina Verardo
- Valle d’Aosta Health Local Unit, Regional Operating Centre of Valle d’Aosta (COR Valle d’Aosta), Aosta, Italy
| | - Dario Mirabelli
- COR Piedmont, Unit of Cancer Prevention, University of Turin and CPO-Piemonte, Torino, Italy
| | - Valerio Gennaro
- COR Liguria, UO Epidemiology, IRCCS Az, Ospedaliera Universitaria San Martino, National Cancer Research Institute (IST), Genova, Italy
| | - Carolina Mensi
- COR Lombardy, Department of Preventive Medicine, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico and University of Milan, Milano, Italy
| | - Gert Schallemberg
- Provincial Unit of Health, Hygiene and Occupational Medicine, COR Province of Trento, Trento, Italy
| | - Guido Mazzoleni
- Alto Adige Health Local Unit, COR Province of Bolzano, Bolzano, Italy
| | - Enzo Merler
- Occupational Health Unit, Department of Prevention, COR Veneto, Padua, Italy
| | - Paolo Girardi
- Occupational Health Unit, Department of Prevention, COR Veneto, Padua, Italy
| | - Corrado Negro
- Clinical Unit of Occupational Medicine, COR Friuli-Venezia Giulia, University of Trieste – Trieste General Hospitals, Trieste, Italy
| | - Flavia D’Agostin
- Clinical Unit of Occupational Medicine, COR Friuli-Venezia Giulia, University of Trieste – Trieste General Hospitals, Trieste, Italy
| | - Antonio Romanelli
- Health Local Unit, Public Health Department, COR Emilia-Romagna, Reggio Emilia, Italy
| | - Elisabetta Chellini
- Unit of Environmental and Occupational Epidemiology, COR Tuscany, Cancer Prevention and Research Institute, Firenze, Italy
| | | | - Cristiana Pascucci
- Hygienistic, Environmental and Health Sciences Department, School of Sciences of the drug and the products of health, COR Marche, University of Camerino, Camerino, Italy
| | - Roberto Calisti
- Hygienistic, Environmental and Health Sciences Department, School of Sciences of the drug and the products of health, COR Marche, University of Camerino, Camerino, Italy
| | - Fabrizio Stracci
- Department of Hygiene and Public Health, COR Umbria, University of Perugia, Perugia, Italy
| | - Elisa Romeo
- Department of Epidemiology, COR Lazio, Lazio Region, Rome, Italy
| | - Valeria Ascoli
- Department of Experimental Medicine, COR Lazio, University La Sapienza, Rome, Italy
| | - Luana Trafficante
- Health Local Unit, Occupational Medicine Unit, COR Abruzzo, Pescara, Italy
| | | | | | - Domenica Cavone
- Department of Interdisciplinary Medicine, Section of Occupational Medicine ’B.Ramazzini', COR Puglia, University of Bari, Firenze, Italy
| | | | | | - Rosario Tumino
- Cancer Registry ASP Ragusa and Sicily Regional Epidemiological Observatory, COR Sicily, Policlinico, Italy
| | - Massimo Melis
- COR Sardegna, Regional Epidemiological Centre, Cagliari, Italy
| | - Sergio Iavicoli
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
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12
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Scarselli A, Corfiati M, Di Marzio D, Marinaccio A, Iavicoli S. Gender differences in occupational exposure to carcinogens among Italian workers. BMC Public Health 2018; 18:413. [PMID: 29587708 PMCID: PMC5870210 DOI: 10.1186/s12889-018-5332-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/18/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Many carcinogenic chemicals are still used or produced in several economic sectors. The aim of this study is to investigate differences in occupational exposure patterns to carcinogens by gender in Italy. METHODS Information about the most common carcinogens recorded in the Italian occupational exposures database (SIREP) for the period 1996-2015 was retrieved. Descriptive statistics were calculated for exposure-related variables (carcinogenic agent, occupational group, economic activity sector, and workforce size). The chi-square(χ2) test was used to verify differences between genders, and logistic regression analysis was performed to evaluate the association between gender and risk of having higher exposure levels, after adjusting for age. Concurrent exposures to multiple carcinogens were investigated using the two-step cluster analysis. RESULTS A total of 166,617 exposure measurements were selected for 40 different carcinogens. Exposed workers were only in a small proportion women (9%), and mostly aged 20-44 years (70%) in both genders. Women were more likely to be exposed than men to higher levels for several carcinogens even after correction for age at exposure, and the exposure level was significantly (p < 0.01) associated with occupation, economic sector and workforce size. The five main clusters of co-exposures identified in the entire dataset showed a differential distribution across economic sectors between genders. CONCLUSIONS The exposures to occupational carcinogens have distinguishing characteristics in women, that are explained in part by work and job segregation. Because of the presence of high-exposed groups of female workers in many industrial sectors, further research and prevention efforts are recommended.
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Affiliation(s)
- Alberto Scarselli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy.
| | - Marisa Corfiati
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Davide Di Marzio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Sergio Iavicoli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy
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13
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Binazzi A, Corfiati M, Di Marzio D, Cacciatore AM, Zajacovà J, Mensi C, Galli P, Miligi L, Calisti R, Romeo E, Franchi A, Marinaccio A. Sinonasal cancer in the Italian national surveillance system: Epidemiology, occupation, and public health implications. Am J Ind Med 2018; 61:239-250. [PMID: 29114957 DOI: 10.1002/ajim.22789] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Sinonasal cancer (SNC) is a rare tumor with predominant occupational etiology associated with exposures to specific carcinogens. The aim of this study is to describe SNC cases recorded in Italy in the period 2000-2016. METHODS Clinical information, occupational history, and lifestyle habits of SNC cases collected in the Italian Sinonasal Cancer Register were examined. Age-standardized rates were estimated. RESULTS Overall, 1529 cases were recorded. The age-standardized incidence rates per 100 000 person-years were 0.65 in men and 0.26 in women. Occupational exposures were predominant among the attributed exposure settings, primarily to wood and leather dusts. Other putative causal agents included chrome, solvents, tannins, formaldehyde, textile dusts, and pesticides. Many cases had unknown exposure. CONCLUSIONS Epidemiological surveillance of SNC cases and their occupational history is fundamental for monitoring the occurrence of the disease in exposed workers in industrial sectors generally not considered at risk of SNC as well as in non-occupational settings.
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Affiliation(s)
- Alessandra Binazzi
- Department of Occupational and Environmental Medicine, Epidemiology, Hygiene; National Institute for Insurance Against Accidents at Work (INAIL); Rome Italy
| | - Marisa Corfiati
- Department of Occupational and Environmental Medicine, Epidemiology, Hygiene; National Institute for Insurance Against Accidents at Work (INAIL); Rome Italy
| | - Davide Di Marzio
- Department of Occupational and Environmental Medicine, Epidemiology, Hygiene; National Institute for Insurance Against Accidents at Work (INAIL); Rome Italy
| | - Anna M. Cacciatore
- Sinonasal Cancer Registry of Piedmont; Occupational Health and Safety Department; ASL CN1; Cuneo Italy
| | - Jana Zajacovà
- Sinonasal Cancer Registry of Piedmont; Occupational Health and Safety Department; ASL CN1; Cuneo Italy
| | - Carolina Mensi
- Sinonasal Cancer Registry of Lombardy; Department of Preventive Medicine; Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico; Milan Italy
| | - Paolo Galli
- Sinonasal Cancer Registry of Emilia-Romagna; Department of Public Health; Unit of Workplace Prevention and Safety; AUSL Imola Italy
| | - Lucia Miligi
- Sinonasal Cancer Registry of Tuscany; Cancer Prevention and Research Institute (ISPO); Environmental and Occupational Epidemiology Unit; Florence Italy
| | - Roberto Calisti
- Sinonasal Cancer Registry of Marche; Department of Prevention; SPreSAL; Civitanova Marche Italy
| | - Elisa Romeo
- Sinonasal Cancer Registry of Lazio; Department of Epidemiology; ASL RM1; Rome Italy
| | - Alessandro Franchi
- Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology, Hygiene; National Institute for Insurance Against Accidents at Work (INAIL); Rome Italy
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14
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Ferrante P, Mastrantonio M, Uccelli R, Corfiati M, Marinaccio A. [Pleural mesothelioma mortality in Italy: time series reconstruction (1970-2009) and comparison with incidence (2003-2008)]. Epidemiol Prev 2017; 40:205-14. [PMID: 27436254 DOI: 10.19191/ep16.3-4.p205.087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND the large amount of asbestos used in many Countries (including Italy) is causing an epidemic of asbestos related diseases, which is still ongoing because of their long latency. OBJECTIVES this study is aimed at reconstructing Italian time series of deaths for mesothelioma in the period 1970-2009 and comparing Italian incidence and mortality data. DESIGN, SETTING, AND PARTICIPANTS deaths for pleural cancer (1970-2003,2006-2009) and mesothelioma (2003, 2006-2009) were recorded by the Italian Institute of Statistics (Istat) and provided by the Italian National Agency for New Technologies, Energy and the Environment (ENEA), incidence cases (1993-2008) were provided by the Italian mesotheliomas register (ReNaM) at the Italian National Workers' Compensation Authority (Inail). For the period before ICD-10 implementation (1970-2002) and when Istat data (2004-2005) are lacking, mesothelioma deaths were estimated through statistical models (logistic, Poisson). National incidence and mortality data were compared during the overlapping period (2003, 2006-2008). RESULTS the mortality curve strongly rises from 1970 and seems to be smoothed in the last years. Mortality caused by mesothelioma and incident cases with certain diagnosis are overlapping, as are mortality due to pleural cancer other than mesothelioma and mesothelioma incidence with uncertain diagnosis (probable/possible). CONCLUSIONS this epidemiological analysis of deaths encoded as pleural tumour suggests to carefully investigate space-temporal distribution before excluding they could be mesotheliomas. Some new lights have been thrown on the statistical behaviour of mesothelioma mortality.
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Affiliation(s)
- Pierpaolo Ferrante
- Dipartimento di medicina, epidemiologia e igiene del lavoro e ambientale, Laboratorio di epidemiologia occupazionale e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro (Inail), Roma.
| | - Marina Mastrantonio
- Agenzia nazionale per le nuove tecnologie, l'energia e lo sviluppo economico sostenibile (ENEA), Roma
| | - Raffaella Uccelli
- Agenzia nazionale per le nuove tecnologie, l'energia e lo sviluppo economico sostenibile (ENEA), Roma
| | - Marisa Corfiati
- Dipartimento di medicina, epidemiologia e igiene del lavoro e ambientale, Laboratorio di epidemiologia occupazionale e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro (Inail), Roma
| | - Alessandro Marinaccio
- Dipartimento di medicina, epidemiologia e igiene del lavoro e ambientale, Laboratorio di epidemiologia occupazionale e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro (Inail), Roma
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15
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Scarselli A, Corfiati M, Di Marzio D, Iavicoli S. National Estimates of Exposure to Formaldehyde in Italian Workplaces. Ann Work Expo Health 2017; 61:33-43. [PMID: 28395310 DOI: 10.1093/annweh/wxw004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 11/07/2016] [Indexed: 11/14/2022] Open
Abstract
Purpose Formaldehyde is classified as human carcinogen and the association with nasopharyngeal cancer has been observed in many epidemiological studies. The aim of this study is to evaluate data about occupational exposure levels to formaldehyde in the Italian working force. Methods Airborne concentrations of formaldehyde were extracted from the Italian database on occupational exposure to carcinogens and refer to the period 1996-2014. Descriptive statistics were calculated for exposure-related variables. The number of workers potentially exposed was estimated for the activity sectors better characterized in the database. An analysis through linear mixed models was performed to determine factors influencing the exposure level. Results A total of 1610 formaldehyde exposure measurements were selected from the database, having an overall arithmetic mean of 0.12 mg m-3 and a geometric mean of 0.04 mg m-3. The activity sectors with the highest number of measurements were the manufacturing of chemicals and chemicals products (N = 529) in men and the health and social work in women (N = 105). The number of workers potentially exposed in the selected sectors was 49450, and the most predictive independent variables of the exposure level resulted to be the occupational group and the year of measurement. Conclusions The occupational exposure to formaldehyde occurs in a variety of different sectors, but currently workers at higher risk are those employed in the healthcare sector and in the wood processing industry. Prevention measures have to be targeted to reduce the risk to workers' health, also in a gender perspective. This study confirms the important role of occupational exposure databases as a valuable source of data for the epidemiological assessment of risks in workplaces.
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Affiliation(s)
- Alberto Scarselli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Viale Stefano Gradi, 55, 00143 Rome, Italy
| | - Marisa Corfiati
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Viale Stefano Gradi, 55, 00143 Rome, Italy
| | - Davide Di Marzio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Viale Stefano Gradi, 55, 00143 Rome, Italy
| | - Sergio Iavicoli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Viale Stefano Gradi, 55, 00143 Rome, Italy
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Marsili D, Angelini A, Bruno C, Corfiati M, Marinaccio A, Silvestri S, Zona A, Comba P. Asbestos Ban in Italy: A Major Milestone, Not the Final Cut. Int J Environ Res Public Health 2017; 14:E1379. [PMID: 29137208 PMCID: PMC5708018 DOI: 10.3390/ijerph14111379] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 11/17/2022]
Abstract
Background and history: Italy was the main asbestos producer and one of the greatest consumers in 20th century Europe until the asbestos ban was introduced in 1992. Asbestos exposure affected the population in a wide range of working environments, namely mining and marketing of asbestos, asbestos cement production, shipyards and textile industries. This also determined a widespread environmental asbestos exposure affecting the surrounding communities. Methods: To investigate the drivers and difficulties of the process leading to the asbestos ban and its subsequent implementation, we focused on stakeholder involvement, environmental health policies, capacity building and communication. Results: In the past three decades, stakeholder involvement has been instrumental in advancing the industrial asbestos replacement process, prevention and remediation interventions. Furthermore, involvement also contributed to the integration of environmental and health policies at national, regional and local levels, including capacity building and communication. In a global public health perspective, international scientific cooperation has been established with countries using and producing asbestos. Discussion and Conclusions: Key factors and lessons learnt in Italy from both successful and ineffective asbestos policies are described to support the relevant stakeholders in countries still using asbestos contributing to the termination of its use.
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Affiliation(s)
- Daniela Marsili
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy.
| | - Alessia Angelini
- Institute for Study and Prevention of Cancer, 50139 Florence, Italy.
| | - Caterina Bruno
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy.
| | - Marisa Corfiati
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers Compensation Authority (INAIL), 00143 Rome, Italy.
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers Compensation Authority (INAIL), 00143 Rome, Italy.
| | - Stefano Silvestri
- Institute for Study and Prevention of Cancer, 50139 Florence, Italy.
| | - Amerigo Zona
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy.
| | - Pietro Comba
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy.
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Buresti G, Colonna F, Corfiati M, Valenti A, Persechino B, Marinaccio A, Rondinone BM, Iavicoli S. Economic impact of malignant mesothelioma in Italy: an estimate of the public and social costs. Med Lav 2017; 108:358-66. [PMID: 29086761 DOI: 10.23749/mdl.v108i5.6505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/05/2017] [Accepted: 10/12/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite their considerable interest for public health policies and for occupational disease management and assessment, the economic costs of asbestos-related diseases (ARDs) for society have not been fully estimated or even frequently discussed. OBJECTIVES The aim of this study was to estimate the economic burden of mesothelioma in Italy by assessing the overall societal cost of the disease, applying an econometric model. METHODS We analyzed two main cost groups, public and social. The first includes expenditure borne by the State and other public bodies (medical care costs, insurance, tax and benefits), while the latter uses the human capital approach to measure the loss of productivity suffered by the economy as a whole. RESULTS We provide an estimate of euro 33,000 per patient for medical care costs and euro 25,000 for insurance and compensation; tax and benefits seem to roughly compensate. We estimated a loss of more than euro 200,000 per patient, in terms of loss of production. CONCLUSIONS This study offers a practical approach for estimating the economic impact of mesothelioma, and provides empirical evidence of the huge economic burden linked to this disease, with its high etiologic fraction.
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Affiliation(s)
- Giuliana Buresti
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene - Italian Workers Compensation Authority (INAIL), via Fontana Candida 1, 00078 Monte Porzio Catone (Rome), Italy.
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18
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Binazzi A, Marinaccio A, Corfiati M, Bruno C, Fazzo L, Pasetto R, Pirastu R, Biggeri A, Catelan D, Comba P, Zona A. Mesothelioma incidence and asbestos exposure in Italian national priority contaminated sites. Scand J Work Environ Health 2017; 43:550-559. [PMID: 28985440 DOI: 10.5271/sjweh.3676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives This study aimed to (i) describe mesothelioma incidence in the Italian national priority contaminated sites (NPCS) on the basis of data available from the Italian National Mesothelioma Registry (ReNaM) and (ii) profile NPCS using Bayesian rank analysis. Methods Incident cases of mesothelioma and standardized incidence ratios (SIR) were estimated for both genders in each of the 39 selected NPCS in the period 2000-2011. Age-standardized rates of Italian geographical macro areas were used to estimate expected cases. Rankings of areas were produced by a hierarchical Bayesian model. Asbestos exposure modalities were discussed for each site. Results In the study period, 2683 incident cases of mesothelioma (1998 men, 685 women) were recorded. An excess of mesothelioma incidence was confirmed in sites with a known past history of direct use of asbestos (among men) such as Balangero (SIR 197.1, 95% CI 82.0-473.6), Casale Monferrato (SIR 910.7, 95% CI 816.5-1012.8), and Broni (SIR 1288.5, 95% CI 981.9-1691.0), in sites with shipyards and harbors (eg, Trieste, La Spezia, Venice, and Leghorn), and in settings without documented direct use of asbestos. The analysis ranked the sites of Broni and Casale Monferrato (both genders) and Biancavilla (only for women) the highest. Conclusions The present study confirms that asbestos pollution is a risk for people living in polluted areas, due to not only occupational exposure in industrial settings with direct use of asbestos but also the presence of asbestos in the environment. Epidemiological surveillance of asbestos-related diseases is a fundamental tool for monitoring the health profile in NPCS.
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Affiliation(s)
- Alessandra Binazzi
- Department of Occupational and Environmental Medicine, Epidemiology, Hygiene. National Institute for Insurance against Accidents at Work (INAIL), Via Stefano Gradi 55, 00143 Rome, Italy.
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Scarselli A, Corfiati M, Di Marzio D, Iavicoli S. Appraisal of levels and patterns of occupational exposure to 1,3-butadiene. Scand J Work Environ Health 2017; 43:494-503. [PMID: 28489219 DOI: 10.5271/sjweh.3644] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives 1,3-butadiene is classified as carcinogenic to human by inhalation and the association with leukemia has been observed in several epidemiological studies. The aim of this study was to evaluate data about occupational exposure levels to 1,3-butadiene in the Italian working force. Methods Airborne concentrations of 1,3-butadiene were extracted from the Italian database on occupational exposure to carcinogens in the period 1996-2015. Descriptive statistics were calculated for exposure-related variables. An analysis through linear mixed model was performed to determine factors influencing the exposure level. The probability of exceeding the exposure limit was predicted using a mixed-effects logistic model. Concurrent exposures with other occupational carcinogens were investigated using the two-step cluster analysis. Results The total number of exposure measurements selected was 23 885, with an overall arithmetic mean of 0.12 mg/m3. The economic sector with the highest number of measurements was manufacturing of chemicals (18 744). The most predictive variables of the exposure level resulted to be the occupational group and its interaction with the measurement year. The highest likelihood of exceeding the exposure limit was found in the manufacture of coke and refined petroleum products. Concurrent exposures were frequently detected, mainly with benzene, acrylonitrile and ethylene dichloride, and three main clusters were identified. Conclusions Exposure to 1,3-butadiene occurs in a wide variety of activity sectors and occupational groups. The use of several statistical analysis methods applied to occupational exposure databases can help to identify exposure situations at high risk for workers' health and better target preventive interventions and research projects.
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Affiliation(s)
- Alberto Scarselli
- Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro (INAIL), Dipartimento di Medicina, Epidemiologia, Igiene del Lavoro ed Ambientale, Viale Stefano Gradi, 55, 00143 Roma, Italy.
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Zona A, Fazzo L, Binazzi A, Bruno C, Corfiati M, Comba P, Conti S, Menegozzo S, Nicita C, Pasetto R, Pirastu R, Marinaccio A. [SENTIERI-ReNaM: Discussion and concluding remarks]. Epidemiol Prev 2016; 40:105-108. [PMID: 27825200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
SENTIERI-ReNaM Project analysed the incidence of malignant mesothelioma (MM) for the period 2000-2011 in 39 National Priority Contaminated Sites (NPCSs), and assessed the overall impact of mesothelioma in different types of NPCSs. In the study period, 2,683 incident cases of malignant mesothelioma were recorded: 1,998 males (74.5%), 685 females (25.5%). Excluding cases with non attributable exposure and those non interviewed, exposure was identified in 1,926 cases (70% of all cases): 1,541 males (occupational exposure: 1,414; environmental exposure: 82), 385 females (occupational exposure: 103; environmental exposure: 141). Women experienced mainly environmental and domestic exposures to asbestos. Standard Incidence Ratio (SIR) excesses were observed in men in 27 out of 39 NPCSs and defects in the remaining 12; in women, 20 NPCSs showed SIR excesses, defects in 15; in 4 NPCSs no MM cases occurred among female population. The highest rates were found in NPCSs with asbestos-cement plants (Broni and Casale Monferrato), respectively, 98 per 100,000 per year and 68.6 in men, 72.1 and 45.8 in women. Excluding these two sites, the highest incidence rates were found in the group with harbours and shipyards, where the rates were, respectively, 13.2 among men and 2.5 among women. The results of this report will be communicated to national and local institutions, as well as to NPCSs resident populations.
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Affiliation(s)
- Amerigo Zona
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Lucia Fazzo
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Alessandra Binazzi
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Caterina Bruno
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Marisa Corfiati
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Pietro Comba
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Susanna Conti
- Ufficio di statistica, CNESPS, Istituto superiore di sanità, Roma
| | - Simona Menegozzo
- Istituto nazionale tumori, IRCCS "Fondazione G. Pascale", Napoli
| | - Carmela Nicita
- Registro tumori Ragusa - COR Sicilia, Dipartimento di prevenzione, ASP 7 Ragusa
| | - Roberto Pasetto
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Roberta Pirastu
- Dipartimento di biologia e biotecnologie "Charles Darwin", Sapienza Università di Roma
| | - Alessandro Marinaccio
- Dipartimento di medicina, epidemiologia, igiene del lavoro ed ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
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Comba P, Zona A, Pirastu R, Bruno C, Fazzo L, Pasetto R, Binazzi A, Corfiati M, Marinaccio A. [SENTIERI-ReNaM: Rationale and objectives]. Epidemiol Prev 2016; 40:13-15. [PMID: 27825196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The purpose of the SENTIERI-ReNaM Project is to analyse the incidence of mesothelioma in Italian National Priority Contaminated Sites (NPCSs) in order to estimate the health impact of asbestos on resident populations, disentangling the role of occupational and environmental exposures. SENTIERI Project has provided the relevant information on geographic and demographic structure of NPCSs and on existing sources of contamination. The Italian National Mesothelioma Registry (ReNaM), that covers the whole country through its Regional Operational Centres (CORs), has made available the procedures for estimating the incidence of mesothelioma in NPCSs and for assessing occupational and environmental asbestos exposure of the individual cases. The synergy between these two epidemiological surveillance systems lay also the ground for communication programmes with the affected communities.
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Affiliation(s)
- Pietro Comba
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Amerigo Zona
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma.
| | - Roberta Pirastu
- Dipartimento di biologia e biotecnologie "Charles Darwin", Sapienza Università di Roma
| | - Caterina Bruno
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Lucia Fazzo
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Roberto Pasetto
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Alessandra Binazzi
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Marisa Corfiati
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Alessandro Marinaccio
- Dipartimento di medicina, epidemiologia, igiene del lavoro ed ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
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Pasetto R, Fazzo L, Zona A, Bruno C, Pirastu R, Binazzi A, Corfiati M, Silvestri S, Comba P, Marinaccio A. [SENTIERI-ReNaM: Burden of disease from mesothelioma in national priority contaminated sites in Italy]. Epidemiol Prev 2016; 40:99-104. [PMID: 27825199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND in Italy, National Priority Contaminated Sites (NPCSs) are defined as of concern for remediation; most of them are sites with a long-lasting industrial activity. OBJECTIVE the study aims to estimate the burden of disease from mesothelioma in NPCSs. DESIGN mesothelioma incidence in the period 2000-2011 was estimated for the populations residing in the 39 Italian NPCSs. Data were taken from the Italian National Mesothelioma Registry (ReNaM). NPCSs were ranked into risk groups (RGs) on the basis of the presence of the following asbestos-exposing activities: 1. asbestos-cement plants; 2. asbestos mines; 3. harbours with shipyards; 4. illegal dumping sites containing asbestos; 5. petrochemicals and/or refineries, and/or steel plants; 6. chemical plants and/or landfills without explicit mention of asbestos. For the population residing in each NPCS, crude rates per 100,000 per year and number of observed minus expected cases (Obs-Exp) by gender were computed. Expected cases were calculated using the age-class rates of a reference population (the geographical macroarea of every NPCS). For every RG, the meta-analytic estimate of the attributable proportion (AP), i.e., the proportion of cases attributable to the local context, was computed, being the AP for each NPCS expressed as (Obs-Exp/Obs) x100. RESULTS the total number of mesothelioma cases estimated in the considered period of 12 years is 2,741 (2,048 males, 693 females). The total number of Obs-Exp cases was 1,531 (1,178 in males, 353 in females). In males, crude rate ranges from 71.5 in the RG1 to 3.0 in RG4, while in females it ranges from 48.4 in RG1 to 0.6 in RG4. In males, AP in RGs from 1 to 3 is over 65%, in RG4 is 59%, in RG5 is 30%, in RG6 is -14%. AP in females gradually drops from 95% in RG1 to -64% in RG6. CONCLUSIONS the burden of mesothelioma in populations residing in NPCSs is high, with an AP gradient consistent with the a priori RG. This burden impacts on females in a different way: rates are lower than male ones; AP is similar to male ones in the RGs 1 and 3.
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Affiliation(s)
- Roberto Pasetto
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Lucia Fazzo
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Amerigo Zona
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma.
| | - Caterina Bruno
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Roberta Pirastu
- Dipartimento di biologia e biotecnologie "Charles Darwin", Sapienza Università di Roma
| | - Alessandra Binazzi
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Marisa Corfiati
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Stefano Silvestri
- Collaboratore Istituto per lo studio e la prevenzione oncologica, Firenze
| | - Pietro Comba
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Alessandro Marinaccio
- Dipartimento di medicina, epidemiologia, igiene del lavoro ed ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
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Marinaccio A, Binazzi A, Comba P, Corfiati M, Fazzo L, Bruno C, Pirastu R, Pasetto R, Zona A. [SENTIERI-ReNaM: Materials and methods]. Epidemiol Prev 2016; 40:16-18. [PMID: 27825197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In the framework of SENTIERI Project, this study is aimed to identify excess risks of malignant mesothelioma (MM) in Italian National Priority Contaminated Sites (NPCSs) included in the national environmental remediation programme and to discuss the results by means of data available from the Italian National Mesothelioma Registry (ReNaM). Re- NaM has a regional structure with Regional Operational Centres (CORs) in charge of identifying mesothelioma incident cases and defining the asbestos exposure modalities thought an individual questionnaire. Starting from the 44 NPCSs selected in SENTIERI Project, we excluded Calabria and Sardinia Regions from the analyses (3 NPCSs). Furthermore, for 2 sites (Emarese in Valle d'Aosta and Tito in Basilicata) no incident MM cases have been detected in the considered period. Incident cases of MM and Standardized Incidence Ratios (SIR), with corresponding 90% confidence intervals, have been estimated in each NPCS, for both gender, in the period 2000-2011. Age-standardized rates of Italian geographical macro-areas (North- East, North-West, Centre, South and Islands) have been used to estimate expected cases. For every analyzed site, the occupational and non-occupational asbestos exposure modalities are discussed.
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Affiliation(s)
- Alessandro Marinaccio
- Dipartimento di medicina, epidemiologia, igiene del lavoro ed ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Alessandra Binazzi
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Pietro Comba
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Marisa Corfiati
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Lucia Fazzo
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Caterina Bruno
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Roberta Pirastu
- Dipartimento di biologia e biotecnologie "Charles Darwin", Sapienza Università di Roma
| | - Roberto Pasetto
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Amerigo Zona
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma.
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Binazzi A, Zona A, Marinaccio A, Bruno C, Corfiati M, Fazzo L, Menegozzo S, Nicita C, Pasetto R, Pirastu R, De Santisi M, Comba P. [SENTIERI-ReNaM: Results]. Epidemiol Prev 2016; 40:19-98. [PMID: 27825198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Mesothelioma incidence has been analyzed in National Priority Contaminated Sites (NPCSs) to estimate the health impact of asbestos exposure on resident people. The burden of professional and environmental exposures has been identified through data of the Regional Operational Centres (CORs), made available by the Italian National Mesothelioma Registry (ReNaM). An excess of mesothelioma incidence is confirmed in sites with a known past history of direct use of asbestos, such as Balangero, Casale Monferrato, Broni, Bari-Fibronit, and in coastal areas, where shipyards, harbours and other industries that involved a wide use of asbestos are represented (e.g., Trieste, La Spezia, Venice, and Leghorn). An excess of mesothelioma has been observed in settings where the asbestos is not mentioned as contaminant in the decree that included these sites among NPCSs, such as Cengio and Saliceto in Northern Italy; Falconara Marittima and the Bacino Idrografico Fiume Sacco in the Central Italy; the Litorale Domizio Flegreo and Agro Aversano, Milazzo, and Gela in the Southern Italy. Observed excess in the various NPCSs confirms the large-scale occurrence in contaminated Italian sites of a significant amount of total mesothelioma cases observed at national level. The analysis of occupational risk in epidemiological studies with an ecological design helps in defining the contribution of different factors to the overall risk.
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Affiliation(s)
- Alessandra Binazzi
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Amerigo Zona
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma.
| | - Alessandro Marinaccio
- Dipartimento di medicina, epidemiologia, igiene del lavoro ed ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Caterina Bruno
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Marisa Corfiati
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Lucia Fazzo
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Simona Menegozzo
- Istituto nazionale tumori, IRCCS "Fondazione G. Pascale", Napoli
| | - Carmela Nicita
- Registro tumori Ragusa - COR Sicilia, Dipartimento di prevenzione, ASP 7 Ragusa
| | - Roberto Pasetto
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Roberta Pirastu
- Dipartimento di biologia e biotecnologie "Charles Darwin", Sapienza Università di Roma
| | - Marco De Santisi
- Dipartimento ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Pietro Comba
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
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Di Lorenzo L, Vacca A, Corfiati M, Lovreglio P, Soleo L. Evaluation of Tumor Necrosis Factor-Alpha and Granulocyte Colony-Stimulating Factor Serum Levels in Lead-Exposed Smoker Workers. Int J Immunopathol Pharmacol 2016; 20:239-47. [PMID: 17624258 DOI: 10.1177/039463200702000204] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Inorganic lead (Pb) is able to modulate the immune response even at low to moderate exposure levels. It inhibits in vitro and in vivo activities of neutrophil leucocytes and influences their blood count in humans. Neutrophil functions are governed by a number of cytokines. Pb has been shown to affect leukocyte production of some of these cytokines in vitro. The objective of this study is to assess serum tumor necrosis factor-alpha (TNF-α) and granulocyte colony-stimulating factor (G-CSF) levels of thirty-three male lead-exposed (E) workers at a lead recycling plant as compared with twenty-eight male non-exposed (NE) workers at a food processing plant, whose current smoking habit was known. Serum TNF-α and G-CSF levels were measured by a quantitative sandwich enzyme immunoassay. Blood lead levels (Pb-B) were significantly higher in E (geometric mean (GM) 30.7 μg/dl, GSD 1.7; min-max: 9.1–81.6 μg/dl) workers than controls (GM 3.6 μg/dl, GSD 1.7; min-max: 1.0–11.0 μg/dl). E workers had significantly higher serum TNF-α (median: 107.1; min-max: 11.1–623.0 pg/ml) and G-CSF levels (median: 53.0, min-max: 31.1–197.0 pg/ml) than NE workers (TNF-α: median: 12.0; min-max: 9.4–18.8 pg/ml; G-CSF: median: 34.3, min-max: 25.1–52.2 pg/ml). In particular, the TNF-α level was shown to be significantly influenced by lead exposure and smoking habit, as well as by interaction between these two factors. Both serum TNF-α and G-CSF levels were correlated with Pb-B and absolute neutrophil count. This study is the first to detect higher serum levels of G-CSF in E over NE workers. Our data confirm that exposure to low to medium doses of lead may interfere in the complex cytokine network involved in inflammation, especially in workers who are current smokers.
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Affiliation(s)
- L Di Lorenzo
- Department of Internal and Public Medicine, Section of Occupational Medicine, University of Bari, Italy.
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Scarselli A, Corfiati M, Di Marzio D. Occupational exposure in the removal and disposal of asbestos-containing materials in Italy. Int Arch Occup Environ Health 2016; 89:857-65. [PMID: 26970752 DOI: 10.1007/s00420-016-1126-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 03/02/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE A great variety of asbestos-containing materials are present in both residential and work settings because of the widespread use made in the past, and many occupational activities still entail the risk of asbestos exposure in Italy, more than 2 decades after the total national ban, mainly those involved in the removal and disposal of asbestos. The aim of the study was to evaluate the level and extent of asbestos exposure in Italy between the years 1996-2013 in the sector of asbestos abatement. METHODS Data were collected from firm registries of asbestos-exposed workers and descriptive statistics were calculated for exposure-related variables. RESULTS Overall, 15,860 measurements of asbestos exposure were selected from the national database of registries, mostly referring to the construction sector (N = 11,353). Despite the mean exposure levels are low, the air concentration of asbestos fibers measured during these activities may overcome the action level established by the Italian legislation and, in a limited number of cases, can exceed even the occupational limit value. Among occupations at higher risk, there are also garbage collectors and insulation workers. CONCLUSIONS Starting from the analysis of the Italian database of occupational exposure registries, this study outlines the current levels of asbestos exposure in abatement-related sectors, discussing their possible implications for public health policies and surveillance programs.
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Affiliation(s)
- Alberto Scarselli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy.
| | - Marisa Corfiati
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Davide Di Marzio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy
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Marinaccio A, Binazzi A, Bonafede M, Corfiati M, Di Marzio D, Scarselli A, Verardo M, Mirabelli D, Gennaro V, Mensi C, Schallemberg G, Merler E, Negro C, Romanelli A, Chellini E, Silvestri S, Cocchioni M, Pascucci C, Stracci F, Ascoli V, Trafficante L, Angelillo I, Musti M, Cavone D, Cauzillo G, Tallarigo F, Tumino R, Melis M. Malignant mesothelioma due to non-occupational asbestos exposure from the Italian national surveillance system (ReNaM): epidemiology and public health issues. Occup Environ Med 2015; 72:648-55. [DOI: 10.1136/oemed-2014-102297] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 11/25/2014] [Indexed: 11/04/2022]
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Corfiati M, Scarselli A, Binazzi A, Di Marzio D, Verardo M, Mirabelli D, Gennaro V, Mensi C, Schallemberg G, Merler E, Negro C, Romanelli A, Chellini E, Silvestri S, Cocchioni M, Pascucci C, Stracci F, Romeo E, Trafficante L, Angelillo I, Menegozzo S, Musti M, Cavone D, Cauzillo G, Tallarigo F, Tumino R, Melis M, Iavicoli S, Marinaccio A. Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry. BMC Cancer 2015; 15:286. [PMID: 25885893 PMCID: PMC4404011 DOI: 10.1186/s12885-015-1301-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 03/31/2015] [Indexed: 11/10/2022] Open
Abstract
Background Previous ecological spatial studies of malignant mesothelioma cases, mostly based on mortality data, lack reliable data on individual exposure to asbestos, thus failing to assess the contribution of different occupational and environmental sources in the determination of risk excess in specific areas. This study aims to identify territorial clusters of malignant mesothelioma through a Bayesian spatial analysis and to characterize them by the integrated use of asbestos exposure information retrieved from the Italian national mesothelioma registry (ReNaM). Methods In the period 1993 to 2008, 15,322 incident cases of all-site malignant mesothelioma were recorded and 11,852 occupational, residential and familial histories were obtained by individual interviews. Observed cases were assigned to the municipality of residence at the time of diagnosis and compared to those expected based on the age-specific rates of the respective geographical area. A spatial cluster analysis was performed for each area applying a Bayesian hierarchical model. Information about modalities and economic sectors of asbestos exposure was analyzed for each cluster. Results Thirty-two clusters of malignant mesothelioma were identified and characterized using the exposure data. Asbestos cement manufacturing industries and shipbuilding and repair facilities represented the main sources of asbestos exposure, but a major contribution to asbestos exposure was also provided by sectors with no direct use of asbestos, such as non-asbestos textile industries, metal engineering and construction. A high proportion of cases with environmental exposure was found in clusters where asbestos cement plants were located or a natural source of asbestos (or asbestos-like) fibers was identifiable. Differences in type and sources of exposure can also explain the varying percentage of cases occurring in women among clusters. Conclusions Our study demonstrates shared exposure patterns in territorial clusters of malignant mesothelioma due to single or multiple industrial sources, with major implications for public health policies, health surveillance, compensation procedures and site remediation programs. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1301-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marisa Corfiati
- Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy.
| | - Alberto Scarselli
- Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy.
| | - Alessandra Binazzi
- Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy.
| | - Davide Di Marzio
- Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy.
| | - Marina Verardo
- Regional Operating Center of Valle d'Aosta (COR Valle d'Aosta), Valle d'Aosta Health Local Unit, Aosta, Italy.
| | - Dario Mirabelli
- COR Piedmont, Unit of Cancer Prevention, University of Turin and CPO-Piemonte, Torino, Italy.
| | - Valerio Gennaro
- COR Liguria, Epidemiology and Prevention Department, National Cancer Research Institute (IST), Genova, Italy.
| | - Carolina Mensi
- COR Lombardy, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan, Milano, Italy.
| | - Gert Schallemberg
- COR Province of Trento, Provincial Unit of Health, Hygiene and Occupational Medicine, Trento, Italy.
| | - Enzo Merler
- COR Veneto, Occupational Health Unit, Department of Prevention, Padua, Italy.
| | - Corrado Negro
- COR Friuli-Venezia Giulia, University of Trieste -Trieste General Hospitals, Clinical Unit of Occupational Medicine, Trieste, Italy.
| | - Antonio Romanelli
- COR Emilia-Romagna, Health Local Unit, Public Health Department, Reggio Emilia, Italy.
| | - Elisabetta Chellini
- COR Tuscany, Cancer Prevention and Research Institute, Unit of Environmental and Occupational Epidemiology, Firenze, Italy.
| | - Stefano Silvestri
- COR Tuscany, Cancer Prevention and Research Institute, Unit of Environmental and Occupational Epidemiology, Firenze, Italy.
| | - Mario Cocchioni
- COR Marche, Environmental and Health Sciences Department, University of Camerino, Hygienistic, Camerino, Italy.
| | - Cristiana Pascucci
- COR Marche, Environmental and Health Sciences Department, University of Camerino, Hygienistic, Camerino, Italy.
| | - Fabrizio Stracci
- COR Umbria, University of Perugia, Department of Hygiene and public health, Perugia, Italy.
| | - Elisa Romeo
- COR Lazio, Department of Experimental Medicine, University La Sapienza, Roma, Italy.
| | - Luana Trafficante
- COR Abruzzo, Health Local Unit, Occupational Medicine Unit, Pescara, Italy.
| | - Italo Angelillo
- COR Campania, Department of Experimental Medicine, Second University of Naples, Napoli, Italy.
| | - Simona Menegozzo
- COR Campania, Department of Experimental Medicine, Second University of Naples, Napoli, Italy.
| | - Marina Musti
- COR Puglia, Department of Internal Medicine and Public Medicine, University of Bari, Section of Occupational Medicine "B. Ramazzini", Bari, Italy.
| | - Domenica Cavone
- COR Puglia, Department of Internal Medicine and Public Medicine, University of Bari, Section of Occupational Medicine "B. Ramazzini", Bari, Italy.
| | | | | | - Rosario Tumino
- COR Sicily, "Civile - M.P. Arezzo" Hospital, Ragusa Cancer Register Unit, Ragusa, Italy.
| | - Massimo Melis
- COR Sardegna, Regional Epidemiological Center, Cagliari, Italy.
| | - Sergio Iavicoli
- Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy.
| | - Alessandro Marinaccio
- Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy.
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Gagliardi D, Di Tecco C, Ronchetti M, Autieri S, Bonafede M, Corfiati M, Manca S, Russo S, Iavicoli S. [The INSuLa Project: a knowledge survey of employers]. G Ital Med Lav Ergon 2014; 36:419-425. [PMID: 25558746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In the framework of the INSuLa project, supported by Italian Ministry of Health, a national survey was conducted to evaluate the perceptions of employers about Occupational Safety and Health (OSH) activities. Main findings of this survey are presented in this paper. The survey was conducted on a sample of 1,010 employers weighted by economic activity sector, company size and geographic area. An ad hoc questionnaire was administered through Computer Assisted Telephone Interviewing methodology. Most of employers "mostly" or "completely" agree with the usefulness of OSH activities and the efficacy of specific prevention and protection measures. Around 37.7% of employers consider OSH management a shared responsibility with workers and 56.1% of them feel the OSH level to be increased following the implementation of Legislative Decree no. 81/08. The findings of this survey provide a picture of Italian employers' point of view about OSH and identify gaps and needs, thus contributing to choose proper actions for the improvement of OSH
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Affiliation(s)
- Diana Gagliardi
- INAIL, Settore Ricerca, Dipartimento di Medicina del Lavoro, Roma, Italy.
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30
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Binazzi A, Scarselli A, Massari S, Bonafede M, Corfiati M, Di Marzio D, Iavicoli S, Marinaccio A. [Active research, registration, and prevention of tumors of professional origin]. G Ital Med Lav Ergon 2014; 36:360-364. [PMID: 25558735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Occupational cancer is an important public health concern in Italy and in many industrialized countries. The difficulties in monitoring and the complexity in retrieving occupational cancer cases have required the enrolment of a national epidemiologic sureveillance system at national scale with active search methods. A structured system for the registration of occupational cancer cases is normed by the Decree No. 81/2008, that accounts for the previous legislative procedures and experiences. Research activities and prevention of occupational cancer should be integrated with insurance policies to the purpose of an efficient protection of workers health.
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Affiliation(s)
- Alessandra Binazzi
- Inail, Dipartimento di Medicina, epidemiologia, igiene del lavoro e ambientale, Roma, Italy
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31
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Scarselli A, Corfiati M, Marzio DD, Iavicoli S. Evaluation of workplace exposure to respirable crystalline silica in Italy. Int J Occup Environ Health 2014; 20:301-7. [PMID: 25078346 DOI: 10.1179/2049396714y.0000000078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Crystalline silica is a human carcinogen and its use is widespread among construction, mining, foundries, and other manufacturing industries. PURPOSE To evaluate occupational exposure to crystalline silica in Italy. METHODS Data were collected from exposure registries and descriptive statistics were calculated for exposure-related variables. The number of potentially exposed workers was estimated in a subset of industrial sectors. Linear mixed model analysis was performed to determine factors affecting the exposure level. RESULTS We found 1387 cases of crystalline silica exposure between 1996 and 2012. Exposure was most common in construction work (AM = 0·057 mg/m(3), N = 505), and among miners and quarry workers (AM = 0·048 mg/m(3), N = 238). We estimated that 41 643 workers were at risk of exposure in the selected industrial sectors during the same period. CONCLUSIONS This study identified high-risk sectors for occupational exposure to crystalline silica, which can help guide targeted dust control interventions and health promotion campaigns in the workplace.
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Marinaccio A, Ferrante P, Corfiati M, Di Tecco C, Rondinone BM, Bonafede M, Ronchetti M, Persechino B, Iavicoli S. The relevance of socio-demographic and occupational variables for the assessment of work-related stress risk. BMC Public Health 2013; 13:1157. [PMID: 24325192 PMCID: PMC4029374 DOI: 10.1186/1471-2458-13-1157] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 11/20/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Work-related stress is widely recognized as one of the major challenges to occupational health and safety. The correlation between work-related stress risk factors and physical health outcomes is widely acknowledged. This study investigated socio-demographic and occupational variables involved in perceived risk of work-related stress. METHODS The Italian version of the Health and Safety Executive Management Standards Indicator Tool was used in a large survey to examine the relationship between work-related stress risks and workers' demographic and occupational characteristics. Out of 8,527 questionnaires distributed among workers (from 75 organizations) 6,378 were returned compiled (74.8%); a set of mixed effects models were adopted to test single and combined effects of the variables on work-related stress risk. RESULTS Female workers reported lower scores on control and peer support and more negative perceptions of relationships and change at work than male workers, most of them with full-time contracts. Age, job seniority, and educational level appeared positively correlated with control at work, but negatively with job demands. Fixed-term workers had positive perceptions regarding job demands and relationships, but more difficulties about their role at work than permanent workers. A commuting time longer than one hour and shift work appeared to be associated with higher levels of risk factors for work-related stress (except for role), the latter having more negative effects, increasing with age. CONCLUSIONS The findings suggest that the assessment and management of work-related stress risk should consider specific socio-demographic and occupational risk factors such as gender, age, educational level, job status, shift work, commuting time, job contracts.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sergio Iavicoli
- Italian Workers' Compensation Authority, Research area, Occupational medicine department, Via di Fontana Candida 1, Rome 00100, Monteporzio Catone, Italy.
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Binazzi A, Scarselli A, Corfiati M, Di Marzio D, Branchi C, Verardo M, Mirabelli D, Gennaro V, Mensi C, Schallenberg G, Merler E, De Zotti R, Romanelli A, Chellini E, Pascucci C, D'Alò D, Forastiere F, Trafficante L, Menegozzo S, Musti M, Cauzillo G, Leotta A, Tumino R, Melis M, Marinaccio A. [Epidemiologic surveillance of mesothelioma for the prevention of asbestos exposure also in non-traditional settings]. Epidemiol Prev 2013; 37:35-42. [PMID: 23585432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To show how malignant mesothelioma (MM) surveillance not only identifies settings of exposure representing past industrial history, but it may also detect conditions of current exposure relevant for the prevention, if the wide spectrum of asbestos uses is considered. DESIGN Active search of MM cases and exposure assessment at individual level through a questionnaire; identification of exposure circumstances relevant for prevention. SETTING AND PARTICIPANTS Italy, all the Regions where a Regional Operating Centre (COR) is established to identify all MM cases diagnosed in the population and analyze their occupational, residential, household and environmental histories. Period of diagnosis: 1993-2008. MAIN OUTCOME MEASURES Descriptive analysis of MM cases and of asbestos exposures. RESULTS ReNaM includes 15,845 cases of MM diagnosed between 1993 and 2008.The male/female ratio is 2.5. Mean age at diagnosis is 69 years. Pleural MMs represent 93% of all cases. Exposures have been investigated in 12,065 cases (76%). The median latency time is 46 years. In addition to clusters of MM cases in activities well known to entail asbestos use, different current exposure circumstances requiring intervention have been evidenced. CONCLUSIONS On the basis of this experience, epidemiological surveillance of all occupational cancers should be implemented to foster synergies with the compensation system and the Local Health Authorities' occupational safety and health services, as required by the Italian Legislative Decree N. 81/2008.
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Affiliation(s)
- Alessandra Binazzi
- INAIL, Settore Ricerca, Certificazione e Verifica, Dipartimento di Medicina del Lavoro, Laboratorio di Epidemiologia.
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34
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Di Lorenzo L, Corfiati M, Catacchio T. [Liver angiosarcoma from past exposure to vinyl chloride: a case report]. Med Lav 2012; 103:459-465. [PMID: 23405480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Experimental data and large occupational cohort studies in polyvinyl chloride (PVC) manufacturing plants have shown that vinyl chloride monomer (VCM) at high environmental concentrations, such as those measured in western chemical companies at least until the mid-1970's can cause liver angiosarcoma. OBJECTIVE To describe a recent, accurately diagnosed case of fatal liver angiosarcoma, for which it was possible to establish the causal relationship with past VCM exposure. RESULTS The deceased subject had been working as blue-collar for at least eleven years (1968-1979) in a PVC plant. VCM exposure was high on average and very high during autoclave cleaning, compared with VCM air measurements reported in those years at plants in Europe and the United States. The latency period was about 40 years. The duration of exposure, the cumulative exposure and the latency described were similar to those associated in the scientific literature with an excess risk for liver angiosarcoma. CONCLUSION The Italian Workers' Compensation Authority (INAIL) has already acknowledged the occupational origin of this neoplastic disease with clear advantages for all parties concerned, not only in economical terms.
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Affiliation(s)
- L Di Lorenzo
- Dipartimento Interdisciplinare di Medicina, Università degli Studi di Bari, Bari, Italy.
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35
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Di Lorenzo L, Corfiati M, Cassano F. [The health protection of Italian workers abroad: complex and varied but still guaranteed]. G Ital Med Lav Ergon 2011; 33:175-179. [PMID: 23393830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The employment contracts for Italian working abroad are legally different. So many national laws, European Union (EU) directives and regulations should be applied concerning health and safety at work. This paper is aimed to clarify these features, focusing on their impact on workers' health surveillance. For originally transnational contracts the law applicable is chosen by the parties but in compliance with minimum standards of workers' health protection. An authorization by Italian Labour Minister is also needed for employment in non-EU countries requiring minimum protection conditions. Italian legislation is applied to temporary work abroad. Long-lasting or permanent abroad transfer is regulated as originally transnational work. Workers posted in a EU country should receive the same protection ensured by laws, regulations, collective agreements or arbitrations to resident workers. Health surveillance of workers hired or transferred to work abroad is performed by a occupational physician (OP) operating in the foreign country. Temporary abroad workers undergo health surveillance by the Italian OP. The workplace inspection could be conducted by the OP through audiovisual electronic systems, reserving the on-site visit to particular situations. The host employer is responsible for health surveillance of posted workers entrusted to a local OP.
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Affiliation(s)
- Luigi Di Lorenzo
- Dipartimento di Medicina Interna e Medicina Pubblica, Università degli studi di Bari.
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36
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Di Lorenzo L, Borraccia V, Corfiati M, Mantineo GA, Caciari T, Marino M, Soleo L. Lead exposure in firearms instructors of the Italian State Police. Med Lav 2010; 101:30-37. [PMID: 20415047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Several studies evaluated exposure to lead in relatively small groups of firearms instructors and shooters, mainly operating at indoor ranges. OBJECTIVE To assess the levels of lead exposure in a large sample of firearms instructors of the Italian State Police (SP) operating at either indoor or outdoor ranges. METHODS A crosssectional study was conducted in firearms instructors working in indoor (No. 188) and outdoor (No. 188) ranges compared with 170 foodplant workers. The personal and work characteristics and current blood lead (Pb-B) levels were evaluated The concentrations of environmental lead (Pb-E) were measured using personal samplers in 6 indoor and 6 outdoor firing ranges. RESULTS The Pb-B levels in the two groups of firearms instructors were well below the ACGIH BEI, but significantly higher than in food plant workers. In the entire study sample the Pb-B level was seen to be influenced by age and job group. An excess risk of having Pb-B >100 microg/l was found in indoor range instructors and in those with greater job seniority. Pb-E <25 pg/m3 was measured in all the firing ranges examined. DISCUSSION The low Pb-B and Pb-E levels assessed are the result of primary and secondary prevention interventions carried out over the years by the Italian State Police. The current Pb-B levels also seemed to be poorly influenced by higher past environmental and/or occupational lead exposure. In fact a certain number of firearms instructors, mainly operating at indoor ranges and with greater job seniority, had Pb-B levels consistent with occupational exposure to lead. Environmental and biological monitoring of lead exposure and specific health surveillance are therefore still necessary in this job group topreventpossible adverse health effects of lead even at low doses.
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Affiliation(s)
- L Di Lorenzo
- Department of Internal and Public Medicine, E. C. Vigliani Occupational Health Section, University of Bari, Bari, Italy.
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Di Lorenzo L, Corfiati M, Giangaspero G, Spaccavento DS, Ria W, Soleo L. [Evaluation of plans for reclamation from products containing asbestos to ensure safety to the workers and the general population]. G Ital Med Lav Ergon 2007; 29:646-649. [PMID: 18409886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Fifty-two working plans for abatement of asbestos-containing materials (ACM) were examined being presented over 12 months at a Public Occupational Health Service in Apulia (Italy) by authorized companies. Most of the interventions took place in urban areas and civil buildings and lasted few days with employment of a limited number of workers. They mainly consisted in removal practices. The weight of ACM abated varied from 30 to over 14,000 kg. Air monitoring of asbestos fibres was included not in all plans. When airborne fibres were detectable, the threshold of environmental pollution (20ff/L) was sometimes reached or exceeded. This finding appeared to be relevant for asbestos exposure of workers and general population. A higher fibre dispersion occurred during abatement of amounts of ACM more than 1,000 kg. The Occupational Health Service should be legally and operatively able to make regular workplace inspections, especially when large quantities of ACM have to be abated.
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Affiliation(s)
- L Di Lorenzo
- Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Medicina del Lavoro "E.C. Vigliani", Università di Bari, Policlinico di Bari, 70124 Bari, Italy.
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Di Lorenzo L, Trabucco S, Massola A, Corfiati M, Bello A, Soleo L. [A case of occupational lung disease (welder lung) in a mechanical worker]. G Ital Med Lav Ergon 2007; 29:840-843. [PMID: 18409991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A case of welder's lung is reported in a male hard smoker who had worked as welder-carpenter for almost 30 years. In order to establish an etiologic diagnosis, given the informed consent from the worker, open lung biopsy was performed that allowed to obtain sufficiently large specimens of affected lung to make histological, immunohistochemical and mineralogical examination. In such a way the pathologic features were accurately defined and a multidisciplinary approach was applied to differential diagnosis. The worker is recommended to undergo a strict health surveillance because of the reported association of welder's lung with lung cancer, especially in smokers.
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Affiliation(s)
- L Di Lorenzo
- Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Medicina del Lavoro "E. C. Vigliani", Università di Bari, Policlinico di Bari, 70124 Bari, Italy.
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39
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Di Lorenzo L, Borraccia V, Corfiati M, Mantineo GA, Petrillo MR, Soleo L. [Exposure to low doses of inorganic lead and arterial pressure among fire arm instructors of the Italian State Police]. G Ital Med Lav Ergon 2006; 28:194-5. [PMID: 16805462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
UNLABELLED Firearm instructors represent a particular occupational group exposed to low lead (Pb) doses. Even low blood lead levels (PbB) of this metal can cause an increase of blood pressure (BP). OBJECTIVE To assess the Pb exposure of the firearm instructors of the Italian State Police (SP) and the effects of Pb on their PA. SUBJECTS AND METHODS 376 instructors were studied, including 188 subjects working at indoor and 188 at outdoorfiring ranges. After obtaining informed consent, information on work, social and pathological history was collected and measurements of body mass index (BMI), BP and blood lead (PbB) level were obtained from the medical records. RESULTS The mean PbB level of the instructors of outdoor ranges (6.7 +/- 5.3 microg/dl) was significantly lower than those of indoor ranges (8.5 +/- 7.6 microg/dl). In the instructors of outdoor ranges the diastolic BP (DBP) was significantly influenced by BMI and PbB, also considering the common confounding factors. DISCUSSION The mean PbB level of the firearm instructors of the Italian SP resulted to be clearly below the biological limit value for Pb. In the instructors of outdoor ranges the even low PbB levels detected were able to determine a slight, but significant increase of DBP, also after correction for the main confounding variables. It is therefore necessary to keep on effecting biological monitoring and health surveillance of firearm instructors of SP and to promote the reduction of their body weight.
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Affiliation(s)
- L Di Lorenzo
- Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Medicina del Lavoro EC Vigliani, Università di Bari, Italy.
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40
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Basso A, Di Lorenzo L, Cramarossa AA, Corfiati M, Ria W, Bellino R, Crivellini S, Lofrumento M, Soleo L. [Evaluation of myopia in a group of people working with video terminals: first results]. G Ital Med Lav Ergon 2006; 28:207-9. [PMID: 16805469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
UNLABELLED Since the 70's the occupational use of electronic systems equipped with visual display terminals (VDTs) became wide-spread also in Italy. Some longitudinal studies on large samples of VDT workers found no significant changes of myopia (M) with regard to years and daily hours spent working at a VDT. OBJECTIVE To evaluate the prevalence and the time course of M in 209 VDT workers employed in the service sector. MATERIALS AND METHODS After obtaining workers' informed consent their work, social, family and personal medical histories were collected. Myopia was defined as need of >0.25 D negative spherical correction. Average daily hours duringfollow-up and overall years spent working at a VDT were calculated as exposure indexes. RESULTS The mean baseline age was 39.2 years (SD: 8.7, min-max: 22-62) and the mean education was 14 years (SD: 2.2). The mean follow-up period was 5.5 (3-9) years. The prevalence of M was 45.5% at the start and 49.8% at the end of the study. It was higher in workers with >13 years of education and in those < 40 year-old. A slight but significant increase of the degree of M (dioptres) occurred during the follow-up. The change in the degree of M was not different between the classes of VDT exposure (< or = 4 and >4 daily hours; < or =15 and >15 years spent), of education and of age at the end of follow-up. DISCUSSION The high mean educational level can partly explain the higher prevalence of M detected in the workers on study with respect to the one described elsewhere on VDT workers and general population. The progression of the M seems not to be related to the professional and personal variables analyzed, but to depend on the natural evolution of M. Further studies are needed to confirm these preliminary data in larger groups of VDT workers.
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Affiliation(s)
- A Basso
- Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Medicina del Lavoro EC Vigliani, Università di Bari, Italy
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Di Lorenzo L, Silvestroni A, Martino MG, Gagliardi T, Corfiati M, Soleo L. Evaluation of peripheral blood neutrophil leucocytes in lead-exposed workers. Int Arch Occup Environ Health 2006; 79:491-8. [PMID: 16416288 DOI: 10.1007/s00420-005-0073-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2005] [Accepted: 12/05/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Inorganic lead can interfere with humoral and especially cell-mediated immunity even at frequently occurring (<50 microg/dl) blood lead (Pb-B) levels. Occupational exposure to lead causes a primary impairment of the chemotactic and phagocytic activities of neutrophil leucocytes. OBJECTIVE To verify whether, after taking into account the main confounding factors, occupational lead exposure is shown to induce changes in the number of blood neutrophil leucocytes, and to assess a possible dose-response relationship between Pb-B and the circulating neutrophil count in exposed workers. SUBJECTS AND METHODS The study included 68 male lead-exposed (E) workers and 59 male workers in a food plant, recruited as controls (NE). A standardized questionnaire probing work, social, familial and personal medical history was administered to all the subjects. Blood and urine samples were collected to determine the dose and effect biological indices of lead and the total white blood cell and neutrophil counts. RESULTS Pb-B levels were significantly higher in E (geometric mean (GM): 20.5 microg/dl; 3.2-120 microg/dl) than in NE workers (GM: 3.5 microg/dl; 1-11 microg/dl). The mean absolute neutrophil count (ANC) was significantly higher in E workers with respect to NE workers. ANC correlated significantly with the biological lead dose and effect indices. Moreover, there was a dose-dependent increase of ANC with increasing Pb-B levels. The linear relationship between ANC and Pb-B was confirmed even after correction for age, body mass index and smoking habit. We also found an interaction between Pb-B level and smoking habit in increasing the number of blood neutrophils in lead-exposed workers. CONCLUSION Our study is the first to describe a dose-dependent effect of lead on ANC in exposed workers. Our results underline the importance of promoting a further reduction of occupational lead exposure levels, adopting adequate individual protection means, as well as conducting medical campaigns against smoking, at the workplace.
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Affiliation(s)
- Luigi Di Lorenzo
- Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Medicina del Lavoro, Università di Bari, Policlinico di Bari, 70124 Bari, Italy.
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Di Lorenzo L, Soleo L, Cassano F, Elia G, Schiavulli N, Martino MG, Corfiati M, Bulfaro D, Apostoli P. [Anemia in workers exposed to lead: update on differential diagnosis]. G Ital Med Lav Ergon 2005; 27 Suppl 1:54-61. [PMID: 15915656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Occupational lead exposure can cause anemia at blood lead levels >50 microg/dl, as high as rarely occurs in industrialized countries nowadays. Whereas other forms of anemia are fairly probable to be found in lead exposed workers, especially in areas highly endemicfor extraoccupational anemias, such as beta thalassemia and iron deficiency anemia. The etiology of anemias has to be correctly defined in order to assess suitable therapeutical approaches and medicolegal consequences. The objective of this study is to verify in male lead exposed workers whether an accurate evaluation of hemocromocytometric parameters and of usual biological indices of lead exposure and effect on heme can differentiate the most common forms of anemia in Southern Italy. 68 workers occupationally exposed to low to moderate lead doses were studied and 59 workers of an alimentary plant have been taken as control group. On venous blood samples collected from these workers a complete hemocromocytometric test was performed and blood lead and erythrocytic zincoprotoporphyrin were determined. Anemia (Hb <l3 g/dl) was detected in six lead exposed workers and in a nonexposed worker. The reasoned evaluation of laboratory parameters led to identify among lead exposed workers four subjects with high probability of beta-thalassemic trait and two with lead poisoning anemia. Moreover a diagnostic algorithm was developed based on literature that seems to be able to discriminate lead poisoning from other causes of anemia in lead exposed workers in this study.
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Affiliation(s)
- L Di Lorenzo
- Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Medicina del Lavoro, Università di Bari, Italy.
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Urbano ML, Di Lorenzo L, Russo A, Corfiati M, Gagliardi T, Silvestroni A, Lovreglio P, Tempesta M, Cassano F, Soleo L. [Assessment of neurobehavioral functions of workers exposed to low doses of metallic lead]. G Ital Med Lav Ergon 2005; 27 Suppl 1:62-7. [PMID: 15915657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The effects of low-dose lead occupational exposure on neurobehavioral functions are still not well defined by international literature. The objective of this study is to assess by psychometric testing the presence of possible neuropsychological impairment in a group of male Italian workers with low blood lead levels in comparison to an adequate non exposed worker group. Given informed consent to take part to the study, all workers were interviewed about their working and clinical history and underwent determination of blood lead levels (PbB). An internationally validated computerized battery of psychometric tests and a standardized paper-and-pencil version of mood self-rating scale and WAIS-R Vocabulary subtest were also administered to the workers. Exposed workers had a geometric mean of PbB significantly higher than non exposed workers, but rather low (16.4 +/- 1.7 microg/dl). The results of psychometric tests were not significantly different between the two worker groups, even after adjusting for the main confounding factors. In workers exposed to low lead doses no neurobehavioral abnormalities were demonstrated by the administered psychometric test battery.
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Affiliation(s)
- M L Urbano
- Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Medicina del Lavoro, Università di Bari, Italy
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Di Lorenzo L, Cassano F, Elia G, Gagliardi T, Silvestroni A, Lovreglio P, Corfiati M, Soleo L. [Effects on arterial pressure of exposure to low doses of inorganic lead: preliminary results]. G Ital Med Lav Ergon 2003; 25 Suppl:114-5. [PMID: 14979109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The aim of this study is to evaluate the effects of occupational exposure to low inorganic lead (Pb) doses on blood pressure of exposed (E) workers. 44 workers of a foundry of lead wrecks and 14 workers employed in enameling and decoration of a manufacturing firm of artistic ceramics were examined. The group of non-exposed (NE) subjects is formed by 59 workers of packaging unit of a food industry. A questionnaire has been administered to all the workers on general characteristics and life habits. Systolic and diastolic blood pressure were also measured and venous blood collection performed for the determination of blood lead levels. Mean blood lead levels (PbB) and mean diastolic blood pressure (DBP) resulted significantly higher in the group of exposed workers of the foundry. Stratifing exposed workers with respect to the median of PbB (18 micrograms/dl), workers with PbB > 18 micrograms/dl presented a mean DBP significantly higher than exposed with PbB < or = 18 micrograms/dl and non-exposed subjects. PbB takes part significantly in determination of DBP, also considering main confounding factors as age, BMI, pack-years and alcohol consumption.
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Affiliation(s)
- L Di Lorenzo
- Dipartimento di Medicina Interna e di Medicina Pubblica, Sezione di Medicina del Lavoro, Università degli Studi di Bari
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Di Lorenzo L, Corfiati M, Bulfaro D, Liuzzi G, Zenzola M, Soleo L. [Aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio in health surveillance of workers exposed to vinyl chloride monomer: preliminary results]. G Ital Med Lav Ergon 2003; 25 Suppl:109-11. [PMID: 14979107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
An AST/ALT ratio > 1 is predictive of liver fibrosis and cirrhosis in patients with chronic hepatitis C virus infection. The aim of this case-control study is to assess AST/ALT ratio in 150 workers exposed to VCM (E) from the beginning of the 1960s to the end of the 1990s. The non-exposed group (NE) consists in 150 male workers employed in the production of a food industry. At least since 1983 exposed subjects worked at VCM environmental concentrations < 3 ppm. All the workers underwent venous blood collection for assessment of AST and ALT. Exposed workers presented mean AST/ALT ratio and frequency of AST/ALT ratio > 1 significantly higher than non-exposed. The mean AST/ALT ratio results significantly higher in the exposed group, also after stratification for alcohol consumption. In exposed workers who consume alcoholic beverages and are operating since before 1983 AST/ALT ratio is significantly and positively influenced only by the working age until 1983. If these results will be confirmed, AST/ALT ratio could be proposed to be included in the periodic medical surveillance of VCM workers.
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Affiliation(s)
- L Di Lorenzo
- Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Medicina del Lavoro, Università degli Studi di Bari
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