[Mesothelioma-30 years after the asbestos ban in Germany]. / Mesotheliome ­ 30 Jahre nach dem Asbestverbot in Deutschland.

In 1993, a total asbestos ban was introduced in Germany. Thirty years later, mesothelioma is still one of the most frequent occupational diseases. Recent data on incidence, mortality, recognized occupational diseases, early detection, and assessment are presented in this article.

Asbestos history and use.

All six fiber types called asbestos can cause all the diseases related to exposure, including lung cancer. Known to the ancients, the modern history of asbestos hazards started in the 1890s with more and more data accumulating over time. Use increased exponentially in the middle of the 20th century with major use coming in construction and ship building. The recognition of asbestos as causing lung cancer dates to the early 1940s.

Relationships between asbestos exposure and pleural plaques: dose and time effects using fractional polynomials.

OBJECTIVE: The aim of this study was to confirm the relationship between several parameters of exposure to asbestos and pleural plaques (PP) using data from a large cohort of retired workers occupationally exposed to asbestos in France. METHOD: A large screening programme, including high-resolution CT (HRCT) examinations at inclusion and two other HRCT campaigns, was organised from 2003 to 2016 in four regions of France for voluntary, formerly asbestos-exposed workers. Exposure to asbestos has been evaluated by industrial hygienists based on the complete work history. The time since first exposure, the time since last exposure, Cumulative Exposure Index and maximum level of exposure to asbestos, were used in logistic regression using fractional polynomials to model the relationship with PP. RESULTS: The study included 5392 subjects with at least one HRCT available. There was a significant non-linear effect of time since first exposure, time since last exposure and Cumulative Exposure Index to asbestos on the presence of PP. The risk of PP increased with increasing Cumulative Exposure Index to asbestos adjusted for time since first exposure, age and smoking status. Models also show that PP odds rise with increasing time since first exposure adjusted for cumulative index exposure, age and smoking status. PP odds decrease when time since last exposure increases. CONCLUSION: The study provides new data on the link between asbestos exposure and the presence of PP using fractional polynomials with non-linear relationships for time exposure parameters and asbestos exposure parameters.

The asbestos-asbestosis exposure-response relationship: a cohort study of the general working population.

OBJECTIVES: The association between asbestos exposure and asbestosis in high-exposed industrial cohorts is well-known, but there is a lack of knowledge about the exposure-response relationship for asbestosis in a general working population setting. We examined the exposure-response relationship between occupational asbestos exposure and asbestosis in asbestos-exposed workers of the Danish general working population. METHODS: We followed all asbestos-exposed workers from 1979 to 2015 and identified incident cases of asbestosis using the Danish National Patient Register. Individual asbestos exposure was estimated with a quantitative job exposure matrix (SYN-JEM) from 1976 onwards and back-extrapolated to age 16 for those exposed in 1976. Exposure-response relations for cumulative exposure and other exposure metrics were analyzed using a discrete time hazard model and adjusted for potential confounders. RESULTS: The range of cumulative exposure in the population was 0.001 to 18 fibers per milliliter-year (f/ml-year). We found increasing incidence rate ratios (IRR) of asbestosis with increasing cumulative asbestos exposure with a fully adjusted IRR per 1 f/ml-years of 1.18 [95% confidence interval (CI) 1.15- -1.22]. The IRR was 1.94 (95% CI 1.53-2.47) in the highest compared to the lowest exposure tertile. We similarly observed increasing risk with increasing cumulative exposure in the inception population. CONCLUSIONS: This study found exposure-response relations between cumulative asbestos exposure and incident asbestosis in the Danish general working population with mainly low-level exposed occupations, but there is some uncertainty regarding the exposure levels.

Decade-long insights: tracking asbestos-related health impacts among formerly exposed workers in Palermo, Italy.

Background: Asbestos is a foremost occupational carcinogen globally. Despite the prohibition under Law 257/1992, Italy persists as one of the European nations most burdened by asbestos-related diseases (ARDs). This research assessed ARD cases in asbestos-exposed workers from the Province of Palermo, Italy, spanning 2010-2021. Methods: Data acquisition utilized the epidemiological dataset from the 'Service of Prevention and Safety on Work Environment' under the Prevention Department of Palermo's Local Health Authority (LHA). Results: Between 2010 and 2021, we identified 245 ARD instances, comprising 163 Asbestosis/Pleural plaques, 41 Lung Cancers, 38 Mesotheliomas, and 3 unspecified cases. Multivariate analysis indicated a notable decline in temporal exposure for mesothelioma (HR=0.933; 95% CI=0.902-0.965) and lung cancer (HR=0.93; 95% CI=0.90-0.978) relative to pleural plaques/asbestosis. Tobacco use displayed a pronounced correlation with lung cancer (smoker HR=64.520 95% CI=13,075-318.390; former smoker HR=20.917 95% CI=4,913-89.048). A significant link was observed between mesothelioma and pleural plaques/asbestosis in those employed in shipbuilding and repair (HR=0.371 95% CI=0.155-0.892). Conclusions: ARDs persist in clinical observations, even following the 1992 cessation of asbestos-related activities, emphasizing an enduring public health challenge. Enhancing prevention strategies is paramount, focusing on amplifying anamnestic and occupational data collection, thereby facilitating superior early diagnosis strategies for these maladies in the occupationally exposed cohort.

Mortality rates from asbestos-related diseases in Italy during the first year of the COVID-19 pandemic.

Background and aim: Patients with interstitial lung diseases, including asbestosis, showed high susceptibility to the SARS-CoV-2 virus and a high risk of severe COVID-19 symptoms. Italy, highly impacted by asbestos-related diseases, in 2020 was among the European countries with the highest number of COVID-19 cases. The mortality related to malignant mesotheliomas and asbestosis in 2020 and its relationship with COVID-19 in Italy are investigated. Methods: All death certificates involving malignant mesotheliomas or asbestosis in 2010-2020 and those involving COVID-19 in 2020 were retrieved from the National Registry of Causes of Death. Annual mortality rates and rate ratios (RRs) of 2020 and 2010-2014 compared to 2015-2019 were calculated. The association between malignant pleural mesothelioma (MPM) and asbestosis with COVID-19 in deceased adults ≥80 years old was evaluated through a logistic regression analysis (odds ratios: ORs), using MPM and asbestosis deaths COVID-19-free as the reference group. The hospitalization for asbestosis in 2010-2020, based on National Hospital Discharge Database, was analyzed. Results: In 2020, 746,343 people died; out of them, 1,348 involved MPM and 286 involved asbestosis. Compared to the period 2015-2019, the mortality involving the two diseases decreased in age groups below 80 years; meanwhile, an increasing trend was observed in subjects aged 80 years and older, with a relative mortality risks of 1.10 for MPM and 1.17 for asbestosis. In subjects aged ≥80 years, deaths with COVID-19 were less likely to have MPM in both genders (men: OR = 0.22; women: OR = 0.44), while no departure was observed for asbestosis. A decrease in hospitalization in 2020 with respect to those in 2010-2019 in all age groups, both considering asbestosis as the primary or secondary diagnosis, was observed. Conclusions: The increasing mortality involving asbestosis and, even if of slight entity, MPM, observed in people aged over 80 years during the 1st year of the COVID-19 pandemic, aligned in part with the previous temporal trend, could be due to several factors. Although no positive association with COVID-19 mortality was observed, the decrease in hospitalizations for asbestosis among individuals aged over 80 years, coupled with the increase in deaths, highlights the importance of enhancing home-based assistance during the pandemic periods for vulnerable patients with asbestos-related conditions.

CT Characteristics of Pleural Plaques Related to Occupational or Environmental Asbestos Exposure from South Korean Asbestos Mines

OBJECTIVE: This study evaluated the CT characteristics of pleural plaques in asbestos-exposed individuals and compared occupational versus environmental exposure groups. MATERIALS AND METHODS: This study enrolled 181 subjects with occupational exposure and 98 with environmental exposure from chrysotile asbestos mines, who had pleural plaques confirmed by a chest CT. The CT scans were analyzed for morphological characteristics, the number and distribution of pleural plaques and combined pulmonary fibrosis. Furthermore, the CT findings were compared between the occupational and environmental exposure groups. RESULTS: Concerning the 279 subjects, the pleural plaques were single in 2.2% and unilateral in 3.6%, and showed variable widths (range, 1-20 mm; mean, 5.4 +/- 2.7 mm) and lengths (5-310 mm; 72.6 +/- 54.8 mm). The chest wall was the most commonly involved (98.6%), with an upper predominance on the ventral side (upper, 77.8% vs. lower, 55.9%, p < 0.001) and a lower predominance on the dorsal side (upper, 74.9% vs. lower, 91.8%, p = 0.02). Diaphragmatic involvement (78.1%) showed a right-side predominance (right, 73.8% vs. left, 55.6%, p < 0.001), whereas mediastinal plaques (42.7%) were more frequent on the left (right, 17.6% vs. left, 39.4%, p < 0.001). The extent and maximum length of plaques, and presence and severity of combined asbestosis, were significantly higher in the occupational exposure group (p < 0.05). CONCLUSION: Pleural plaques in asbestos-exposed individuals are variable in number and size; and show a predominant distribution in the upper ventral and lower dorsal chest walls, right diaphragm, and left mediastinum. Asbestos mine workers have a higher extent of plaques and pulmonary fibrosis versus environmentally exposed individuals.

Enfermedad pulmonar por amianto en trabajadores de acería / Pulmonary disease due to asbestos in steel industry workers

Las enfermedades relacionadas al amianto se producen por la inhalación de fibras de asbestos en su variedad crisotilo o amianto blanco. A pesar de que en la Argentina la prohibición data del año 2003, existen numerosas industrias donde se sigue trabajando con este mineral, entre ellas las metalúrgicas y acerías. Actualmente se conoce la alta patogenicidad de este material, por lo que en muchos países existen programas de seguimiento de los trabajadores expuestos. Se describen las características generales y manifestaciones clínicas pulmonares de 27 pacientes que trabajaron en una gran acería de América del Sur. El diagnóstico de amiantopatías se realizó mediante historia clínica laboral, antecedente de exposición al amianto, estudios complementarios de función pulmonar e imágenes del tórax. Se analizaron la fuente de exposición (laboral, doméstica y ambiental), tiempo de exposición y período de latencia en los pacientes de los cuales se detectó enfermedad relacionada. Los antecedentes de tabaquismo fueron tenidos en cuenta para el análisis. En 22 pacientes se presentaron patologías benignas (81.4%), 16 de ellos tenían lesiones exclusivamente pleurales y otros 6 asbestosis. Las patologías malignas se presentaron en 5 pacientes (18.5%), en 4 fueron mesoteliomas y en uno carcinoma pulmonar. El problema de la exposición al amianto tiene vigencia actual. De ahí la necesidad de un programa de vigilancia en trabajadores expuestos al amianto actualmente o en el pasado, para detectar, notificar, registrar e investigar las características de estas patologías.

Asbestos-related diseases are caused by the inhalation of asbestos fibers in their variety chrysotile or white asbestos. Although the ban in Argentina dates from 2003, there are numerous industries where work continues with this mineral, including iron and steel industries. It is currently known the high pathogenicity of this material, so that in many countries there are programs to monitoring the exposed workers. Here we describe the general characteristics and pulmonary manifestations in 27 patients who had worked in a very huge steel factory in South America. The diagnosis of asbestos-related diseases was made by a medical-occupational record, history of asbestos exposure, additional studies of lung function and chest images. Then the sources of exposure (occupational, domestic and environmental), exposure time and latency period were analyzed, in those patients in whom a related disease was detected. Smoking history was also taken into account. Twenty-two patients had benigns pathologies (81.4%), sixteen of them with lesions localyzed in pleura, and other six pulmonary asbestosis. The malignant pathologies occurred in five patients (18.5%), in four of them mesothelioma and in other one lung cancer. The problem of asbestos exposure has contemporary relevance. Hence the need for a surveillance program in workers exposed to asbestos in the past or currently, to detect, report, record and investigate the characteristics of these pathologies.

Enfermedad pulmonar por amianto en trabajadores de acería / Pulmonary disease due to asbestos in steel industry workers

Las enfermedades relacionadas al amianto se producen por la inhalación de fibras de asbestos en su variedad crisotilo o amianto blanco. A pesar de que en la Argentina la prohibición data del año 2003, existen numerosas industrias donde se sigue trabajando con este mineral, entre ellas las metalúrgicas y acerías. Actualmente se conoce la alta patogenicidad de este material, por lo que en muchos países existen programas de seguimiento de los trabajadores expuestos. Se describen las características generales y manifestaciones clínicas pulmonares de 27 pacientes que trabajaron en una gran acería de América del Sur. El diagnóstico de amiantopatías se realizó mediante historia clínica laboral, antecedente de exposición al amianto, estudios complementarios de función pulmonar e imágenes del tórax. Se analizaron la fuente de exposición (laboral, doméstica y ambiental), tiempo de exposición y período de latencia en los pacientes de los cuales se detectó enfermedad relacionada. Los antecedentes de tabaquismo fueron tenidos en cuenta para el análisis. En 22 pacientes se presentaron patologías benignas (81.4%), 16 de ellos tenían lesiones exclusivamente pleurales y otros 6 asbestosis. Las patologías malignas se presentaron en 5 pacientes (18.5%), en 4 fueron mesoteliomas y en uno carcinoma pulmonar. El problema de la exposición al amianto tiene vigencia actual. De ahí la necesidad de un programa de vigilancia en trabajadores expuestos al amianto actualmente o en el pasado, para detectar, notificar, registrar e investigar las características de estas patologías.(AU)

Asbestos-related diseases are caused by the inhalation of asbestos fibers in their variety chrysotile or white asbestos. Although the ban in Argentina dates from 2003, there are numerous industries where work continues with this mineral, including iron and steel industries. It is currently known the high pathogenicity of this material, so that in many countries there are programs to monitoring the exposed workers. Here we describe the general characteristics and pulmonary manifestations in 27 patients who had worked in a very huge steel factory in South America. The diagnosis of asbestos-related diseases was made by a medical-occupational record, history of asbestos exposure, additional studies of lung function and chest images. Then the sources of exposure (occupational, domestic and environmental), exposure time and latency period were analyzed, in those patients in whom a related disease was detected. Smoking history was also taken into account. Twenty-two patients had benigns pathologies (81.4%), sixteen of them with lesions localyzed in pleura, and other six pulmonary asbestosis. The malignant pathologies occurred in five patients (18.5%), in four of them mesothelioma and in other one lung cancer. The problem of asbestos exposure has contemporary relevance. Hence the need for a surveillance program in workers exposed to asbestos in the past or currently, to detect, report, record and investigate the characteristics of these pathologies.(AU)

Enfermedad pulmonar por amianto en trabajadores de acería. / [Pulmonary disease due to asbestos in steel industry workers].

Asbestos-related diseases are caused by the inhalation of asbestos fibers in their variety chrysotile or white asbestos. Although the ban in Argentina dates from 2003, there are numerous industries where work continues with this mineral, including iron and steel industries. It is currently known the high pathogenicity of this material, so that in many countries there are programs to monitoring the exposed workers. Here we describe the general characteristics and pulmonary manifestations in 27 patients who had worked in a very huge steel factory in South America. The diagnosis of asbestos-related diseases was made by a medical-occupational record, history of asbestos exposure, additional studies of lung function and chest images. Then the sources of exposure (occupational, domestic and environmental), exposure time and latency period were analyzed, in those patients in whom a related disease was detected. Smoking history was also taken into account. Twenty-two patients had benigns pathologies (81.4

), sixteen of them with lesions localyzed in pleura, and other six pulmonary asbestosis. The malignant pathologies occurred in five patients (18.5

), in four of them mesothelioma and in other one lung cancer. The problem of asbestos exposure has contemporary relevance. Hence the need for a surveillance program in workers exposed to asbestos in the past or currently, to detect, report, record and investigate the characteristics of these pathologies.

Actualización en enfermedad respiratoria y exposición ambiental: una relación invisible / Update in Respiratory Disease and Environmental Exposure: an Invisible Relationship

En el último año, se han producido contribuciones relevantes en diferentes aspectos de la patología laboral/ambiental respiratoria. En el caso de las enfermedades neoplásicas asociadas a la inhalación de asbesto,las áreas de interés más recientes se sitúan en la búsqueda de marcadores tumorales, la importancia de ladeterminación del depósito de fibras de amianto en muestras biológicas y en los nuevos regímenes terapéuticosen el mesotelioma pleural maligno. En el asma relacionada con el trabajo, se ha publicado un artículode consenso en el que se establecen unas recomendaciones basadas en evidencias clínicas, dirigidas aldiagnóstico y el manejo del asma relacionada con el trabajo. En referencia a las neumonitis por hipersensibilidad,en una amplia serie de 86 pacientes con pulmón del cuidador de aves se describen las característicasclínicas y evolutivas de esta patología. En este año se han publicado además interesantes estudios queenfatizan la necesidad de realizar una historia laboral en los pacientes con síntomas respiratorios para sospecharuna relación causal o sinérgica con el tabaco. Finalmente, se han publicado resultados de diferentestrabajos dirigidos a elucidar el papel de la contaminación urbana, principalmente derivada del tráfico rodado,en el deterioro de la función pulmonar. Un estudio reciente demuestra que sería posible obtener unasignificativa reducción de la mortalidad atribuida a la contaminación urbana, reduciendo los niveles de PM2,5, y concluye que en Europa es necesario adoptar estándares más restrictivos para proteger la salud delos ciudadanos, coincidiendo con la propuesta de la Organización Mundial de la Salud(AU)

Significant contributions have been made in the past year on different aspects of occupational/environmental respiratory disease. In the case of neoplastic diseases associated with asbestos inhalation,the areas of most interest have been in the search for tumour markers, the importance of the determinationof asbestos fibre deposits in biological samples, and new therapeutic schemes in malignant pleuralmesothelioma. A consensus article has been published on occupational asthma, in which some clinicalevidenced-based recommendations are established, directed at the diagnosis and management of workrelatedasthma. As regards hypersensitivity-induced pneumonitis, the clinical and evolutionary aspects ofthis disease have been described in a large series of 86 patients with pigeon-fancier lung. There have alsobeen interesting studies published this year that emphasise the need to take an occupational history inpatients with respiratory symptoms in order to look for a causal or synergic relationship with smoking.Finally, the results of studies have been published which were directed at elucidating the role of urbancontamination, mainly caused by road traffic, in the deterioration of lung function. A recent study showedthat it would be possible to achieve a significant reduction in urban mortality attributed to urbancontamination by reducing the levels of PM 2.5. They conclude that more restrictive standards need to beadopted in Europe to protect the health of the population, which coincides with the proposal by the WorldHealth Organisation(AU)

Exposição ocupacional e ocorrência de pneumoconioses na região de Campinas (SP) Brasil, 1978-2003 / Occupational exposure and occurrence of pneumoconioses in Campinas, Brazil, 1978-2003

OBJETIVO: Desenvolver e consolidar uma ampla base de dados acerca da ocorrência das pneumoconioses numa região industrializada do Brasil, com especial referência às atividades mais freqüentemente relacionadas a essas doenças. MÉTODOS: Numa avaliação retrospectiva observacional, coletaram-se dados referentes à casuística ambulatorial das pneumoconioses no Hospital das Clínicas da Universidade Estadual de Campinas, entre o período de 1978 e 2003. Incluíram-se os indivíduos com diagnóstico de pneumoconiose, com base no histórico ocupacional e no radiograma do tórax, segundo recomendações da Organização Internacional do Trabalho, de 1980 e 2000, com anormalidades compatíveis com comprometimento intersticial do parênquima pulmonar. RESULTADOS: Foram identificados 1.147 casos de pneumoconiose (1.075 homens e 72 mulheres), sendo 1.061 casos (92,5 por cento) de silicose, 51 (4,45 por cento) de pneumoconiose por poeira mista, 15 (1,31 por cento) de asbestose, 13 (1,13 por cento) de pneumoconiose por rocha fosfática e 7 (0,61 por cento) de outras pneumoconioses (por carvão, grafite e metais duros). As alterações radiológicas com profusão 1/0, 1/1 e 1/2 e as pequenas opacidades regulares p, q e r foram as mais freqüentes, tendo sido identificados 192 casos (16,74 por cento) com grandes opacidades. Observou-se redução pronunciada da ocorrência dos casos a partir da década de 1990; adicionalmente, o tempo de exposição foi caracteristicamente mais breve do que o observado em série norte-americana. CONCLUSÕES: Os dados do presente estudo estabelecem uma ampla base de dados para a investigação da ocorrência de pneumoconioses numa região industrializada brasileira, tornando factível a realização de estudos de seguimento e a elaboração de políticas de saúde relacionadas aos agravos respiratórios ocupacionais.

OBJECTIVE: To develop and consolidate a comprehensive database on the occurrence of pneumoconioses in an industrialized region of Brazil, with a special focus on the activities most frequently related to these diseases. METHODS: A retrospective, observational study was conducted in order to gather data on cases of pneumoconioses treated at the outpatient clinic of the State University at Campinas Hospital das Clínicas between 1978 and 2003. Individuals diagnosed with pneumoconiosis, based on their occupational history and on chest X-ray findings of abnormalities consistent with interstitial lung disease involving the parenchyma, in accordance with the 1980 and 2000 recommendations of the International Labour Organization, were included in the study. RESULTS: A total of 1147 cases of pneumoconiosis were identified (1075 in males and 72 in females): 1061 cases of silicosis (92.5 percent); 51 cases of mixed-dust pneumoconiosis (4.45 percent); 15 cases of asbestosis (1.31 percent); 13 cases of phosphate rock-related pneumoconiosis (1.13 percent); and 7 cases of other types of pneumoconiosis (0.6 percent), including those related to exposure to coal, graphite and hard metals. The most common chest X-ray findings were 1/0, 1/1 or 1/2 profusion and small regular opacities (p, q or r), although 192 patients (16.74 percent) presented large opacities. There has been a substantial decline in the occurrence of the disease since the 1990s, and the duration of exposure was typically shorter than that observed in a study conducted in the United States. CONCLUSIONS: Our findings have been compiled into a comprehensive database for the investigation of pneumoconiosis in an industrialized area of Brazil. These data make it possible to conduct follow-up studies and develop health policies related to occupational respiratory disorders.

Diagnósticos histopatológicos das pneumoconioses / Histopathological diagnosis of pneumoconiosis

As doenças asbesto-induzidas constituem um grave problema de saúde em decorrência de um grande número de trabalhadores expostos ao asbesto ao longo dos últimos 50 anos. Processos judiciais contra indústrias que lidam com asbesto somam centenas, com crescente adição de novos casos. O assunto relativo à asbestose é complexo, e muito embora a história natural das doenças induzidas esteja bem estabelecida, muitas áreas importantes, como a patologia, permanecem ainda pouco compreendidas. No Brasil, desde 1940, o asbesto é explorado comercialmente, sendo que nos últimos anos sua produção é da ordem de 200.000 toneladas por ano, estimando-se que na atividade de mineração cerca de 10.000 trabalhadores foram expostos a essa fibra, desconhecendo-se a estimativa do número de pessoas expostas na produção de fibrocimento, especialmente telhas e caixas d'água. Um estudo, de cunho inter-institucional, com metodologia de investigação científica apropriada, para avaliar as repercussões sobre a saúde dos trabalhadores nas minas de asbesto, em nosso país foi elaborado e intitulado "Moralidade e Mortalidade Entre Trabalhadores Expostos ao Asbesto na Atividade de Mineração 1940-1996". O objetivo deste trabalho foi fornecer uma visão ampla das doenças asbesto-induzida, com ênfase às dificuldades no diagnóstico histopatológico, através da experiência adquirida com o desenrolar desse projeto.

Asbestos-related diseases constitute a major health problem due to the great number of workers exposed to asbestos over the past 50 years. Personal injury lawsuits against industries that deal with asbestos number in the hundreds, and new cases continue to be filed. The scientific issues related to asbestos are complex, and, although the broad outlines of asbestos-related diseases have been well-established, many significant aspects (such as the pathology involved) are poorly understood. In Brazil, asbestos has been mined commercially since 1940, with production levels recently approaching 200,000 tons/year, resulting in the asbestos exposure of approximately 10,000 workers in the mining activity, and an unknown number of workers in asbestos-cement industry, primarily roofers and concrete rooftop water tank installers. One study, using appropriate methods of scientific investigation to evaluate the effects of such exposure on the health of asbestos mine workers in Brazil was conducted as part of a multicenter study and entitled "Morbidity and Mortality Among Workers Exposed to Asbestos in Mining Activities, 1940-1996". Drawing upon the experience acquired during the course of that study, the objective of the current report was to give an overview of asbestos-related diseases, with a special focus on the difficulties involved in establishing the histopathological diagnosis.

Cohorte poblacional de trabajadores expuestos a amianto. Navarra 1999-2004 / Cohort of asbestos exponed workers. Navarre (Spain) 1999-2004

Fundamento. La construcción de una cohorte poblacional de trabajadores expuestos a amianto es importante porque facilita la vigilancia, permite cumplir con la obligación ética de reconocer el origen laboral de las lesiones y contribuye al desarrollo de la investigación científica. El objetivo es describir el procedimiento que se ha seguido para identificar a los trabajadores expuestos a amianto en Navarra y conocer su respuesta a la oferta de vigilancia de la salud.Metodología. El registro de trabajadores expuestos a amianto se crea en 1999, incorporando empresas y trabajadores a partir de las fuentes de información disponibles, de ámbito nacional y regional, y se consolida con la búsqueda activa de expuestos, tanto activos como inactivos.Resultados. La cohorte es de 2.294 trabajadores, de 33 empresas; 40% están activos, la mitad trabajan fabricando vehículos de motor, 91% expuestos a crisotilo, 25% expuestos a concentraciones de fibras de amianto iguales o superior a 0,20 por cm3 de crisotilo ó 0,10 para otros. En los años 70 y 90 es cuando mayor número de trabajadores inicia la exposición; quienes comenzaron en los años 40 y 50 tienen tiempos de exposición más altos. En la vigilancia médica 72% acepta la oferta, con mayor participación de los activos. Conclusiones. La creación de la cohorte y su seguimiento han permitido reconocer el triple de casos de patología por amianto en relación con los declarados espontáneamente en los once años anteriores al programa, lo que refleja su importancia. El nivel de aceptación de la vigilancia es adecuado, dada la metodología del programa

Background. The identification of a population cohort of workers exposed to asbestos is important because it facilitates health surveillance, allowing us to fulfil the ethical obligation of recognizing the occupational origin of the illness and contributing to the development of scientific research. The goal of this study is to identify the asbestos exposed workers in Navarre and the success of the health surveillance offer.Methods. The register of asbestos exposed workers was created in 1999. It includes companies and workers from the national register, the records of the regional institution of occupational health and the data of the occupational health services and the inspectorate of sick leave. The health programme deals with occupational and post-occupational workers.Results. The cohort consists of 2,294 workers, from 33 companies, 40% of whom are active, half work manufacturing motor vehicles, 91% are exposed to chrysotile, 25% exposed to high concentrations (0.20 fibers /cm3 or more for chrysotile or 0.10 fibers /cm3 for others). The 1970s and 1990s were when most workers began to be exposed. Workers who began in the 1940s and 1950s have longer exposure times. Medical surveillance is accepted by 72%, with higher acceptance among those who are active.Conclusions. The follow-up has allowed us to recognize three times as many cases of pathology for asbestos, in comparison with those declared spontaneously in the eleven years prior to the program, which reflects its importance. The level of acceptance of the surveillance is adapted, given the methodology of the programme

Análisis y detección de fibras en tejido pulmonar / Analysis and detection of fibres in the pulmonary tissue

Las técnicas microscópicas para el análisis defibras en tejido pulmonar y lavado broncoalveolar hanaportado información de gran interés para un mejorentendimiento de las enfermedades relacionadas conla inhalación de asbesto. Estas pruebas sirven deayuda para establecer una estimación individual de laexposición previa al amianto.Un análisis mineralógico de la concentración defibras intrapulmonares puede ser necesario en algunasocasiones especiales, como por ejemplo cuando losdatos obtenidos en la historia ocupacional sean pocorelevantes o inconclusos.Por todo ello, este tipo de estudios se utiliza cadavez más en trabajos clínicos y en la resolución de problemasmedicolegales, pero la complejidad de algunode ellos hace conveniente la creación de laboratoriosde referencia que permitan la homogeneización metodológicay faciliten la comparación de resultados.Las enfermedades pleuropulmonares relacionadascon la inhalación al asbesto son consideradas como detipo profesional y, por tanto, están sujetas a una seriede requisitos legales para su reconocimiento y posiblecompensación. Una historia de exposición con períodode latencia adecuado, junto con un cuadro clínicoradiológicocompatible, puede ser suficiente para eldiagnóstico pero, en determinadas situaciones, comopor ejemplo cuando los datos de exposición no sonprecisos, el análisis y detección de fibras de asbesto enmuestras respiratorias o de tejido pulmonar puede seraclaratorio

Microscopic techniques for the analysis of fibresin pulmonary tissue and bronchovesicular washinghave provided information of great interest for abetter understanding of diseases related to theinhalation of asbestos. These tests serve to help inestablishing an individual estimation of previousexposure to asbestos.A mineralogical analysis of the concentration ofintra-pulmonary fibres can be needed on some specialoccasions, for example when the data obtained fromthe occupational history are of scarce relevance orinconclusive.For these reasons, this type of study isincreasingly used in clinical work and in resolvingmedico-legal problems, but the complexity of some ofthem makes the creation of reference laboratoriesuseful as they make methodological homogenisationpossible and facilitate the comparison of results.Plueropulmonary diseases related to inhalingasbestos are considered to be of occupational type andare therefore subject to a series of legal requisites fortheir recognition and possible compensation. A historyof exposure with a suitable latency period, togetherwith a compatible clinical-radiological picture, can besufficient for the diagnosis but, in certain situations,such as when the exposure data are not precise, theanalysis and detection of asbestos fibres in respiratorysamples or from the pulmonary tissue can beclarifying

Asbesto (amianto) e doença: revisäo do conhecimento científico e fundamentaçäo para um urgente mudança da atual política brasileira sobre a questäo / Asbestos and disease: state-of-the-art review and a rationale for urgent change in current Brazilian policy

Revê-se o estado do conhecimento científico quanto aos efeitos da inalaçäo de fibras de asbesto (amianto) na saúde humana e sua prevençäo. Propöe-se a fundamentaçäo científica do debate que se faz no Brasil, visando alterar a política governamental sobre a questäo, de modo a priorizar a defesa da vida, da saúde e do meio-ambiente. No início, säo discutidos aspectos tecnológicos e econômicos acerca do asbesto e, em especial, da crisotila. A seguir, explana-se a evoluçäo do conhecimento científico internacional sobre os efeitos da inalaçäo de fibras de asbesto na saúde. Após isso, descreve-se o conhecimento nacional acerca dos danos oriundos do amianto, concluindo-se que as doenças descritas no exterior constam de nossa literatura médica há tempos. Na seqüência, enfoca-se o debate sobre a nocividade do asbesto-crisotila, o qual aponta para a sua confirmaçäo. Depois, expöem-se as respostas da comunidade internacional à questäo e a mobilizaçäo pela proibiçäo do asbesto. Por fim, estuda-se a inadequaçäo da posiçäo brasileira e explicita-se a necessidade de revisäo urgente.