Occupational exposure to PCDDs, PCDFs, and DL-PCBs in metallurgical plants of the Brescia (Lombardy Region, northern Italy) area.

The concentration values of polychlorodibenzodioxins (PCDDs), polychlorodibenzofurans (PCDFs), and dioxin-like polychlorobiphenyls (DL-PCBs) in blood serum samples (pools) of metallurgical workers in the area of the city of Brescia (northern Italy) were statistically processed. As to workers' exposure characteristics, pools were divided into 34 professionally exposed (PE) and 11 non-professionally exposed (NPE). A further subdivision of PE pools was according to workplaces in which ferrous (N = 24) and non-ferrous (N = 10) materials were handled. To evaluate the aforesaid differences we applied the age-adjusted Generalized Linear Models. We identified significant (P ≤ 0.05) exposure models of the classification groups. The first subdivision was confirmed by the concentrations of 1,2,3,4,6,7,8-H7CDF, DL-PCB 105, and DL-PCB 189; the second was confirmed by the concentrations of PCDF TEQ97, PCDD + PCDF + DL-PCB (TEQTOT) TEQ97, 2,3,4,7,8-P5CDF, 1,2,3,6,7,8-H6CDD, 1,2,3,4,6,7,8-H7CDD, and PCB 189. Based on the literature, all mentioned congeners have been found in stack gas and fly ash samples of metallurgical plants: therefore, these indicators indicate the exposure to such work environments. Specifically, the concentrations measured in the workers' blood serum appear to depend on the type of material processed during work.

[Symptoms and upper limb work-related musculo-skeletal disorders among 173 supermarket cashiers]. / Disturbi e patologie da sovraccarico biomeccanico degli arti superiori in un campione di 173 lavoratori addetti alle casse di supermercati.

BACKGROUND: Cashiers in supermarket chains have long been considered at risk for the development of work related musculo-skeletal disorders of the upper limbs (UL-WMSDs). The aim of this study was to assess the prevalence of UL-WMSDs among workers operating supermarket cash tills and, after clinical tests, their frequency. METHODS: A standardized questionnaire was given to a random group of 173 workers in order to collect information regarding symptoms in the upper limbs (pain and parasthesia). Among the 111 workers who reached a "positive clinical history threshold" we selected a random sample of subjects to undergo clinical tests (professional medical care, ultrasound examination, electro-neurographic examination). RESULTS: 64% of the workers had a positive clinical history for UL-WMSDs. The most frequently reported disorder was pain, especially in the shoulder, while 37% of workers suffered from one or more disorders of the upper limbs. Clinical tests were performed on 51 workers (47 women) whose average length of service was 20 years and 2/3 were part-time workers; a total of 43 UL-WMSDs (59%) were diagnosed in 30 workers, including 13 (30.2%) cases of compressive neuropathies, 13 cases of hand/elbow tendinitis (30.2%) and 17 cases of shoulder tendinitis (39.5%). The average age of these 30 subjects was 47 years, with a length of service of 23 years, mostly part-time workers. CONCLUSIONS: We found a high prevalence of general disorders and cases of UL-WMSDs among the workers investigated, including part-time workers and workers who were not working exclusively as cashiers. The study also revealed a poor health surveillance programme to identify/ UL-WMSDs that should be the responsibility of the occupational physician and a consequent underestimation of risk and lack of the information needed to adopt preventive measures.

[Critical in demolition and removal of asbestos cement materials]. / Criticità nei lavori di demolizione e rimozione di manufatti in cemento amianto.

Those involved in the asbestos removal is the main category of workers currently exposed to asbestos in the province of Brescia. Although Italy, since 1991, has special rules for the protection of workers exposed to asbestos, improved further by D. Lgs. n. 81 of 2008, the working conditions found in shipyards are still far from a satisfactory degree of protection of workers. Sanitary facilities are largely lacking, management of work clothing is left to chance, use of filtering face masks is often incorrect, wetting of surfaces with encapsulant is frequently inadequate, daily cleaning of work areas and areas of construction that may have been contaminated by asbestos fibers with extractors absolute filters is shortly implemented. Little attention is also paid to the protection of workers from the premises concerned to the replacement of the cover, as well as to the dispersion in the external environment of asbestos fibers that contaminate the gutters removed and sent for disposal. Finally, it is still very high risk of falling from, documented by the tribute of serious and fatal accidents that occur in these sites. Increased surveillance of Health Prevention Services of ASL is required to achieve higher levels of prevention.

[Dust and silica exposure on metallurgical furnace maintenance using refractory materials]. / Esposizione a polveri e a silice nella manutenzione dei rivestimenti refrattari dei forni metallurgici.

In the metallurgical industries the silica risk has long been known, particularly for the refractoryes maintenance workers. The maintenance of furnaces, ladles and tundisches refractory linings, on the current organization of production, is provided by companies under contract. The information available about the characterization of risk for this group of workers are at present inadequate. The study investigates the exposure to dust, also containing free crystalline silica (SLC), through the analysis of samples of commercial products used in the reconstruction of refractory linings of furnaces, ladles and tundisches, materials from the demolition of refractory articles and dust from work areas. It also presents the results of an environmental investigation conducted during the demolition and reconstruction of the refractory in three steel mills. The Authors, by the numerous inspections and the systematic survey of working conditions, have formulated a SLC risk profile and some proposals for prevention.

[Occupational risk and work-related diseases on steel foundries]. / Rischi per la salute e patologie do lavoro nelle fonderie di ghisa.

The iron foundries are still well represented in the area of Brescia and, despite having been involved in a major technological developments, have still risks to the health of workers. In order to verify the state of the art and effectiveness of prevention measures implemented by various companies, in recent years have carried out numerous inspections, environmental monitoring and biological. Furthermore, there were in the regional information system diseases reported and/or by the reported health. In particular it is shown that, in addition to chemical and physical risk factors, although in a much reduced compared to the 80s, are still present in our workplace pollutants (PAHs, silica, metal fumes, formaldehyde) at the base of classification of iron foundries in group 1, carcinogenic to humans, IARC, 1987 e 2012.

[Cumulative exposure to polychlorodibenzo-p-dioxins (PCDDS), polychlorodibenzofurans (PCDFS) and polychlorobiphenyls (PCB) in the metallurgic workers and the general population in Brescia province, northern Italy]. / Esposizione cumulativa a policlorodibenzodiossine (PCDD), policlorodibenzofurani (PCDF) e policlorobifenili (PCB) in lavoratori metallurgici e nella popolazione generale della provincia di Brescia.

High temperature metallurgical processes may significantly contribute to the release of polychlorodibenzo-p-dioxins (PCDDs) and polychlorodibenzofurans (PCDFs) into the environment. Aim of this study was to evaluate the exposure to PCDDs, PCDFs, dioxin-like PCBs (DL-PCBs) and non dioxin-like PCBs (NDL-PCBs) in a sample of 300 workers of metallurgical plants operating in the Brescia area and in a control group of 113 men. Serum samples were grouped in pools of 10 and analyzed for their concentration of PCDDs and PCDFs, DL- and NDL-PCBs. Metallurgical workers show serum concentrations of NDL-PCBs similar to those observed in non-occupationally exposed living in Brescia, except in the case of some congeners, such as PCBs 28, 52, 101 which result to be significantly higher in metallurgical workers. Their concentrations range of "dioxins" was of 32.5 - 84.8 pgTEQ g(-1) lb. No significant difference was found between metallurgical workers and the control group on the whole, but the difference became significant when comparing metallurgical workers with the group of the 47 subjects living in remote non industrialised areas. In conclusion, concentrations of total PCBs observed in metallurgy workers are comparable with those observed in the control group, with the exception of a few, more volatile, congeners which resulted to be higher in metallurgy workers. Concentrations of PCDDs and PCDFs showed a range of values similar to that observed in the general population of Brescia not professionally exposed. However, concentrations of PCDDs and PCDFs observed in subjects resident in "remote" areas were significantly lower than those assessed in metallurgy workers and subjects living in the town of Brescia. On the whole, men living in the town of Brescia show levels of PCBs, PCDDs and PCDFs higher than those observed in other groups of the Italian general population, this reflecting the intense industrial activity of the town.

[Lung asbestos fibre burden in textile workers with malignant mesothelioma]. / Carico polmonare di fibre di amianto in mesoteliomi di lavoratori tessili.

BACKGROUND: Lung burden of amphibole fibres is a good biological index of occupational cumulative asbestos exposure. Malignant mesothelioma (MM) has been amply documented in textile industry workers, dealing either with mineral fibres or with vegetable and animal fibres. So far the concentration of asbestos fibres in lung tissue among textile workers has not been reported in Italy. We analysed asbestos burden in the lung tissue of eleven textile-workers with malignant mesothelioma, mainly employed in industries near Brescia, in the North of Italy. OBJECTIVES: To characterize lung asbestos concentration and fibre type retained in the lung of asbestos and non-asbestos textile workers. METHODS: Sample of lung parenchyma from necropsies and extrapleural pneumonectomy were collected, stored and analysed by scanning electron microscope, according to the methods recommended in the current scientific literature. Nine patients were interviewed directly for occupational history. RESULTS: Eleven cases of MM (10 primary pleural, 1 primary peritoneal) were collected, 9 women and 2 men, aged between 51 and 87 years, 4 asbestos-textile workers and 7 non-asbestos textile workers. The highest values of asbestos fibres were detected in all the workers of the former group and in 3 non-asbestos workers (jute recycling employees), with concentrations between 9.1 and 397 million/g of dried lung tissue. The total fibre concentration in the other 4 non-asbestos textile workers (silk and cotton production workers) ranged from 0.33 to 1.2 million/g of dried lung tissue. In only one of these subjects, did lung amphibole burden exceed 1,000,000 amphibole fibres longer than 1 microm per g of dried tissue. Eight cases out of eleven, showed a higher concentration of amphiboles than chrysotile. We detected amphibole fibres in all the "non-asbestos" textile workers and for two of them a higher concentration of tremolite. CONCLUSION: i) Among textile workers using asbestos or jute recycling, the asbestos fibre burden is as high as that found in other high risk jobs (e.g. asbestos-cement workers); ii) among non-asbestos textile workers, employed in cotton and silk production, the fibre content in lung tissue was much lower and it was nonetheless above the occupational cut-off for one of them; iii) tremolite found in lung tissue of non-asbestos textile workers with MM could be a contaminant of chrysotile friction materials or originate, with other amphiboles, from some other source as yet to be investigated.

[Pulmonary concentration of asbestos fibers in steel workers with pleural mesothelioma]. / Concentrazione polmonare di fibre di amianto in lavoratori siderurgici affetti da mesotelioma pleurico.

The asbestos fibre burden of the lung has been used in the past as a biological indicator of cumulative exposure to the mineral so much so that in 1997 reference limits even for non-occupationally exposed people have been proposed. This kind of analysis was performed on groups of workers of different type of industries and allowed to achieve a qualitative-quantitative estimate of past exposure to asbestos, even in absence of exposure estimates by environmental monitoring. An important example is the steel industry where asbestos was widely used in the past, but for which there are not available exposure estimates of workers. Among the mesothelioma cases collected by the Mesothelioma Registry of the Province of Brescia from 1980 to present there are 55 workers who spent at least 5 years in steel industry, on a total of 289 cases classified as asbestos exposed (19%). For 8 subjects who worked in steel mills and production of electrical steel pipes, of which 4 in the same plant, lung tissue samples were available for the asbestos fibres burden analysis (7 samples coming from autopsies and 1 from extra-pleural pneumonectomy). In all cases the diagnosis was given with histological analyses supplemented with immunohistochemistry. In 7 cases autopsied the diagnosis was confirmed. The work histories have been reconstructed in detail through the interview process, inclusive of details of duties performed. The asbestos fibre burden analyses showed a range of concentrations between 260,000 and 11,000,000 ff per grams of dry tissue; the concentration of amphiboles was much higher than that of chrysotile. The highest body burden was detected in the maintenance workers of the same plant in witch a cluster of malignant mesothelioma was observed. In conclusion, this study illustrates the results of asbestos fibres burden analyses in subjects where exposure to asbestos is sure but not quantifiable. The results showed also that these concentrations can reach values that overlap with those found in asbestos-cement workers and in asbestos-textile workers. These data suggest to consider the cases of mesothelioma occurred in the steel workers at least as "possible" exposure, even in the absence of adequate information on the circumstances of contact with asbestos. This study, although based on a small number of cases, is the only one ever held in Italy on workers in this sector.

[PAH exposure in asphalt workers]. / Monitoraggio biologico dell'esposizione ad idrocarburi policiclici aromatici in un gruppo di asfaltatori.

BACKGROUND: There has been interest in evaluating the potential carcinogenicity of bitumen fumes in asphalt workers since the 1960's. The IARC classified air-refined bitumens as possible human carcinogens, while coal-tar fumes were classified as known carcinogens. Occupational/environmental PAH exposure can be measured by several urinary markers. Urinary 1-OHP has become the most commonly used biological marker of PAH exposure in asphalt workers. OBJECTIVES: The aim of this study was to assess asphalt workers' exposure levels by monitoring 1-OHP urinary excretion and compare this data with those of non-occupationally exposed subjects. METHODS: We investigated three groups of asphalt workers: 100 in summer 2007, 29 in winter 2007, and 148 during summer 2008 and compared 1-OHP urinary concentrations using Kruskall-Wallis test. RESULTS: Median 1-OHP urinary concentrations during the three biomonitoring sampling periods were 0.65, 0.17 and 0.53 microg/g creatinine respectively. There was a significant difference in 1-OHP values between the three groups (p < 0.001). CONCLUSIONS: our study showed that PAH exposure of asphalt workers' is higher than that observed in the general population and in workers in urban areas. Our results suggest that PAH exposure in the three groups studied is not sufficiently kept under control by the use of personal protective equipment and that biomonitoring is useful in evaluating PAH exposure and for risk assessment. Regulations need to be enforced for workers exposed to cancer risk, such as the register of workers exposed to carcinogens.

[Work-related carpal tunnel syndrome. Motivations and results of a surveillance system]. / Sindrome del tunnel carpale da attività lavorativa. Motivazioni e risultati di un sistema di sorveglianza.

BACKGROUND: Current statistics show that work-related carpal tunnel syndrome (CTS) has been increasing constantly over the last ten years. Nevertheless, available data on the incidence of CTS in the general population and on the occupational proportion of the aetiology of this disease suggest considerable underreporting of work-related cases, which reflects on the number of cases reported to INAIL (National Insurance Institute for Industrial Accidents) and does not give an accurate epidemiological picture of their origin and distribution. For this reason, in the course of a prevention programme of upper limb disorders due to biomechanical overload, a second experiment concerning CTS surveillance system was carried out by collecting self-reported information via postal questionnaires. The aim of this study was to estimate the prevalence of work-related cases in the selected group of the general population and to identify work tasks and factories with significant risk of CTS clusters. METHODS: From the hospital discharge lists of the Province of Brescia for 2001 and 2005, 1558 surgical cases were selected, aged 18-65 years, excluding housewives (nearly 25% of the total); thus 637 surgical cases were included in the study (68.6% female and 31.4% male). RESULTS AND CONCLUSIONS: Obesity frequency was observed to be higher in the sample than in the general population. This was not the case for diabetes. The probability of surgical CTS cases attributable to occupational exposure was estimated by dividing the 637 cases into three exposure categories:probable, possible and improbable with results of respectively 44.4%, 36.6% and 19%; in the first category, the frequency among females was 78.8%. The CTS cases among females less than 40 years old was 40% in the probable exposure category versus 10% into the improbable exposure category. In the latter category, the prevalence of concomitant hand tendinitis was 11% versus 22% in the probable exposure category. Obese patients fell into the three occupational risk groups in the same proportion. Among the 283 STC cases considered as probable occupational exposure cases, only 11 were reported as required by law to the Occupational Health Service. Whereas a number of work tasks and work sectors with high risk factors were confirmed, there were relatively few factories with a possible presence of clusters, probably due to the small sample size compared to the general population and to the density of the factories potentially at risk. The epidemiological surveillance thus carried out provided more evidence confirming the serious underreporting of the work-related STC cases in a highly industrialised province and also provided useful information on the local situation regarding high-risk occupations, which need to be addressed via interventions of primary prevention should, possibly with greater involvement of the occupational physicians.

[Asbestos fibre lung burden and exposure indices in asbestos-cement workers]. / Carico polmonare di fibre di asbesto e indici di esposizione cumulativa in lavoratori del cementoamianto.

BACKGROUND: In many previous studies, the asbestos fibres retained in the lung were regarded as a good index of cumulative occupational asbestos exposure. Twelve workers suffering from asbestos-related diseases and had been employed in an asbestos-cement factory operating from 1961 to 1994 underwent post mortem investigations in the course of a criminal law suit. OBJECTIVES: Samples of lung tissues were collected for electron microscopy analysis to measure the asbestos fibre burden of the lungs in workers with high exposure, and assess the possible correlation between asbestos fibre lung burden and the estimated levels of cumulative exposure. METHODS: Samples of lung parenchyma obtained from a consecutive series of 12 post-mortem examinations that were performed between 1994 and 2007and included 5 cases of malignant pleural mesothelioma, 4 lung cancers, 1 case of asbestosis and2 ofpleuralplagues, were collected, stored and analysed by SEM electron microscopy, according to the methods suggested by the current scientific literature. For each worker, all males, a detailed occupational history was reconstructed by means ofpersonal interviews; both the measurements of airborne asbestos fibresperformed by the factory in the 1970's and the duration of each single job in the plant were taken into account to estimate an individual cumulative exposure index. RESULTS: A wide variation of total asbestos fibre concentrations in the lung (1,320-118 million) was observed; in all 12 workers, the lung amphibole fibre burden exceeded 1,000,000 fibres per g/dry tissue, The highest values were detected in the mesothelioma cases, in which the mean fibre concentrations differed statistically (t=2.29, p=0.045) from the mean calculated for the other asbestos-related diseases; in 9 subjects only amphibole fibres were detected. There was a good correlation between total asbestos fibre concentration and cumulative exposure index (r=0.91, p<0.0001). CONCLUSION: This study, which was numerically the biggest ever performed in Italy for this category of workers, confirms a wide range of total asbestos fibre burden in heavily occupationally exposed workers and showed that of the asbestos-related diseases, the highest lung concentrations of asbestos fibres were reached in cases of mesothelioma. It was also observed that almost the entire lung burden consists of only amphibole fibres, all exceeding 1 million per gramme of dry tissue. This study tested a synthetic cumulative occupational exposure index, which appears to be well correlated to the level of exposure established by biological analysis.

[Malignant mesothelioma in garment sewing-machine workers]. / Mesoteliomi maligni nelle confezioni abbigliamento: un'ulteriore fonte di esposizione ad amianto.

BACKGROUND: Due to poor information collected through patient interviews, a considerable number of malignant mesothelioma (MM) cases still remain classified as "unknown" asbestos exposure in the Italian Mesotelioma Registry (Re.Na.M). At the same time, some occupational asbestos exposures, which were previously unknown, have been demonstrated in certain types of work, i.e., in agriculture and in the textile industry. OBJECTIVES: The aim of this research was to investigate the possible past occupational exposure to asbestos in clothing workers using sewing-machines. METHODS: The MM cases were collected from the Mesothelioma Registry of Brescia. Work histories were obtained via a standardized questionnaire. Investigations were conducted in sewing-machine maintenance workshop in order to collect information regarding the possible use of asbestos parts. In addition, the use of asbestos friction materials and the use of insulated asbestos materials was checked in the clothing divisions by interviewing the management and maintenance workers of two companies where cases of MM were observed. RESULTS: The Mesothelioma Registry of Brescia identified and collected 10 MM cases with past work in the clothing industry: 6 used sewing-machines and 4 were self-employed tailors. The search for asbestos materials gave positive results as the use of friction materials had been widespread since the 1950's in all types of sewing-machines; in addition, asbestos materials were used to insulate some parts of the ironing equipment and the steam pipelines. CONCLUSION: The results of this investigation suggest assigning at least "possible occupational asbestos exposure" to those cases employed in clothing manufacture since the 1950's, who used sewing-machines or pressing machines, according to the Re.Na.M guidelines. Other possible occupational exposures to asbestos in this working sector cannot be excluded; when the simple interview of patients does not reveal such exposures further investigations are needed in order to demonstrate all the possible circumstances of exposure.

[Recycle of jute bags; asbestos in agriculture, exposure and pathology ]. / Riciclaggio di sacchi di juta, patologie asbesto-correlate ed esposizione ad amianto in agricoltura.

During the last four years, a deeper examination of malignant mesothelioma (MM) cases occurred within non asbestos textile industry highlighted asbestos past exposure in several textile industrial divisions. In spite of that, poor information about recycled textile bags previously containing asbestos fibres is available to the National Mesothelioma Registry, although holding a remarkable data bank on more than 3500 work histories and sources of asbestos exposures. Besides the analysis of the exposure circumstances and the registered health effects of the past exposure within the recycling activity, the aim of this research was to relate the possible involvement of the agricultural sector, where the use of recycled jute bags was very diffused. The MM cases were collected from the Mesothelioma Registry of Brescia, asbestosis, pleural plaques and lung cancer cases were collected from the Occupational Diseases Archive of the Local Public Occupational Health Service of the Province of Brescia. During the 1977-2006 period, 8 cases of MM, 4 cases of pulmonary asbestosis, 4 of isolated bilateral pleural plaques and I of lung cancer in pulmonary asbestosis, were observed among workers employed in bags recycling activity in 4 small companies, one of them still operating, employing about 50 workers. Even more, among the 65 MM cases classified by the Registry with "unknown asbestos exposure" (UAE), the most relevant frequency of working histories concerned the agriculture sector. Confirming a past signalling, the investigations underlined the cross linkage between this working activity and the diffusion of recycled bags in the agriculture sector. In the Province of Brescia, the activities of these small jute bags recycling plants were linked, even geographically, to the asbestos cement manufacture plant using a huge number of bags, roughly until mid seventies. Therefore, a large number of these recycled bags, previously containing asbestos, were generally used for harvesting and trading agricultural typical products of northern Italy. According to the 2003 National Mesothelioma Registry Guide Lines, MM in agricultural workers are still classified as UAE due to poor information available. In the light of these new findings, it looks reasonable to review the UAE within agriculturalists attributing a new classification of "possible" occupational asbestos exposure, although other exposure circumstances might have occurred in the past.

[Cancer of the nasal cavity and paranasal sinuses in poultry breeders. An unsuspected occupation at risk]. / Tumori naso-sinusali in allevatori avicoli: una insospettata occupazione a rischio.

BACKGROUND: Wood dust exposure is strongly associated with the induction of cancer of the nasal cavity and paranasal sinuses (NSC), mainly among furniture production workers. Only limited information is available on wood dust exposure in other industrial sectors, including agriculture. NSC's are defined as "high occupational aetiology fraction" neoplasms, and are therefore indicated as sentinel tumours in occupational medicine. OBJECTIVES: The report concerns two cases of NSC that occurred in two poultry breeders and the investigations performed in order to define their occupational exposure. METHODS AND RESULTS: Epidemiological surveillance of NSC within the framework of routine activity of the Cancer Registry of the Province of Brescia (one million inhabitants) identified the two cases. Initially the first NSC case was considered as "probably exposed to formaldehyde" during shed tile disinfecting operations. After discovery of a similar case and further investigation in the sector formaldehyde exposure was found to be at a very low level. However, the observation that hard and soft wood dust was present, followed by dust monitoring, revealed a high level of exposure. The 23 personal and area air samples, performed in a turkey breeding shed, gave concentrations of between 1.3 and 2.3 mg/mc during low dust exposure jobs and concentrations of between 4 and 43.2 mg/mc during litter replacement (100% exceeded the ACGH TLV limit of 1 mg/cm and 25% were even above the legal limits (5 mg/mc according to Italian D.Lgs. 66/2000)). Since breeders are not aware of this type of risk and the use ofpersonal protection is not scrupulous, the local health and safety unit has started an information campaign for the entire work category as regards the necessity of controlling this cancer risk. The two cases of NSC described here were reported to the National Labour Insurance Institute (INAIL) for compensation. CONCLUSION: NSC epidemiological surveillance performed through a population registry proved to be of great use in the identification of cases among employees in similar sectors, and thus the identification of previously unknown wood dust exposures with consequent implementation of preventive measures.

[Pleural mesothelioma in cotton spinning workers]. / Mesoteliomi pleurici in lavoratori tessili addetti alla filatura del cotone.

BACKGROUND: Cases of malignant mesothelioma (MM) in the non-asbestos textile industry have recently been described, but asbestos exposure in spinning and looming has seldom been reported. Nevertheless, on a national level the Italian Mesothelioma Registry (Re.Na.M) contains numerous cases of MM with past non-asbestos textile work but classified as "unknown" exposure due to poor information. OBJECTIVES: The aim of this research was to investigate possible past occupational exposure to asbestos in this specific industrial sector. METHODS: The MM cases were collected from the Mesothelioma Registry of Brescia. Work histories were obtained via a standardized questionnaire. Investigations were conducted in textile machinery manufacturing plants in order to collect information regarding the possible use of asbestos parts; at the same time, the use of asbestos friction materials and the use of sprayed asbestos for noise abatement purposes or thermal insulation was checked in the cotton industry by interviewing the management of two companies where a cluster of MM was observed. RESULTS: The Mesothelioma Registry of Brescia retrieved and collected 15 MM cases with past work in the cotton spinning industry, 4 of them employed in the same company. Further search of asbestos use gave positive results as the use of friction materials has been widespread since the fifties, while sprayed asbestos was not found anywhere in the cotton industry. On the other hand, half of the cases were employed during the thirties and forties, when friction materials appear to have been asbestos-free. Therefore the other hypothesis of exposure could be direct manufacture of asbestos yarn. CONCLUSION: The results of this investigation indicate the attribution, at least, of possible asbestos exposure"for those cases employed in textile industries since the fifties, according to the Re.Na.M guidelines; for those cases employed before that period the same classification can be attributed on an epidemiological basis. Previous work periods need further investigation in order to demonstrate the circumstances of the occupational asbestos exposure, given the heterogeneity of work processes and machinery characteristic of this industrial sector.

[Epithelial naso-sinusal cancer incidence and the role of work in 100 cases diagnosed in the Province of Brescia (northern Italy), in the period 1978-2002]. / Incidenza dei tumori naso-sinusali epiteliali ed attività lavorative in 100 casi diagnosticati in provincia di Brescia dal 1978 al 2002.

BACKGROUND: Naso-sinusal cancers (NSC) cover a group of rare tumours in Italy for which the role of occupational risk has been established. The systematic survey of NSC in the province of Brescia made it possible to analyse the jobs of the cases occurring in the area. OBJECTIVES: The aims of the research were: estimation of epithelial NSC incidence both in the general population and among wood and leather workers, description of the frequency and type of occupational exposure to substances or manufacturing processes. METHODS: The epithelial type cases were obtained from the Naso-sinusal Cancer Register (population-based) operating in the Province of Brescia since 1994. Work histories were obtained via a standardized questionnaire. RESULTS: The annual incidence ofepithelial NSC (for 100,000) in the entire population (1,090,000 inhabitants, ISTAT census 1991) from 1993 to 1997 and from 1998 to 2002 was nearly the same, 0.82 and 0.90 for men, 0.37 and 0.37 for women, respectively. The nasal cavity was the most affected anatomic site (45%) and squamous cell carcinoma was the most frequent histotype (44%) among the first 100 cases whose case histories were appropriate; in the ethmoidal sinus adenocarcinoma represented 62% of the cases; 25% of all cases were exposed to occupational carcinogens (list A) and particularly to wood dust (17%), even if only of softwood species (30%), and leather dusts (7%) especially in the shoe repair. The average latency period was 47 years (SD 7.4) and 44 years (SD 5.6) respectively; 71% of these epithelial NSC cases involved the ethmoid and 85% were adenocarcinomas. Only 1% of the cases was exposed to chromium and nickel and occurred in galvanization processes. Among the exposures to occupational risks with limited epidemiological evidence (list B) there was one case exposed to formaldehyde and 42 cases occurring in the building, agricultural, metallurgic and textile sectors. Thus all the exposures to occupational risks, both certain and probable (lists A and B) reached 84% among men and 17% among women. Epithelial NSC annual incidence rates (for 100,000) estimated among the wood and leather workers for the period 1985-2002 were 13 and 6.5 respectively. CONCLUSION: The results confirm the meaning of sentinel event for these tumours in occupational health and justify maintaining an active surveillance programme for the cases occurring in the area.

[Two cases of pleural mesothelioma following unusual and unrecognized exposure to asbestos. The role of Occupational Health and Safety Service in identifying past occupational exposure]. / Mesoteliomi pleurici da insolita e ignorata esposizione professionale ad amianto. Ruolo dei Servizi territoriali di prevenzione nell'individuazione della pregressa esposizione lavorativa.

BACKGROUND: In Italy there was a wide use of asbestos in various manufacturing sectors and for many different uses, some of which are still partly or completely unknown. A detailed reconstruction of the work histories of mesothelioma patients made it possible, in some cases, to identify ignored circumstances of asbestos exposure. Moreover, the identification of cluster of cases takes on special significance in suggesting a possible previous asbestos exposure, where the information collected on single cases do not imply as much. OBJECTIVES: This report concerns two cases of malignant mesothelioma that occurred in two workers employed in the same processes in a small factory that manufactured and repaired electric motors for hand tools. METHODS AND RESULTS: In the Province of Brescia (one million inhabitants) a Mesothelioma Register is in operation. The first case was classified, according to Re.Na.M.1996 criteria (National Mesothelioma Register) as "unknown" occupational exposure. The identification of a second case, that was discovered thanks to the surveillance system of the Mesothelioma Register, encouraged the local Occupational Health and Safety Service to perform a more detailed investigation that revealed, for both subjects, previously unknown occupational exposure. This consisted of grinding, in a damp setting, electric motor parts bushed with phenolic thermosetting resins reinforced with chrysotile asbestos. Moreover, weekly cleaning of the plants could have been an occasion for dust dispersion. It is likely that this exposure did not last long and was limited in extent. Other similar reports of such circumstances of occupational exposure were not available in the literature. CONCLUSIONS: The results confirm the high information value of systematic collection of incidental cases in the population, which is feasible thanks to the disease register, and the significant role of the local Occupational Health Services in demonstrating past asbestos exposure.

[Sino-nasal inverted papillomas and occupational etiology]. / Papillomi invertiti naso-sinusali ed eziologia occupazionale.

The sino-nasal inverted papilloma is a rare benign tumour with certain aggressive features because of frequent relapses and the high probability of malignant degeneration. For these reasons, several studies have been made to evaluate the efficacy of the different courses of treatment, but only afew studies have been carried out to establish the etiology of this tumour, which is still uncertain. Although it is believed that viral infection, chronic inflammation and cigarette smoking can play an important etiological role, it has recently been suggested that occupational risk factors, such as those involved in malignant epithelial sino-nasal cancer (SNC), can also be involved in causing sino-nasal inverted papilloma. A group of 70 patients was examined who have been diagnosed with inverted papilloma from 1991 to 2003; the occupational history, collected via the standardized questionnaire, showed that risk factors like wood and leather dusts, chromium and nickel vapours or fumes and formaldehyde were associated with only 5% of all cases. This proportion is much lower than that established for SNC in several epidemiological studies. Although occupational environmental pollution can be a source of chronic sino-nasal mucosa irritation, on the basis of our results we believe that a causal relationship between exposure to occupational risk factors and inverted papilloma is not likely, differently from the suggestions made in other studies. Consequently, an epidemiological surveillance of inverted papilloma as a "sentinel" tumour, as has been proposed in Italy for SNC, is not considered necessary. Among the possible non-occupational risk factors we observed that 75% of the male patients were smokers and 40% of all patients suffered from chronic sinusitis and sino-nasal polyps. Lastly, among the 70 cases of inverted papilloma, we observed 5 with malignant degeneration.

Malignant mesothelioma and the working environment: the viewpoint of the occupational physician.

BACKGROUND: Firm scientific evidence supports the causal association between malignant mesothelioma (MM) and occupational exposure to asbestos. Risk attributable to occupation varies from 30 to 80% across different populations. The existence of a threshold level below which there is no risk of MM is still debated. A prompt and thorough assessment of exposure is essential to evaluate and manage MM cases, from diagnostic and epidemiological points of view. OBJECTIVES AND METHODS: To highlight the multiple areas of intervention by Occupational Physicians (OP) in MM evaluation and management, to describe an experience of OP in the province of Brescia. RESULTS: The main areas of interest of the OP are exposure assessment, diagnosis (clinical, etiological), medico-legal issues, social consequences, preventive strategies, risk communication, scientific dispute/uncertainties. By means of an active search, the Brescia MM registry, managed by OP belonging to the local health authority observed 309 MM from 1977 to 2003; the local Institute of Occupational Health, hosted in a hospital of national relevance, evaluated about 200 MM in the last decade. The main outcomes of OP activity are the high percentage of direct interviews, individual case management, expert exposure assessment, etiological diagnosis, counselling, medico-legal assistance, better knowledge of occupational risks, enhanced cooperation among health professionals (oncologists, pathologists, surgeons, pneumologists, general practitioners and OP), important contribution to Registries and to epidemiology (estimates of attributable risks, incidence, survival rates), with positive social and scientific consequences (insurance agencies, trade union organizations, public events, teaching opportunities). CONCLUSIONS: This experience highlights the multifaceted role of OP in active research and evaluation of MM cases, in the context of a multidisciplinary approach.

[Musculoskeletal conditions of the upper and lower limbs as an occupational disease: what kind and under what conditions. Consensus document of a national working-group. ISPESL]. / Le affezioni muscolo-scheletriche degli arti superiori e inferiori come patologie professionali: quali e a quali condizioni. Documento di Consenso di un gruppo di lavoro nazionale. ISPESL.

BACKGROUND AND OBJECTIVES: In via of the progressive emergence in Italy of work-related musculoskeletal disorders, the EPM Research Unit decided to set up a national working group with the aim of producing a Consensus Document including methods and criteria as an initial attempt towards managing such diseases as true "listed" work-related diseases as is already done in the other European Union countries. The working group includes experts from INAIL, ISPESL, welfare assistance institutions, local prevention and health protection services: The group's research activity was included in ISPESL's funded research plan. CONTENTS: The Consensus Document includes a review of epidemiologic issues reported in the international literature, comments on the application of current legislation, observations on the guilt profiles of employers and occupational physicians, as well as medical-legal issues. The document proposes an analytical list of musculoskeletal disorders of upper (and lower) limbs and the operational criteria for identification of working activities involving a risk from upper limb biomechanical overload. In this case, more than on other occasions, it was realized how difficult it is to adopt consolidated task/risk/damage matrices since the same task may or may not be at risk depending both on the way the task is done and on the technical aspects (lines, work parts, procedures, tools) and organization (rate, rotas, breaks). CONCLUSIONS: For the specific aims of the present document, it is possible to identify, though not exhaustively and with some limitations, a series of jobs and working conditions where the risk may be reasonably presumed and for which it is possible to adopt a list system (at least as regards "significant exposure"). The document also includes a chapter on health surveillance recommendations for the occupational physician.