Occupational asbestos exposure and ovarian cancer: updated systematic review.

BACKGROUND: The association between asbestos exposure and ovarian cancer has been questioned given the possible misdiagnosis of peritoneal mesothelioma as ovarian cancer. AIMS: To update a systematic review on ovarian cancer risk in women occupationally exposed to asbestos, exploring the association with the time since first exposure and the duration of exposure. METHODS: We searched PubMed from 2008 onwards, screened previous systematic reviews, combined standardized mortality ratios (SMR) using random effect models and quantified heterogeneity using the I2 statistic. To assess tumour misclassification, we compared the distribution of observed excess ovarian cancers (OEOC) to that expected (EEOC) from the distribution of peritoneal cancers in strata of latency and exposure duration. RESULTS: Eighteen publications (20 populations), including a pooled analysis of 21 cohorts, were included. The pooled SMR was 1.79 (95% confidence interval 1.38-2.31), with moderate heterogeneity between studies (I2 = 42%), based on 144 ovarian cancer deaths/cases. The risk was increased for women with indirect indicators of higher exposure, longer duration and latency, and lower for chrysotile than for crocidolite exposure. The effect of duration and latency could not be completely disentangled, since no multivariate analysis was available for time-related variables. The dissimilarity index between OEOC and EEOC for the time since first exposure was small suggesting a similar pattern of risk. CONCLUSIONS: While some misclassification between ovarian and peritoneal cancers cannot be excluded, the observed excess risk of ovarian cancer should be added to the overall disease burden of asbestos.

Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy.

Background: Diagnosis of mesothelioma based on death certificate is subject to misclassification, which may bias the results of epidemiology studies. A high proportion of mesothelioma harbor mutations in the BRCA1-associated protein 1 (BAP1) gene. Methods: We searched medical and pathology records and specimens for 127 workers from a textile-asbestos factory in Italy who died during 1963-2013 with a diagnosis of pleural or peritoneal neoplasm or mesothelioma on death certificate, to confirm the diagnosis with immunohistochemistry markers. We calculated the odds ratio of confirmation by selected characteristics and asbestos exposure variables. When sufficient pathology material was available, we analyzed BAP1 protein expression. Results: The diagnosis of mesothelioma was histologically confirmed for 35 cases (27.6%); 5 cases were classified as non-mesothelioma (3.9%), for 33 cases a mention of mesothelioma was found on record but no sufficient material was available for revision (26.0%); no records were available for 54 cases (death-certificate-only 42.5%). Diagnostic confirmation was not associated with sex, location of the neoplasm, age, or duration of employment; however, there was a significant association with time since first employment (P for linear trend 0.04). An association between duration of employment and time since first employment was observed for confirmed cases but not for death-certificate-only cases. BAP1 protein was lost in 18/35 cases (51.4%), without an association with sex, location, age, indices of asbestos exposure, or survival. Conclusions: We were able to confirm by immunohistochemistry a small proportion of mesothelioma diagnoses on certificates of deceased asbestos workers, and confirmation correlated with latency of asbestos exposure but not other characteristics. BAP1 protein loss is a frequent event in mesothelioma of asbestos-exposed workers, but does not correlate with exposure.

Work-related stress as a cardiovascular risk factor in police officers: a systematic review of evidence.

PURPOSE: Several studies suggest that work-related stress in police officers may be associated with an increased risk of cardiovascular diseases. A systematic review of studies is, however, still lacking. METHOD: According to PRISMA statement, a systematic search of PubMed, ISI Web of Science, Cinahl and PsychInfo electronic databases was undertaken. Studies published in English between 1/1/2000 and 31/12/2016 were included. A studies quality assessment was performed using the Newcastle Ottawa scale (NOS). RESULTS: The preliminary search retrieved 752 records. After selection, 16 studies (total population 17,698) were retrieved. The average quality of studies was low. Exposure to stress in cross-sectional studies was inconstantly associated with hypertension, obesity, dyslipidaemia, and impaired glucose metabolism. In addition, there was a prevalence of positive studies showing an association between stress and cardiovascular disease morbidity. Studies of higher quality, such as longitudinal studies on large sample size, were more supportive of a significant positive association between stress and cardiovascular risk factors. Results were, however, often conflicting and inconsistent with regard to definitions and measurement of stress, features of individual study design, study conduct, and conclusions drawn. CONCLUSIONS: A sound precautionary principle would be to adopt worksite health promotion programs designed to implement stress management strategies in this category of workers.

Cancer mortality in cohorts of workers in the European rubber manufacturing industry first employed since 1975.

BACKGROUND: Increased cancer risk has been reported among workers in the rubber manufacturing industry employed before the 1960s. It is unclear whether risk remains increased among workers hired subsequently. The present study focused on risk of cancer mortality for rubber workers first employed since 1975 in 64 factories. PATIENTS AND METHODS: Anonymized data from cohorts of rubber workers employed for at least 1 year from Germany, Italy, Poland, Sweden, and the UK were pooled. Standardized mortality ratios (SMRs), based on country-specific death rates, were reported for bladder and lung cancer (primary outcomes of interest), for other selected cancer sites, and for cancer sites with a minimum of 10 deaths in men or women. Analyses stratified by type of industry, period, and duration of employment were carried out. RESULTS: A total of 38 457 individuals (29 768 men; 8689 women) contributed to 949 370 person-years. No increased risk of bladder cancer was observed [SMR = 0.80, 95% confidence interval (CI) 0.46; 1.38]. The risk of lung cancer death was reduced (SMR = 0.81, 95% CI 0.70; 0.94). No statistically significant increased risk was observed for any other cause of death. A reduced risk was evident for total cancer mortality (SMR = 0.81, 95% CI 0.76; 0.87). Risks were lower for workers in the tyre industry compared with workers in the general rubber goods sector. Analysis by employment duration showed a negative trend with SMRs decreasing with increasing duration of employment. In an analysis of secondary end points, when stratified by type of industry and period of first employment, excess risks of myeloma and gastric cancer were observed each due, essentially, to results from one centre. CONCLUSION: No consistent increased risk of cancer death was observed among rubber workers first employed since 1975, no overall analysis of the pooled cohort produced significantly increased risk. Continued surveillance of the present cohorts is required to confirm the absence of long-term risk.

Modeling of coagulation, curd firming, and syneresis of milk from Sarda ewes.

This study investigated the modeling of curd-firming (CF) over time (CF(t)) of sheep milk. Milk samples from 1,121 Sarda ewes from 23 flocks were analyzed for coagulation properties. Lactodynamographic analyses were conducted for up to 60 min, and 240 CF individual observations from each sample were recorded. Individual sample CFt equation parameters (RCT(eq), rennet coagulation time; CF(P), asymptotic potential value of curd firmness; k(CF), curd-firming instant rate constant; and k(SR), curd syneresis instant rate constant) were estimated, and the derived traits (CF(max), the point at which CF(t) attained its maximum level, and tmax, the time at which CF(max) was attained) were calculated. The incidence of noncoagulating milk samples was 0.4%. The iterative estimation procedure applied to the individual coagulation data showed a small number of not-converged samples (4.4%), which had late coagulation and an almost linear pattern of the ascending part of the CF(t) curve that caused a high value of CF(P), a low value of k(CF), and a high value of k(SR). Converged samples were classified on the basis of their CF(t) curves into no-k(SR) (18.0%), low-k(SR) (72.6%), and high-k(SR) (4.5%). A CF(t) that was growing continuously because of the lack of the syneresis process characterized the no-k(SR) samples. The high-k(SR) samples had a much larger CFP, a smaller k(CF), and an anticipation of tmax, whereas the low-k(SR) samples had a fast k(CF) and a slower k(SR). The part of the average CF(t) curves that showed an increase was similar among the 3 different syneretic groups, whereas the part that decreased was different because of the expulsion of whey from the curd. The traditional milk coagulation properties recorded within 30 min were not able to detect any appreciable differences among the 4 groups of coagulating samples, which could lead to a large underestimation of the maximum CF of all samples (if predicted by a30), with the exception of the no-k(SR) samples. Large individual variability was found and was likely caused by the effects of the dairy system, such as flock size (on CF(max), t(max), and % ewes with no-k(SR) milk), flock within flock size (representing 11 to 43% of total variance for % ewes with no-k(SR) milk and CF(max), respectively), days in milk (on all model parameters and CF(max)), parity (on RCT(eq), k(SR), and CF(max)), daily milk yield (on RCT(eq) and CF(max)), and position of the individual pendulum that significantly affected model parameters and derived traits. In conclusion, the results showed that the modeling of coagulation, curd-firming, and syneresis is a suitable tool to achieve a deeper interpretation of the coagulation and curd-firming processes of sheep milk and also to study curd syneresis.

Allergic reaction and metal hypersensitivity after shoulder joint replacement.

PURPOSE: Metal ion release may cause local and systemic effects and induce hypersensitivity reactions. The aim of our study is first to determine if implant-related hypersensitivity correlates to patient symptoms or not; second, to assess the rate of hypersensitivity and allergies in shoulder arthroplasty. METHODS: Forty patients with shoulder replacements performed between 2015 and 2017 were studied with minimum 2-year follow-up; no patient had prior metal implants. Each patient underwent radiographic and clinical evaluation using the Constant-Murley Score (CMS), 22 metal and cement haptens patch testing, serum and urine tests to evaluate 12 metals concentration, and a personal occupational medicine interview. RESULTS: At follow-up (average 45 ± 10.7 months), the mean CMS was 76 ± 15.9; no clinical complications or radiographic signs of loosening were detected; two nickel sulfate (5%), 1 benzoyl peroxide (2.5%) and 1 potassium dichromate (2.5%) positive findings were found, but all these patients were asymptomatic. There was an increase in serum aluminum, urinary aluminum and urinary chromium levels of 1.74, 3.40 and 1.83 times the baseline, respectively. No significant difference in metal ion concentrations were found when patients were stratified according to gender, date of surgery, type of surgery, and type of implant. CONCLUSIONS: Shoulder arthroplasty is a source of metal ion release and might act as a sensitizing exposure. However, patch test positivity does not seem to correlate to hypersensitivity cutaneous manifestations or poor clinical results. Laboratory data showed small constant ion release over time, regardless of gender, type of shoulder replacement and implant used. LEVELS OF EVIDENCE: Level II.

[The evaluation of biological effects of exposure to respirable crystalline silica in building industry]. / Esposizione a Silice Libera Cristallina in edilizia: valutazione degli effetti biologici.

The building industry entails the exposure to Respirable Crystalline Silica (RCS), though there is a large variability among different sectors. The environmental values reported for the current conditions seem to be relatively low. For example the mean exposure estimated by IOM for all industrial sectors in the EU is 0.07 mg/m3. There are few studies in the building sector which show similar values. This is obviously not representative of past exposure. Moreover, the problems of sampling and analysis techniques are still at issue. The well known effect of RCS exposure is silicosis. The carcinogenicity of RCS is still under debate, especially regarding the question of whether RCS is carcinogenic "per se" or whether the risk of developing lung cancer is mediated by silicosis. Although the IARC includes RCS in the Group I (human carcinogen), the reference should be the CLP regulation, of which carcinogen definition criteria allow to state that today there are not sufficient data to classify RCS as a carcinogen and that it seems more appropriate to include RCS in different STOT.RE categories. This is valid for building industry as well as for the other industrial sectors. In Italy the recommended exposure limit is the ACGIH value of 0.025 mg/m3. At EU level it is still debated which is the best choice, based on cost/benefits evaluation, among the following limit values: 0.2, 0.1 and 0.05 respectively. The authors obviously believe that the most protective value should be adopted.

[New data on pumice's structure and biological effects among miners and millers]. / Nuove acquisizioni sull struttura dell pietra pmie e possibili effetti pleurici nei lavoratori del settore.

Pleural plaques among pumice workers on Lipari Island have been described and the Authors have suggested the hypothesis that such biological effect could be related to the particles' morphology characterized by the presence of elements similar to fibers. Analysis on compact bulk materials and on dust samples from different sites of the Island have been performed to obtain information on the chemical composition of such materials. The Scan Electron Microscopy (SEM) analyses confirm the presence of fibrous particles with a chemical structure similar to the Refractory Ceramic Fibers (RCF) composition. These results could explain the presence of plural plaques among the workers and new clinical and epidemiological evaluations of the potential effects associated to this exposure are needed.

The opinion of the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII) on silica-exposure and lung cancer risk.

BACKGROUND: The Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII) began a thorough overview of the silica-silicosis-lung cancer question starting in 2005. METHODS AND RESULTS: The body of informa tion obtained from a number of epidemiological studies, meta-analyses and reviews following the decision of the IARC to classify Respirable Crystalline Silica (RCS) as a human carcinogen (Group 1) led to different conclusions, which can be summarized as follows: basically an increased risk of developing lung cancer is demonstrated and generally accepted for silicotics; the association of lung cancer and exposure to silica per se is controversial, with some studies in favour of an association and some leading to contrary conclusions. Due to methodological problems affecting most studies and the difficulty in identifying the mechanism of action, we agree that the silica-lung cancer association is still unclear. The UE approach is more practical than scientific, in that it recommended the use of "good practices" subject to an agreement with the social partners, without any need to classify RCS as a human carcinogen. However, in 2008 the UE asked the Institute of Occupational Medicine (IOM) in Edinburgh to assess, as a primary objective, the impact of introducing a system for setting Occupational Exposure Limits (OELs) based on objective risk criteria. CONCLUSION: In the present state of the art SIMLII's conclusions are: a) There is no need to label RCS with phrase H350i (ex R.49); b) It is of utmost importance to enforce compliance with current OELs; c) Future guidelines specific for silicosis risk should include adequate health surveillance; d) For legal medicine purposes, only lung cancer cases with an unquestionable diagnosis of silicosis should be recognised as an occupational disease.

[The diagnosis of diseases due to occupation]. / La diagnosi delle malattie do lavoro.

Occupational diseases are essentially defined by aetiological characteristics, and not by nosological characteristics, because the latter in most cases are not specific. This is particularly so for "work-related" diseases but still stays true for most "occupational" diseases. This implies that the diagnostic path for occupational diseases must include one additional step as compared to the standard procedure typical of non occupational medicine. The last is satisfactory after a suitable history and clinical-instrumental phase and thus a nosological definition are completed. The former includes an additional mandatory third phase, the one defining a reliable causal relationship taking into account a reasonable relationship between, on one side, the qualitative, quantitative and temporal aspects of the specific risk, and, on the other side, the observed "effect". These items must be systematically looked for (unless they are practically unobtainable) if a correct diagnosis of an occupational disease has to be reached.

[Alimentation, health promotion and work: a strategy for alimentary education and food quality promotion]. / Alimentazione, promozione della salute e lavoro: un modello integrato di educazione alimentare e promozione della qualità del cibo.

As health promotion activity have been started two alimentary education projects for CTO Turin Hospital and LntesaSanpaolo bank group employers. Both projects have been co-ordinated by structure of Occupational Health of CTO Hospital and Turin University. The first step of the projects provided information and formation by using a brochure containing good alimentation tips. In the next step each participant at projects registered daily the food choice on specific software. At the end of observational period (six months) each participant received a final report containing quali-quantitative evaluation on the food choice uprightness. At the same time in IntesaSanpaolo bank group it have been proceeded, following Slow Food indication, on introducing a new menu based on using localfood products.

[Early lung cancer detection in an occupational asbestos exposed population: clinical impact of low-dose computed tomography screening]. / Diagnosi precoce del tumore al polmone in una popolazione esposta professionalmente ad amianto--impatto clinico dello screening con TC spirale.

Lung cancer is the primary cause of cancer mortality in developed countries. Early detection and surgical resection is essential for the treatment of lung cancer. The introduction of low-dose spiral computed tomography (LDCT) is considered one of the most promising clinical research developments in early diagnosis of lung cancer. Our study is aimed at the evaluation of spiral CT in a cohort of subjects with a past occupational exposure to asbestos at high risk of developing lung cancer. 149 subjects were enrolled between 2007 and 2009 (the criteria for enrollment were date of birth between 1930-1961, no previous cancer and general good health, latency from the beginning of exposure > 10 years, exposure duration > 1 year, possibility to undergo to surgery). A helical low-dose CT (LDCT) of the chest was performed yearly and an evaluation protocol derived from IEO with a morphological analysis of nodules have been adopted. 13 nodules were diagnosed in the first CT, 7 in the second and 3 in the third but no invasive procedures have been taken and no lung cancer have been detected. Our early follow-up data aren't able yet to evaluate the effect of screening with LDCT on mortality but have do not confirm some of the literature initial results such as the Increase in cases of overdiagnosis (false positive) due to the high prevalence of benign lesions.

Mortality from cancer and other causes in the Balangero cohort of chrysotile asbestos miners.

OBJECTIVES: To provide further information on mortality from cancer and other causes among chrysotile asbestos miners several years after exposure ceased, we updated the analyses from the Balangero mine worker cohort with follow-up to the end of 2003. METHODS: The cohort included 1056 men, for a total of 34 432 man-years of observation. We obtained employment data from factory personnel records, and ascertained vital status and causes of death through population registers and death certificates from municipal registration offices. We computed expected numbers of deaths and standardised mortality ratios (SMRs) for relevant causes using the province of Turin and national death rates, for each 5-year calendar period and age group. RESULTS: We found a significant excess mortality from pleural cancer only (4 deaths, SMR 4.67) and pleural and peritoneal cancers combined (5 deaths, SMR 3.16). All pleural and peritoneal cancer deaths occurred 30 or more years after first exposure. The SMRs were 1.27 for lung cancer (45 deaths), 1.82 for laryngeal cancer (8 deaths) and 1.12 for all cancers (142 deaths). Cumulative dust exposure and the various time factors considered did not show a clear pattern of risk associated with mortality from lung cancer. There were 57 deaths from cirrhosis (SMR 2.94) and 54 from accidents and violence (SMR 1.88). Overall, we observed a total of 590 deaths as compared to 412.9 expected (SMR 1.43). CONCLUSIONS: This updated analysis, with almost 60% of the cohort having died, confirmed the excess mortality from pleural and peritoneal cancers and from several alcohol-related causes.

Formaldehyde and cancer risk: a quantitative review of cohort studies through 2006.

BACKGROUND: Occupational exposure to formaldehyde has been associated with excess risk of nasopharyngeal and selected other cancers. PATIENTS AND METHODS: We reviewed and pooled the results of cohort studies published through February 2007. RESULTS: There were 5651 deaths from all cancers observed in six cohorts of industry workers and six of professionals, with a pooled relative risk (RR) of 0.95 for industry workers and of 0.87 for professionals. Nine deaths from nasopharyngeal cancer in three cohorts of industry workers yielded a pooled RR of 1.33, which declined to 0.49 after excluding six cases from one US plant. The pooled RR for lung cancer was 1.06 in industry workers and 0.63 in professionals. Corresponding values were 1.09 and 0.96 for oral and pharyngeal, 0.92 and 1.56 for brain, 0.85 and 1.31 for all lymphatic and hematopoietic cancers, and 0.90 and 1.39 for leukemia. CONCLUSIONS: Comprehensive review of cancer in industry workers and professionals exposed to formaldehyde shows no appreciable excess risk for oral and pharyngeal, sinonasal or lung cancers. A non-significantly increased RR for nasopharyngeal cancer among industry workers is attributable to a cluster of deaths in a single plant. For brain cancer and lymphohematopoietic neoplasms there were modestly elevated risks in professionals, but not industry workers.

[IARC evaluations: how are they conducted and what suggestions are derived therefrom?]. / Le valutazioni IARC: come sono condotte e quali implicazioni ne derivano?

The IARC Monographs on the Evaluation of Carcinogenic Risks to Humans are considered by several Institutions a point of reference for the prevention of adverse effects (namely cancer) of occupational exposures. The conclusions which lead to the Classification of a substance or an industrial process are the results of a vote within a Working Group of experts and are expressed in terms of "evidence" based on both epidemiological and experimental data or "other relevant data". Several points are discussed which include the methods of identification of the experts, the criteria of evaluation of the available data, the meaning of some definitions and finally the impact of IARC conclusions and Classification on Public Health regulations and secondarily on compensation procedures or trial decisions. Three recent examples regarding the Classification of Free Crystalline Silica, Shift-Work and Vinyl Chloride Monomer, which cannot be accepted as such without some criticism, are reported. In conclusion the Authors appreciate the effort of the IARC to provide a source of information which "may assist national and international authorities in making risk assessments and in formulating decisions concerning any necessary preventive measures". However, they suggest that the IARC "overall evaluation" should not be taken as confidently as if no doubt at all would exist on the final statement and the consequent Classification. Some suggestions as to the solution of the question are also provided.

[The role of occupational physician in the application of the 2006 "agreement on workers' health protection through the good handling and use of crystalline silica and products containing it": the experience in mining sector]. / Il ruolo del medico competente nell'applicazione dell'accordo europeo sulla silice: l'esperienza nel settore estrattivo.

The 2006 "Agreement on Workers' Health Protection Through the Good Handling and Use of Crystalline Silica and Products Containing it" between social parts defines a standardization of exposition control methods and medical surveillance. The Occupational Physician is integral part in exposition evaluation process and risk stratification in which derives the medical surveillance program. This study presents a first application of the European agreement in mining sector and the role of Occupational Physician in the evaluation of the risk to define methods of prevention. In particular it will be precised the choice of homogenous groups, the classification of exposed workers from results of workplace monitoring, the choice of technical prevention and individual protection equipments, and then the strategy of medical surveillance.