[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.

[Incidence of malignant mesothelioma (1980-1999) and asbestos exposure in 190 cases diagnosed among residents of the province of Brescia]. / Incidenza del mesotelioma maligno (1980-1999) ed esposizione ad amianto in 190 casi diagnosticati in residenti nella provincia di Brescia.

Several cases of malignant mesothelioma (MM) previously unknown to the Occupational Health and Safety Service were recognised in the Province of Brescia after an active surveillance program carried out during the first nineteen years of operation; a large proportion of the cases involved workers occupationally exposed to asbestos. A local Mesothelioma Register was subsequently set up in 1993 and by the end of 1999, 190 MM cases had been collected. The annual incidence ratio (standardized on the Italian population, census 1981, x100,000 person-years) was calculated in the 1980-1999 period and showed an increasing trend for location in the pleura in both sexes; in the 1996-1999 period the incidence ratio was 2.95 for males and 1.35 for females. In the same period, this trend was not observed for peritoneal location, with an incidence ratio of 0.17 and 0.37 for males and females respectively. 161 pleural MM (84.7%) and 28 peritoneal MM (14.7%) are described; histopathologic diagnosis was performed in 161 cases (84.7%). Anamneses were collected for 88% of the cases but with direct information from patients only in 65% of these in the recent period. Only 7 cases of asbestosis were diagnosed in the MM cases, whereas 31 cases of pleural abnormalities were observed but only 17 of these were observed in workers occupationally exposed to asbestos. Occupational asbestos exposure was evaluated as certain, probable or possible in 45% of total cases and in 54% of recently (1996-1999) observed cases, which were ten times more frequent in males. Exposure occurred in sectors works where asbestos was not used as raw material, such as construction, iron and steel and metal working. MM's from environmental and non-occupational exposure to asbestos were very few, 1.5% and 0.5% respectively. In 65 MM's asbestos exposure was unknown (34.2%); 50% of these concerned females; for whom the industry and jobs are discussed. The distribution of histologic types of MM was similar in asbestos exposed and non exposed cases. No association between peritoneal mesotheliomas and heavy exposure to asbestos was observed. Ten cases of MM were diagnosed in subjects under 45 years old (5.2%) with only one case occupationally exposed. 2 cases were exposed to radiation therapy (1%) and 2 cases to thoracic trauma (1%). Although in Italy MM has been included in the list of compensatable occupational diseases by law since 1994, a large number of cases occupationally exposed to asbestos are still not recognised by the National Insurance Institute (INAIL). A number of problems limiting work of the Mesothelioma Register and its usefulness are discussed. The Lombardy Mesothelioma Register set up in January 2000 should be able to overcome the limits identified in the past.

[Active epidemiological surveillance and prevention of diseases caused by biomechanical overload of the upper limbs: experience at a territorial service of occupational medicine]. / Sorveglianza epidemiologica attiva e prevenzione delle patologie da sovraccarico biomeccanico degli arti superiori: l'esperienza di un servizio territoriale di medicina del lavoro.

Nowadays in the western countries, the Work Musculoscheletal Disorders (WMSDs) are the most relevant work-related diseases either for the large number of at-risk workers and for the high prevalence of cases among them. Among WMSDs, the Carpal Tunnel Syndrome (CTS) is considered a sentinel event in occupational medicine and epidemiological surveillance systems were set up to study its temporal occurrence and spatial spread. Surprisingly enough, in our country the epidemiology of the WMSDs is still unknown; although observations of important clusters of cases are increasing, these pathologies are still largely underreported by medical doctors. In the high industrialised province of Brescia, Northwestern Italy, only 1% of the 25.000 occupational disease, collected by the occupational medicine and prevention service of the National Health Service (SPSAL) since 1989 to 1997, were coded as WMSDs. Even if the notification of these work-related disorders is compulsory by low since 1973, up-to-now very few cases were reported to SPSALs, and consequently active prevention programs were very few too. For that reason, a project of active surveillance of WMSDs diagnosed on the general population was carried out to improve their identification and to evaluate the work-related etiological fraction as well as to address primary prevention projects. During 1997-1999 618 upper limb musculoskeletal disorders were collected from 2 orthopaedic hospital divisions where cases underwent surgical treatment. 369 of them were interviewed by telephone (253 female, 116 man) and 128 cases (34%) were classified as probable professionally exposed to some known hazard. Female were prevalent (71%), involved particularly in textile, garments, plastic, food production and domestic services. Among men, construction, metallurgic and mechanic were the more frequent jobs. 116 WMSDs were reported to the National Insurance Institute (INAIL). The collection of these WMSDs was the basis for specific communications to the firm manager(s) and to the factory's medical doctor(s) with the aim to make it easy: i) a good health surveillance to exposed workers; ii) a specific risk assessment; iii) carrying out prevention programs and adopting personal protection equipments. Some problems are focused concerning the underreporting of cases, the anamnesis information, the fate of interventions to face the problem in the workplaces. A possible implementation of this project is also discussed to avoid a WMSds surveillance unlinked prevention programs of occupational risks.