[Mortality and cancer risk in agricultural nursery workers: a cohort study in Tuscany Region (Central Italy)]. / Mortalità e rischio cancerogeno nei florovivaisti: uno studio di coorte in Toscana.

OBJECTIVES: to follow-up mortality of agricultural nursery workers of the province of Pistoia (Tuscany Region, Central Italy). DESIGN: the cohort of nursery workers of the Pistoia province was assembled from two sources: subjects who obtained a pesticide license (PAT) and subjects who had been working in agricultural nursery, based on the 2003 regional census (LIF). Vital status and causes of deaths were ascertained through the official records of the municipalities and the Tuscany Mortality Register. The follow-up period for PAT cohort was from 01.01.1984 to 31.12.2015 and for LIF cohort was from 01.01.2003 al 31.12.2015. SETTING AND PARTICIPANTS: the total cohort included 2,732 males and 326 females: the PAT cohort included 1,602 males and 106 females, and the LIF cohort included 1,130 males and 220 females MAIN OUTCOME MEASURES: general and cause-specific Standardized Mortality Ratios (SMRs) and 95% confidence intervals were calculated for the entire cohort and for the PAT and LIF sub-cohorts. Expected deaths by age and gender for each cause of death were obtained from applying the respective rates in the Tuscan population. RESULTS: overall mortality was lower than expected, with notable deficits for all cancers and some specific causes in both genders. Among males, increased SMRs were observed for pancreas (17 observed cases: SMR 129; CI95% 75-207), prostate (22 cases: SMR 121; CI95% 76-183), bladder (18 cases: SMR 139; CI95% 83-220) cancer, and also for multiple myeloma (5 cases: SMR 120; CI95% 39-281). Among females, increased SMR for cancer of digestive system and peritoneum was observed (3 cases: SMR 152; IC95% 31-445). The analyses by calendar period also shown excess for cancers of the genital and urinary system and the lymphohematopoietic system. CONCLUSIONS: although overall deficits for all causes and all cancer were observed, there were notable exceptions for some specific cancer causes, that might be related to pesticides exposure.

Malignant mesotheliomas in textile rag sorters.

OBJECTIVES: To analyse the asbestos exposure characteristics and mesothelioma trend in textile workers operating in the larger Tuscan textile industrial province of Prato between 1988 and 2012. METHODS: All cases of textile workers recorded by the Tuscan mesothelioma register are considered. The demographic and clinical characteristics and asbestos exposure of cases working in the province of Prato are examined. Crude incidence rates between 1988 and 2012 and their 95% confidence intervals (CI) are calculated in rag sorters and other textile workers. The trends of standardized rates are also evaluated, as well as the sources of occupational asbestos exposure from occupational histories of cases affected by other asbestos-related diseases in rag sorters. RESULTS: One hundred and seventy-two malignant mesotheliomas (MMs) have been diagnosed in textile workers in Tuscany. Among these, 46.5% were residents in the province of Prato at the time of diagnosis, half of whom working as rag sorters. All rag sorters with MM are classified as occupationally asbestos exposed, while 71.7% are other textile workers exposed to asbestos. The estimated crude incidence rate in rag sorters in Prato ranges from 74.1×100000 (95% CI: 52.5-101.8) to 166.8×100000 (95% CI: 118.1-229.0). The standardized rates in Prato rag sorters appeared higher throughout the 1990s while in other Prato textile workers the rates increased later on, at the very end of the 1990s. Another 40 cases of asbestos-related diseases in rag sorters were also collected. CONCLUSIONS: A very high incidence of MMs was observed in textile workers in Prato, especially among rag sorters. This result, together with the high number of other asbestos-related diseases in rag sorters, strongly supports the hypothesis of diffuse asbestos exposure in rag sorting, in the absence of any other relevant aetiological factor for malignant mesothelioma.

[Solar ultraviolet radiation risk in outdoor workers: a specific project of Tuscany Region (Italy)]. / Rischio da radiazione solare ultravioletta nei lavoratori outdoor: piano mirato della Regione Toscana.

OBJECTIVE: The aims of Tuscany Regional project were: to study the sun protection attitude of outdoor workers; to measure solar ultraviolet (UV) exposure in work environment; to describe the frequency of photoaging, precancerous lesions, and skin cancers in outdoor workers; to collect information on solar ultraviolet radiation exposure from incident cases of Non-Melanoma Skin Cancer (NMSC) recruited from Tuscany Cancer Registry. DESIGN: Outdoor workers completed a questionnaire devoted to collect information on sun protection attitudes during a typical summer working week. Environmental and personal measurements were carried out. Expert dermatologists examined outdoor workers to assess the frequency of photoaging, precancerous lesions, and skin cancer. A structured questionnaire was mailed to incident cases of NMSC. Information were collected on personal habits and working history, focusing on solar ultraviolet radiation exposure. SETTING AND PARTICIPANTS: Agriculture, construction, quarrying and fishing activities were considered: 292 employees responded to questions about the type of clothing used in the morning and in the afternoon,while working outdoors; 637 outdoor workers underwent skin examination. We contacted 743 cases of NMSC occurred in 2004; 498 subjects accepted to participate in this study. RESULTS: The clothing worn by surveyed subjects was often inadequate compared to the high level of exposure to UV. The skin examination of 637 outdoor workers highlighted 2 melanomas, 7 epitheliomas and 35 actinic keratoses. Among the 498 cases of NMSC, 135 (27%) were diagnosed in outdoor workers. Most represented economic activity sectors were: agriculture, construction, transport, sports. CONCLUSION: The characterization of outside workers revealed unsatisfactory sun protection behaviours. Moreover, previously undetected skin cancers were diagnosed. The study on MNSC confirms the complexity of studying the exposure to UV radiation. The Tuscany Regional project provided useful information on the risk of solar ultraviolet radiation in outdoor workers. Prevention programs are needed.

Spontaneous abortion and maternal work in greenhouses.

BACKGROUND: A positive association between maternal occupational exposure to pesticide and spontaneous abortion has been reported in some studies. Work in greenhouses may imply exposure of pregnant women to pesticides continuously and at elevated level. METHODS: A total of 717 women working in greenhouses provided information on 973 pregnancies, including 110 spontaneous abortions. These pregnancies were classified as exposed or not exposed according to maternal occupation, re-entry activities and application of pesticides in greenhouses during at least 1 month in the first trimester of pregnancy. The ORs for spontaneous abortion were estimated through a generalised estimate equations model for all orders of pregnancy together, and through a logistic regression model limited to first pregnancies. RESULTS: Increased risks of spontaneous abortion were found for maternal re-entry activities within 24 hr after pesticides were applied (all orders of pregnancy: OR 3.2, 95% CI 1.3-7.7; first pregnancies: OR 3.8, 95% CI 1.0-13.9) and for those who applied pesticides (all orders of pregnancy: OR 2.6, 95% CI 1.0-6.6; first pregnancies: OR 3.7, 95% CI 0.7-20,6) CONCLUSIONS: The observed results support the hypothesis of an association between maternal work in greenhouses and spontaneous abortion. The main limitations of the study are lack of information on the specific chemicals used and the small number of pregnancies heavily exposed to pesticides.