Sinonasal cancer incidence in Lombardy, Italy, 2008-20.

BACKGROUND: Epithelial sinonasal cancers (SNC) are rare tumours with recognized associations with known/suspected occupational carcinogens (wood/leather dust, nickel/chromium compounds and formaldehyde). In Italy, a national SNC registry organized as a network of regional registries was established by law in 2008. AIMS: To describe SNC time trends, occupational exposures and geographical distribution in Lombardy, North-West Italy, based on population registry data (2008-20). METHODS: The Lombardy SNC Registry records epithelial SNCs using various sources. Interviews to collect occupational history are performed using a standardized questionnaire. Using several standard populations, we calculated yearly crude and age-standardized rates (ASRs per 100,000 person-years). Standardized incidence ratios (SIR) at municipality level were calculated, and Bayesian models were fitted to produce smoothed SIR maps. RESULTS: We recorded 827 cases (553 men, 274 women). Crude (world standardized) ASRs were 0.9 (0.4) in men and 0.4 (0.2) in women, with no time trends. Interviews were obtained for 485 (88%) men and 223 (81%) women. Among men, 217 (45%) had been exposed to occupational carcinogens (wood/leather dust: 150/65 cases, 31%/13%), while only 36 women (16%) were exposed. Among 201 men with adenocarcinoma, exposure to wood/leather dust occurred in 103/50 cases (75%/50%). Areas with elevated SIRs associated with leather dust were found in the Western areas. Exposure to wood dust was more widespread. CONCLUSIONS: This study found a high frequency of occupational exposures (wood and leather dust), particularly in men with SNC. Employment in shoe industries clustered in the Western part, while work in furniture industries was less spatially structured.

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.

III Italian Consensus Conference on Malignant Mesothelioma of the Pleura. Epidemiology, Public Health and Occupational Medicine related issues.

The III Italian Consensus Conference on Pleural Mesothelioma (MM) convened on January 29th 2015. This report presents the conclusions of the 'Epidemiology, Public Health and Occupational Medicine' section. MM incidence in 2011 in Italy was 3.64 per 100,000 person/years in men and 1.32 in women. Incidence trends are starting to level off. Ten percent of cases are due to non-occupational exposure. Incidence among women is very high in Italy, because of both non-occupational and occupational exposure. The removal of asbestos in place is proceeding slowly, with remaining exposure. Recent literature confirms the causal role of chrysotile. Fibrous fluoro-edenite was classified as carcinogenic by IARC (Group 1) on the basis of MM data. A specific type (MWCNT-7) of Carbon Nanotubes was classified 2B. For pleural MM, after about 45 years since first exposure, the incidence trend slowed down; with more studies needed. Cumulative exposure is a proxy of the relevant exposure, but does not allow to distinguish if duration or intensity may possibly play a prominent role, neither to evaluate the temporal sequence of exposures. Studies showed that duration and intensity are independent determinants of MM. Blood related MM are less than 2.5%. The role of BAP1 germline mutations is limited to the BAP1 cancer syndrome, but negligible for sporadic cases. Correct MM diagnosis is baseline; guidelines agree on the importance of the tumor gross appearance and of the hematoxylin-eosin-based histology. Immunohistochemical markers contribute to diagnostic confirmation: the selection depends on morphology, location, and differential diagnosis. The WG suggested that 1) General Cancer Registries and ReNaM Regional Operational Centres (COR) interact and systematically compare MM cases; 2) ReNaM should report results presenting the diagnostic certainty codes and the diagnostic basis, separately; 3) General Cancer Registries and COR should interact with pathologists to assure the up-to-date methodology; 4) Necroscopy should be practiced for validation. Expert referral centres could contribute to the definition of uncertain cases. Health surveillance should aim to all asbestos effects. No diagnostic test is recommended for MM screening. Health surveillance should provide information on risks, medical perspective, and smoking cessation. The economic burden associated to MM was estimated in 250,000 Euro per case.

[Incidence of malignant mesothelioma and asbestos exposure in the Lombardy region, Italy, 2000-2008]. / Incidenza del mesotelioma maligno ed esposizione ad amianto in Lombardia, 2000-2008.

We evaluated the trend of incidence and asbestos exposure of malignant mesothelioma (MM) in 2000-2008 in the Lombardy Region (Italy). We recorded 2,816 MMs (1,793 men, 1,023 women). The age-standardized rates (x 100,000/year) were 3.4 (men) and 1.4 (women) (standard population: Europe). We found a 3.0% and 0.9% increase per year of number of cases and rate, respectively. Exposure was obtained in 2,671 cases (94.9%). Occupational exposure to asbestos was found for 1,296 (72.3%) men and 377 (36.9%) women, non-occupational exposure in 141 (13.8%) women and 58 (3.2%) men. The exposure profile within gender did not vary over years.

[Health surveillance in workers with a previous exposure to asbestos: a method of retrospective evaluation of exposition]. / La sorveglianza sanitaria degli ex esposti ad amianto come metodo di valutazione retrospettiva dell'esposizione.

The medical surveillance of the previously exposed to asbestos like method of retrospective appraisal of the exposure. The medical surveillance of the previously exposed to asbestos is effected on indication of the Competent Physician by the DL 257/2006. An aspect that often countersigns such typology of surveillance is the lack of relative data about past environmental asbestos exposure. There've been submitted to sanitary controls 140 subject employees in a steel metal company where in past activity of heavy carpentry has been developed. All the subjects have been submitted in the period 1998-2007 to medical visit, PFR with DLCO, radiography of the chest, in some cases TC and BAL. The past exposure has been resulted inclusive between 1962 and 1981. None of these workers has developed asbestosis, while the 10% of the subjects have showed bilateral pleural plaques. 12 subjects have been submitted to close examination through BAL for the determination of the internal dose of asbestos with comparison of middle values of 3.9 ca /ml. Four cases of pulmonary neoplasm and any case of mesothelioma have been diagnosed. This experience shows as the medical surveillance of a homogeneous group of workers can furnish useful data also to frame previous asbestos exposure in absence of environmental data.

[Asbestos risk in the textile industry: final confirmation of data from the Lombardy Mesothelioma Registry]. / Il rischio amianto nel settore tessile: indicazioni dal Registro Mesoteliomi Lombardia e definitiva conferma.

BACKGROUND: Cases of mesothelioma in non-asbestos textile workers have been frequently reported but the identification of asbestos dispersion sources in the workplaces has never been adequately performed. During 3 years of activity of the Mesothelioma Register for Lombardy, 40 cases (10.8% of all cases) were collected in textile workers engaged in all types of productive activities. The hypothesis that a significant asbestos risk for textile workers appeared not negligible. OBJECTIVES: The research was aimed at the identification of asbestos dispersion sources in textile factories. METHODS: Specific information was collected by technicians, maintenance personnel and other experts and direct inspections were carried out in numerous workplaces that had not yet undergone significant changes with respect to the past. Also the industrial machinery utilised in the previous 40-50 years was thoroughly examined. RESULTS: Epidemological evaluation of the recorded cases showed a widespread distribution in the different phases of textile production. Inspections also showed that a large amount of asbestos had been regularly used applied to the ceilings and also to the walls of factories in order to avoid both condensation of steam and reflection of noise. In addition, asbestos had also been widely used to insulate water and steam pipes. The braking systems of most of the machines also had asbestos gaskets, and on several looms some brakes operated continuously in order to keep the warp in constant tension. CONCLUSIONS: Our observations confirmed that since production techniques in the textile industry required working in damp and warm conditions with the noise of the rapidly moving machines, asbestos was very often used because of its absorbent and soundproofing qualities and its resistance to friction. We demonstrated that asbestos was thus widely used in the industry and this certainly produced considerable fibre dispersions in the atmosphere of the workplaces. Asbestos risk must therefore be recognised for all those who have worked in the textile industry in the recent past and, as a result, cases of mesothelioma must be considered occupational diseases.

Safety and immunogenicity of a conjugate vaccine against Haemophilus influenzae type b in splenectomized and nonsplenectomized patients with Cooley anemia.

Patients with thalassemia are at increased risk for infections, especially after undergoing splenectomy. Vaccinations and antimicrobial prophylaxis are recommended in these patients, but the optimal immunization schedule for Haemophilus influenzae type b (Hib) vaccine is unknown. The immunogenicity of a conjugate Hib vaccine was investigated in 57 patients with thalassemia, 32 of whom had undergone splenectomy. Anti-capsular antibodies to Hib (anti-polyribosylribitol phosphate) were measured before vaccination and 2, 6, 12, 24, and 36 months after vaccination. Immunization was well tolerated. All patients achieved protective (>1 microg/mL) antibody levels. Antibody titers declined after the initial postvaccination increase, becoming undetectable in 4 patients and decreasing to concentrations of 0.15-1 microg/mL in another 2 patients when tested 2-3 years after vaccination. Hib conjugate vaccine is safe and immunogenic in patients with thalassemia major; however, additional studies are needed to assess the need and timing of booster vaccination to maintain long-term immunity.

Immunogenicity and safety of three commercial influenza vaccines in institutionalized elderly.

Influenza is a leading cause of morbidity and mortality in elderly people. This prospective, observed-blind, randomized, multicenter trial compares the immunogenicity and safety of three influenza vaccines in a sample of 635 elderly residents of four nursing homes in Milano (Italy). All vaccines were well tolerated: no serious adverse events were recorded, and a small number (9 subjects) of local and systemic reactions were observed. Twenty-nine oropharyngeal swabs were taken during the season from ILI (influenza-like illness) patients, none of whom was positive for influenza and other respiratory viruses. Immunogenicity was evaluated in a subgroup of 111 subjects with blood samples obtained just before vaccination and after 4 and 12 weeks. The adjuvanted vaccines, subunit vaccine with MF59 (a-SUV) and virosome subunit vaccine (v-SUV), induced a higher antibody response than whole virus vaccine (WVV). There was no significant difference between groups that received a-SUV and v-SUV, but the a-SUV group had higher values of geometric mean titres than the v-SUV group for H1N1 and B influenza strains. These findings suggest that influenza vaccination is effective, and they underscore the importance of vaccination programs for institutionalized elderly. Further studies are needed to compare other adjuvanted vaccines in order to define their different properties.

Oral health profile in an institutionalized population of Italian adults with mental retardation.

The oral health of 219 residents with mental retardation living in a long-term-care institution near Milan was assessed. The dental and periodontal status, daily habits, oral hygiene, and oral mucosal status were evaluated. Of the sample, 179 (81.7%) were males. The mean age of the residents was 61.3 years, and the degree of cooperation was evaluated as good for 131 subjects (59.8%), fair for 79 (36.1%), and poor for nine (4.1%). The percentage of residents who were edentulous was 21.5% (47 subjects), of whom 28 subjects (59.6%) were without dentures. Evaluation showed an overall DMFT of 23.1, and the average number of missing teeth was 20.5. All subjects had periodontal disease: Forty-five subjects had calculus and/or shallow pockets (4-5 mm); 61 had deep pockets (> or = 6 mm). The most common mucosal lesion was oral stomatitis (49.3%). These findings underline the need for special programs aimed at institutionalized subjects with mental retardation.

Influenza vaccination among the elderly in Italy.

This article surveys the attitudes and perceptions of a random sample of the elderly population in three regions of Italy on the use and efficacy of influenza vaccine. The data were collected by direct interviews using a standard questionnaire. The results show that vaccination coverage against influenza is inadequate (26-48.6%). The major reasons for nonvaccination were lack of faith in the vaccine and disbelief that influenza is a dangerous illness. These data emphasize the need for a systematic education programme targeted at the elderly and the provision of influenza vaccination, with the increased cooperation of general practitioners.

Comparison of RT-PCR with other diagnostic assays for rapid detection of influenza viruses.

To compare the effectiveness of reverse transcription-polymerase chain reaction (RT-PCR), shell vial culture and cytospin assay as laboratory techniques for rapid diagnosis of influenza infections, a retrospective study was carried out on 270 aliquots of oropharyngeal swabs collected from October 1993 to March 1996 and already characterized by standard isolation procedures, and a prospective study in which 65 clinical samples taken from patients with influenza-like syndrome between October 1996 and March 1997 were tested. In the retrospective study, using conventional isolation as the gold standard, the sensitivity of RT-PCR and cytospin assay for virus A was 100% (95% confidence interval (CI), 89.1-100) and for virus B it was 100% (95% CI, 56.1-100) compared with 77.5% (95% CI, 61.1-88.6) and 71.4% (95% CI, 30.3-94.9) for shell vial culture. The specificity of all the three assays was 100% (95% CI, 98.0-100) for virus A and 100% (95% CI, 98.2-100) for virus B. In the prospective study the sensitivity of RT-PCR was greater than that of the other tests considered, both rapid and standard. It is suggested that RT-PCR should be employed in combination with conventional culture techniques in routine diagnosis of influenza infections in order to obtain results more rapidly and to improve virus detection even in circumstances in which standard isolation could be problematic.