[The Amiantus Program in Poland - 20 years of implementation]. / Program Amiantus w Polsce ­ 20 lat realizacji.

BACKGROUND: Despite the ban on the production of asbestos-containing materials, introduced in Poland over 20 years ago, new cases of asbestos-related diseases are still being recorded. Systematic control of respiratory function in people exposed to asbestos dust is, therefore, extremely important due to the biological properties of this mineral. MATERIAL AND METHODS: The Amiantus preventive medical examination program was undertaken in 2000 to implement the legal rights of former employees of asbestos processing plants for this type of examinations. People who have ever been employed in such factories have been authorized to use preventive medical examinations for the rest of their lives. The research is continuous, spread over time and focused, in particular, on the assessment of the respiratory system. RESULTS: Since the beginning of the program, throughout 20 years of its implementation, 8329 people have been examined, including 5199 (62.4%) men for whom a total of 34 454 medical examinations have been carried out. During the program period, the percentage of diagnosed pathologies increased from 8% in 2000 to 25% in 2019. Overall, 2078 asbestos-related diseases were diagnosed among former employees of asbestos processing plants under the Amiantus Program, which accounted for 25% of this group. Among all diseases caused by exposure to asbestos, the most common were: asbestosis (1880 cases - 90.5%), lung cancer (121 cases - 5.8%) and pleural mesothelioma (77 cases - 3.7%). Diseases of pleura in the form of plaques and diffuse pleural thickening were diagnosed in 40% of the examined patients, while radiological pulmonary shadows affected over 65% of former employees of asbestos processing plants. CONCLUSIONS: The Amiantus Program, thanks to the long observation period, enabled monitoring the health of former employees exposed to asbestos, and created a unique opportunity to carry out epidemiological analyzes. These studies allowed the authors to expand their knowledge of the natural history of asbestos-related diseases. Med Pr. 2020;71(5):595-601.

Call for a global ban policy on and scientific management of asbestos to eliminate asbestos-related diseases.

Asbestos is a primary cause of cancer worldwide. Global estimates indicate workplace exposure of 125 million people and about 255,000 deaths each year. Of the approximately 300 million metric tonnes of asbestos ever produced worldwide, most will become waste and disposed of in landfills. The recycling and transforming asbestos fibre into a non-harmful product offer a sustainable solution, but a global commitment remains elusive. Urgent action is needed. Sixty-seven countries have banned the use of asbestos-containing material, however, repeated calls to stop the use of asbestos globally have gone unheeded. We call for more stringent uniform global legislation and policies, backed up by funds to induce action along with research and education required to eliminate use of asbestos. Only by doing this, will we prevent deaths due to asbestos and help protect the environment.

Implementation of national policies for a total asbestos ban: a global comparison.

BACKGROUND: Two international Conventions from the International Labor Organization (ILO; C162 Asbestos Convention) and the UN (Basel Convention) offer governments guidelines for achieving a total asbestos ban policy, but the long-term effect of these Conventions on policy implementation, and the role of government effectiveness, remains unknown. We aimed to investigate associations between government ratification of the ILO and UN international Conventions, government effectiveness, and implementation of a national total asbestos ban. METHODS: We obtained data for year of a national asbestos ban, year of ratification of one or both international Conventions, and World Bank government effectiveness scores for 108 countries that ever used asbestos. We did a survival analysis for countries with data in the follow-up period (March 22, 1989, to Feb 2, 2018) to assess whether ratification of the international Conventions and greater government effectiveness were associated with time of implementation of a national total asbestos ban. FINDINGS: Of 108 countries with data for asbestos consumption, nine were excluded because they implemented an asbestos ban before 1989. Therefore, 99 countries were included in the survival analysis. 26 countries ratified both international Conventions and 73 ratified either one or no Convention. Countries that ratified both Conventions had a shorter time to adoption of a total asbestos ban (mean 8·9 [SD 6·4] years) than did countries that ratified one or no Conventions (16·9 [6·1] years). After controlling for government effectiveness, countries that ratified both Conventions had a significantly higher conditional probability of banning asbestos than did those ratifying one or no Convention (hazard ratio [HR] 41·8, 95% CI 4·5-383·3; p=0·0010). For every 1 point increment in government effectiveness, the percentage change in HR for persistent asbestos consumption significantly increased by 127% (95% CI 13-354; p=0·021). INTERPRETATION: This study confirms that adoption of both the C162 Asbestos Convention and the Basel Convention facilitates countries in moving towards a total asbestos ban. The effect was reinforced by government effectiveness. Both international programmes and new agreements towards total asbestos bans and government commitments are needed. FUNDING: China Medical University, and the Ministry of Science and Technology (Taiwan).

Communication and health education in communities experiencing asbestos risk and health impacts in Italy.

INTRODUCTION: Numerous municipalities in Italy currently experience asbestos health impact, in particular excesses of pleural mesothelioma incidence and mortality. This paper presents an integrated analysis of epidemiological studies and communication actions in affected municipalities to highlight how communication has been implemented depending on health impact evidence and involvement of local stakeholders. METHODOLOGY: Four case studies are identified concerning industrial and natural sources of asbestos exposure having different diseases burden. This integrated analysis benefited from multidisciplinary skills. DISCUSSION: Evidence of different stakeholders engagement is presented to emphasize their role in the communication process. Similarities and differences among case studies allowed us to identify lessons-learned to be transferred in other asbestos contaminated sites. CONCLUSIONS: The adoption of communication strategies and practices, since the very early evidence of asbestos health impact, represents a relevant contribution for epidemiological and health surveillance, particularly for those communities where asbestos health impact has only been recently reported.

Narrating and remembering as practices of care, community, and commitment in asbestos contaminated contexts.

In contexts of social and environmental disasters, practices of memory and narration can become actions implemented by the affected groups to cope with the suffering related to the disaster experience, to mobilise in the name of social justice, and to favour those dynamics by which the survivors develop their sense of being part of a community. This article is based on qualitative data collected through an anthropological study based on ethnographic fieldwork conducted in Italy and Brazil. It discusses the practices by which the survivors of the impact of asbestos-related disaster on their lives make sense of their suffering experience and engage in a grassroots health-based movement. Attention is paid on the social aspects of the health impact of asbestos exposure, and the role of the affected communities in the elaboration of their own paths of care by remembering and communicating the disaster is considered.

Global Asbestos Disaster.

Introduction: Asbestos has been used for thousands of years but only at a large industrial scale for about 100⁻150 years. The first identified disease was asbestosis, a type of incurable pneumoconiosis caused by asbestos dust and fibres. The latest estimate of global number of asbestosis deaths from the Global Burden of Disease estimate 2016 is 3495. Asbestos-caused cancer was identified in the late 1930's but despite today's overwhelming evidence of the strong carcinogenicity of all asbestos types, including chrysotile, it is still widely used globally. Various estimates have been made over time including those of World Health Organization and International Labour Organization: 107,000⁻112,000 deaths. Present estimates are much higher. Objective: This article summarizes the special edition of this Journal related to asbestos and key aspects of the past and present of the asbestos problem globally. The objective is to collect and provide the latest evidence of the magnitude of asbestos-related diseases and to provide the present best data for revitalizing the International Labor Organization/World Health Organization Joint Program on Asbestos-related Diseases. Methods: Documentation on asbestos-related diseases, their recognition, reporting, compensation and prevention efforts were examined, in particular from the regulatory and prevention point of view. Estimated global numbers of incidence and mortality of asbestos-related diseases were examined. Results: Asbestos causes an estimated 255,000 deaths (243,223⁻260,029) annually according to latest knowledge, of which work-related exposures are responsible for 233,000 deaths (222,322⁻242,802). In the European Union, United States of America and in other high income economies (World Health Organization regional classification) the direct costs for sickness, early retirement and death, including production losses, have been estimated to be very high; in the Western European countries and European Union, and equivalent of 0.70% of the Gross Domestic Product or 114 × 108 United States Dollars. Intangible costs could be much higher. When applying the Value of Statistical Life of 4 million EUR per cancer death used by the European Commission, we arrived at 410 × 108 United States Dollars loss related to occupational cancer and 340 × 108 related to asbestos exposure at work, while the human suffering and loss of life is impossible to quantify. The numbers and costs are increasing practically in every country and region in the world. Asbestos has been banned in 55 countries but is used widely today; some 2,030,000 tons consumed annually according to the latest available consumption data. Every 20 tons of asbestos produced and consumed kills a person somewhere in the world. Buying 1 kg of asbestos powder, e.g., in Asia, costs 0.38 United States Dollars, and 20 tons would cost in such retail market 7600 United States Dollars. Conclusions: Present efforts to eliminate this man-made problem, in fact an epidemiological disaster, and preventing exposures leading to it are insufficient in most countries in the world. Applying programs and policies, such as those for the elimination of all kind of asbestos use-that is banning of new asbestos use and tight control and management of existing structures containing asbestos-need revision and resources. The International Labor Organization/World Health Organization Joint Program for the Elimination of Asbestos-Related Diseases needs to be revitalized. Exposure limits do not protect properly against cancer but for asbestos removal and equivalent exposure elimination work, we propose a limit value of 1000 fibres/m³.

Australia's Ongoing Legacy of Asbestos: Significant Challenges Remain Even after the Complete Banning of Asbestos Almost Fifteen Years Ago.

The most effective way of reducing the global burden of asbestos-related diseases is through the implementation of asbestos bans and minimising occupational and non-occupational exposure to respirable asbestos fibres. Australia's asbestos consumption peaked in the 1970s with Australia widely thought to have had among the highest per-capita asbestos consumption level of any country. Australia's discontinuation of all forms of asbestos and asbestos-containing products and materials did not occur at a single point of time. Crocidolite consumption ceased in the late 1960s, followed by amosite consumption stopping in the mid 1980s. Despite significant government reports being published in 1990 and 1999, it was not until the end of 2003 that a complete ban on all forms of asbestos (crocidolite, amosite, and chrysotile) was introduced in Australia. The sustained efforts of trade unions and non-governmental organisations were essential in forcing the Australian government to finally implement the 2003 asbestos ban. Trade unions and non-government organisations continue to play a key role today in monitoring the government's response to Australian asbestos-related disease epidemic. There are significant challenges that remain in Australia, despite a complete asbestos ban being implemented almost fifteen years ago. The Australian epidemic of asbestos-related disease has only now reached its peak. A total of 16,679 people were newly diagnosed with malignant mesothelioma between 1982 and 2016, with 84% of cases occurring in men. There has been a stabilisation of the age-standardised malignant mesothelioma incidence rate in the last 10 years. In 2016, the incidence rate per 100,000 was 2.5 using the Australian standard population and 1.3 using the Segi world standard population. Despite Australia's complete asbestos ban being in place since 2003, public health efforts must continue to focus on preventing the devastating effects of avoidable asbestos-related diseases, including occupational and non-occupational groups who are potentially at risk from exposure to respirable asbestos fibres.

Experience of Japan in Achieving a Total Ban on Asbestos.

This paper aims to examine the process through which a total ban on asbestos was achieved in Japan. We reconstructed the process, analyzed the roles of involved parties/events, and drew lessons from the Japanese experience of achieving the ban. In Japan, a bill to phase out asbestos was proposed in 1992 but rejected without deliberation. Wide support for such a ban subsequently grew, however, largely due to the actions of trade unions and civil societies in establishing a coalition, raising awareness, organizing asbestos victims and their families, and propagating information on international developments. A governmental decision towards a ban was made in 2002 based on several national and international factors. A huge asbestos scandal in 2005 preponed the achievement of a total ban and led to the establishment of comprehensive measures to tackle asbestos issues. However, challenges remain for the elimination of asbestos-related diseases.

Recommendations for the Diagnosis and Management of Asbestos-Related Pleural and Pulmonary Disease. / Recomendaciones sobre el diagnóstico y manejo de la enfermedad pleural y pulmonar por asbesto.

Asbestos is the term used for a set of mineral silicates that tend to break up into fibers. Its use has been associated with numerous diseases affecting the lung and pleura in particular, all of which are characterized by their long period of latency. Asbestos, moreover, has been recognized by the WHO as a Group IA carcinogen since 1987 and its use was banned in Spain in 2002. The publication in 2013 of the 3rd edition of the specific asbestos health monitoring protocol, together with the development of new diagnostic techniques, prompted the SEPAR EROM group to sponsor publication of guidelines, which review the clinical, radiological and functional aspects of the different asbestos-related diseases. Recommendations have also been made for the diagnosis and follow-up of exposed patients. These recommendations were drawn up in accordance with the GRADE classification system.

The Global Health Dimensions of Asbestos and Asbestos-Related Diseases.

The Collegium Ramazzini (CR) reaffirms its long-standing position that responsible public health action is to ban all extraction and use of asbestos, including chrysotile. This current statement updates earlier statements by the CR with a focus on global health dimensions of asbestos and asbestos-related diseases (ARDs). The ARD epidemic will likely not peak for at least a decade in most industrialized countries and for several decades in industrializing countries. Asbestos and ARDs will continue to present challenges in the arena of occupational medicine and public health, as well as in clinical research and practice, and have thus emerged as a global health issue. Industrialized countries that have already gone through the transition to an asbestos ban have learned lessons and acquired know-how and capacity that could be of great value if deployed in industrializing countries embarking on the transition. The accumulated wealth of experience and technologies in industrialized countries should thus be shared internationally through global campaigns to eliminate ARDs.

The global health dimensions of asbestos and asbestos-related diseases.

The Collegium Ramazzini (CR) reaffirms its long-standing position that responsible public health action is to ban all extraction and use of asbestos, including chrysotile. This current statement updates earlier statements by the CR with a focus on global health dimensions of asbestos and asbestos-related diseases (ARDs). The ARD epidemic will likely not peak for at least a decade in most industrialized countries and for several decades in industrializing countries. Asbestos and ARDs will continue to present challenges in the arena of occupational medicine and public health as well as in clinical research and practice, and have thus emerged as a global health issue. Industrialized countries that have already gone through the transition to an asbestos ban have learned lessons and acquired know-how and capacity that could be of great value if deployed in industrializing countries embarking on the transition. The accumulated wealth of experience and technologies in industrialized countries should thus be shared internationally through global campaigns to eliminate ARDs.

The global health dimensions of asbestos and asbestos-related diseases.

The Collegium Ramazzini is an international scientific society that examines critical issues in occupational and environmental medicine with a view towards action to prevent disease and promote health. The Collegium derives its name from Bernardino Ramazzini, the father of occupational medicine, a professor of medicine of the Universities of Modena and Padua in the late 1600s and the early 1700s. The Collegium is comprised of 180 physicians and scientists from 35 countries, each of whom is elected to membership. The Collegium is independent of commercial interests.

Environmental factors and human health: fibrous and particulate substance-induced immunological disorders and construction of a health-promoting living environment.

Among the various scientific fields covered in the area of hygiene such as environmental medicine, epidemiology, public health and preventive medicine, we are investigating the immunological effects of fibrous and particulate substances in the environment and work surroundings, such as asbestos fibers and silica particles. In addition to these studies, we have attempted to construct health-promoting living conditions. Thus, in this review we will summarize our investigations regarding the (1) immunological effects of asbestos fibers, (2) immunological effects of silica particles, and (3) construction of a health-promoting living environment. This review article summarizes the 2014 Japanese Society for Hygiene (JSH) Award Lecture of the 85th Annual Meeting of the JSH entitled "Environmental health effects: immunological effects of fibrous and particulate matter and establishment of health-promoting environments" presented by the first author of this manuscript, Prof. Otsuki, Department of Hygiene, Kawasaki Medical School, Kurashiki, Japan, the recipient of the 2014 JSH award. The results of our experiments can be summarized as follows: (1) asbestos fibers reduce anti-tumor immunity, (2) silica particles chronically activate responder and regulatory T cells causing an unbalance of these two populations of T helper cells, which may contribute to the development of autoimmune disorders frequently complicating silicosis, and (3) living conditions to enhance natural killer cell activity were developed, which may promote the prevention of cancers and diminish symptoms of virus infections.

[Estimation of the indoor diffusion of asbestos fibers with the diffusion model for the external environment of Pasquill and Gifford]. / Stima della diffusione indoor di fibre di amianto con il modello diffusionale di Pasquill e Gifford per l'ambiente esterno.

In absence of results of environmental monitoring to proceed with the assessment of occupational exposure, it was developed a model that retraces the one of Pasquill and Gifford, currently used for the estimation of concentrations of pollutants at certain distances from the source in outdoor environment. Purpose of the study is the quantitative estimate of the diffusion of airborne asbestos fibers in function of the distance from the source in an factory where railway carriages were produced during the period when asbestos was sprayed as insulator of the body. The treatment was carried out in a large shed without separation from other operations. The application of the model, given the characteristics of the emitting source, has allowed us to estimate the diffusion of particles inside the shed with an expected decrease in concentration inversely proportional to the distance from the source. By appropriate calculations the concentration by weight has been converted into number offibers by volume, the unit of measure currently used for the definition of asbestos pollution.