La Medicina del Lavoro

Our medical research library holds 29 studies published in La Medicina del Lavoro (2016–2025). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 29 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: Mattioli 1885
• Published: 1925 to the present, Italy
• Language: Italian, English
• ISSN: 0025-7818 (print), 2532-1080 (electronic)
• Continues: Il Lavoro
• Its record in the NLM Catalog

2020s

• A 7-Year Active Surveillance Experience for Occupational Lung Cancer in Bologna, Italy (2017-2023). M. Bogni, D. Cervino, M.R. Rossi, et al. 2025;116(2):16173. PubMed · Publisher · Free full text

  Abstract

  Background: In Italy, lung cancer is the second most frequent neoplasm in men and the third in women. Exposure to carcinogens in workplaces plays a significant role. Still, cases attributable to occupational exposure are currently under-reported as occupational diseases: the current National Prevention Plan also encourages active research projects for the detection of cancers attributable to occupational exposure.

  Methods: The Unit of Prevention and Safety in the Workplace of Bologna Local Health Authority (Azienda Unità Sanitaria Locale-AUSL-)created a network for active surveillance of occupational lung cancer cases with the dedicated Diagnostic and Therapeutic Care Pathways(PDTA). Possible occupational exposure cases were selected within all incident PDTA cases using a self-completed patient filter form. Only patients selected through the form were interviewed; occupational physicians collected personal, occupational, and clinical history. Definition of a cooperation system with the local office of the National Institute for Insurance(INAIL)for monitoring the process during the medico-legal assessments conducted by the insurance institute up to resolution.

  Results: 453 cases completed the filter form, 177 had a potential occupational exposure. Of these, 140 accepted the direct interview with occupational physicians. One hundred eleven cases interviewed were assessed with sure or suspect occupational origin: for 82, a claim for recognition was sent to the INAIL, while for the other 29 was sent to INAIL a report for epidemiological purposes. Out of 82 compensation claims, 18 individuals (4 females and 14 males) received compensation, while 4 cases remain under investigation. A total of 53 claims were rejected: 54.7% for lack of exposure to risk factors, 24.5% for insufficient exposure, 9.4% due to inadequate administrative documentation, 7.5% because of insufficient clinical documentation, and 3.8% for the absence of causal association.

  Conclusions: Several occupational lung cancers were found that otherwise would have been unrecognized. Asbestos was the most frequent agent occurring in the most widespread work sectors-construction and manufacture of metalworking products-and in the period of exposure from 1970 to 1980. Other relevant agents were welding fumes and polycyclic aromatic hydrocarbons. Active surveillance, direct patient interviews, and claims for recognition integrated by a complementary report are essential to increase the INAIL compensation rate.

• Girls and Women in Mines: an Invisible Path of Forced Labour in Italy. S. Salerno. 2025;116(5):17012. Historical article PubMed · Publisher · Free full text

  Abstract

  This study aims to shed light on the largely understudied history of girls and women working in Italian mines during the 19th and 20th centuries. Giovanni Loriga authored an outstanding paper on Pneumoconiosis in 1930 at the Johannesburg Conference. By examining his sources from earlier surveys, travel records, and congressional proceedings, the research uncovers data on women and girls in slate (Liguria), asbestos (Piedmont), zinc-lead (Sardinia and Lombardy), and sulfur mines (Sicily), along with their working conditions. The research findings reveal that girls and women were integral to the mining industry throughout Italy, despite being underrepresented and relegated to specific tasks. Ultimately, the paper explores the development of protective Italian legislation, its inadequate enforcement, and suspension during World War I. The paper concludes by highlighting the ongoing global issue of girls' labour in mines, drawing a parallel between the historical situation in Italy and the contemporary reality denounced by organizations like the ILO and UNICEF.

• Cholangiocarcinoma and Occupational Exposure to Asbestos: Insights From the Italian Pooled Cohort Study. S. Curti, M. Gallo, D. Ferrante, et al. 2024;115(2):e2024016. PubMed · Publisher · Free full text

  Abstract

  Background: Recent studies supported the association between occupational exposure to asbestos and risk of cholangiocarcinoma (CC). Aim of the present study is to investigate this association using an update of mortality data from the Italian pooled asbestos cohort study and to test record linkage to Cancer Registries to distinguish between hepatocellular carcinoma (HCC) and intrahepatic/extrahepatic forms of CC.

  Methods: The update of a large cohort study pooling 52 Italian industrial cohorts of workers formerly exposed to asbestos was carried out. Causes of death were coded according to ICD. Linkage was carried out for those subjects who died for liver or bile duct cancer with data on histological subtype provided by Cancer Registries.

  Results: 47 cohorts took part in the study (57,227 subjects). We identified 639 causes of death for liver and bile duct cancer in the 44 cohorts covered by Cancer Registry. Of these 639, 240 cases were linked to Cancer Registry, namely 14 CC, 83 HCC, 117 cases with unspecified histology, 25 other carcinomas, and one case of cirrhosis (likely precancerous condition). Of the 14 CC, 12 occurred in 2010-2019, two in 2000-2009, and none before 2000.

  Conclusion: Further studies are needed to explore the association between occupational exposure to asbestos and CC. Record linkage was hampered due to incomplete coverage of the study areas and periods by Cancer Registries. The identification of CC among unspecific histology cases is fundamental to establish more effective and targeted liver cancer screening strategies.

• Human Exposure to Asbestos in Central Asian Countries and Health Effects: A Narrative Review. Z. Kurzhunbaeva, K. Dzhusupov, A. Spinazzè, et al. 2024;115(6):e2024042. Systematic review PubMed · Publisher · Free full text

  Abstract

  The discovery of the detrimental effects of asbestos on human health came long after its widespread use, with the first scientific evidence of asbestos-related diseases emerging in the late 19th and early 20th centuries. Despite efforts to ban its use, asbestos continues to be mined and used in Central Asia (as well as in Russia, China, and other countries). To gain a deeper understanding of the situation in Central Asia, we have conducted a systematic review of scientific literature on the use of asbestos, exposure assessment, and health consequences of asbestos exposure in this geographic area. This review encompasses studies about exposure assessments, epidemiological data, and biochemical or clinical surveys conducted in Kazakhstan, Uzbekistan, Tajikistan, Turkmenistan, and Kyrgyzstan. A total of 18 articles met the inclusion criteria, and their content is summarised in this review, which represents the first attempt to systematically examine research on asbestos and its impact on the health of workers and the general population in Central Asia countries, including literature published in Russian and English. The findings here highlighted the substantial limitations of the currently available knowledge about the impact of asbestos on health in this geographical area.

• Trends in Asbestos Exposure and Malignant Mesothelioma Incidence in Emilia-Romagna Italy: A Retrospective Study 1996-2023. F. Giacomino, F. Marinelli, I. Bisceglia, et al. 2024;115(4):e2024028. PubMed · Publisher · Free full text

  Abstract

  Malignant mesothelioma (MM) is a rare but lethal cancer strongly associated with asbestos exposure. This retrospective study examines trends in asbestos exposure in Emilia-Romagna, Northern Italy. Between 1996 and 2023, 3,513 cases of MM were recorded, predominantly in males (72%) and in older than 65 years (79%). Occupational exposure accounted for 82% of cases, with a significant increase observed over time from 71% to 88% in the most recent period. A greater definition of professional exposure indicates that certain exposure has gone from 49% in the first period to 62% and 58% in the last two periods; probable exposure showed a decrease from 21% to 16% while possible exposure decreased from 16% to 13%. Familiar exposure remained relatively constant at around 8%, environmental exposure showed a slight decrease from 4% to 2%, while non-occupational exposure remained stable at 2%. Among patients with exclusively occupational exposure (1,826 cases), 87% were male and aged between 65 and 75 years (36%) and 75+ (41%). The exposure rates for the province of residence see the province of Reggio Emilia with the highest occupational exposure rate (2.5 x 100,000 residents), followed by Ravenna (2.3 x 100,000 residents) and Parma and Piacenza which have similar exposure rates with 2.2 x 100,000 residents. Professional sectors such as construction, railway maintenance and metalworking are identified as high-risk industries. Despite efforts to mitigate exposure, non-occupational and environmental exposures persist. The study highlights the importance of continuous surveillance and exposure monitoring to guide effective interventions and legal recognition of MM.

• Mesothelioma Risk among Construction Workers According to Job Title: Data from the Italian Mesothelioma Register. L. Vimercati, D. Cavone, L. De Maria, et al. 2023;114(3):e2023025. PubMed · Publisher · Free full text

  Abstract

  Background: An increased risk of mesothelioma has been reported in various countries for construction workers. The Italian National Mesothelioma Registry, from 1993 to 2018, reported exposure exclusively in the construction sector in 2310 cases. We describe the characteristics of these cases according to job title.

  Methods: We converted into 18 groups the original jobs (N=338) as reported by ISTAT codes ('ATECO 91'). The exposure level was attributed at certain, probable and possible in accordance with the qualitative classification of exposure as reported in the Registry guidelines. Descriptive analysis by jobs highlights the total number of subjects for each single job and certain exposure, in descending order, insulator, plumbing, carpenter, mechanic, bricklayer, electrician, machine operator, plasterer, building contractor, painter and labourer.

  Results: The cases grow for plumbing in the incidence periods 1993-2018, while, as expected, it decreases for insulator. Within each period considered the most numerous cases are always among bricklayers and labourers, these data confirm the prevalence of non-specialised "interchangeable" jobs in Italian construction sector in the past.

  Conclusions: Despite the 1992 ban, the construction sector still presents an occupational health prevention challenge, circumstances of exposure to asbestos may still occur due to incomplete compliance with prevention and protection measures.

• Mesothelioma Risk Among Maritime Workers According to Job Title: Data From the Italian Mesothelioma Register (ReNaM). L. Vimercati, D. Cavone, O. Negrisolo, et al. 2023;114(5):e2023038. PubMed · Publisher · Free full text

  Abstract

  The study describes the 466 cases of malignant mesotheliomas (MM) collected by the National Mesothelioma Register (ReNaM) in Italy in the period 1993-2018 relating to subjects with exclusive asbestos exposure in merchant or military navy. The cases among maritime workers represent 1.8% of the total cases with defined exposure registred in the ReNaM, of which 212 cases (45.4%) among merchant maritime workers and 254 cases (54.5%) among navy. The distribution by site of mesothelioma showed 453 (97.2%) MM cases of the pleura, 11 (2.3%) of the peritoneum and 2 (0.4%) of the tunica vaginalis of the testis. With regard to occupational exposure, it was classified as certain in 318 (68.2%) cases, probable in 69 (14.8%) cases and possible in 79 (16.9%) cases. Among the 23 classified jobs, the highest percentages of certain exposures are among naval engineers, motor mechanics, machine captains and sailors. Machine crew accounted for 49.3% of the cases, deck crew for 27.6%. All cases began exposure on board between 1926 and 1988. Seamen were exposed to asbestos while at sea by virtue of living onboard ships and from continual release of asbestos fibers due to the motion of a vessel. Epidemiological surveillance through the ReNaM has allowed us to verify among cases in the maritime, navy and merchant marine sectors, that in the past, subjects were exposed regardless of the ship's department where have provided service therefore all these cases must be considered as occupational diseases.

• Occupational Risk Factors for Laryngeal Cancer in Tunisia: A Case Control Study. A. Gaddour, A. Brahem, H. Mosbah, et al. 2023;114(6):e2023047. PubMed · Publisher · Free full text

  Abstract

  Background: Tobacco use and alcohol consumption are the primary risk factors for laryngeal cancer (LC). In most populations, occupational exposures are likely to play a minor role in laryngeal carcinogenesis. We aimed to investigate the association between occupational exposure and laryngeal cancer.

  Methods: It is a case-control study that included 140 cases diagnosed between January 2013 and December 2016 and 140 controls matched by sex, age, alcohol consumption, and tobacco consumption.

  Results: Significantly increased risks were found amongst workers of the building sector (OR=4.621; 95% CI [1.826-11.693]) and the mechanical industry sector (OR=5.074; 95% CI [1.425-18.072]). Significant association of laryngeal cancer with various carcinogens was observed such as asbestos (p=0.009; OR=3.68; 95% CI [1.29-10.46]), paint vapors (p=0.005; OR=3.35; 95% CI [1.37-8.16]), solvents (p=0.001; OR=3.29: 95% CI [1.61-6.68]) and cement dust (p=0.003; OR=3.19: 95% CI [1.43-7.12]). After binary logistic regression, cement dust was independently correlated with LC (p=0.042; OR=3.93; 95% CI [1.04-14.78]. The administration sector was associated with decreased risk (p=0.001; OR=0.07; 95% CI [0.03-0.15]) as well as the health sector (p=0.001; OR=0.098; 95% CI [0.02-0.43]).

  Conclusions: Our results supported the role of occupational factors in developing LC. Further studies enabling an in-depth analysis of occupational exposures are necessary to provide a clearer definition of the etiological associations between single agents and circumstances of exposure and the genesis of LC.

• Quantitative Assessment of Asbestos Fibers in Abdominal Organs: A Scoping Review. Y. Caraballo-Arias, F. Roccuzzo, F. Graziosi, et al. 2023;114(6):e2023048. PubMed · Publisher · Free full text

  Abstract

  Background: Quantification of asbestos fibers has been mainly performed in the lung but rarely in other organs. However, this may be relevant to understanding better translocation pathways and the oncogenic effects of asbestos on the human body. Electron microscopy is the best technology available to assess the type of fiber, dimensions, and distribution of asbestos fibers in different tissues and as a biomarker of cumulative dose.

  Objectives: This scoping review aims to summarize the findings of the studies in which asbestos fibers have been quantified by electron microscopy, occasionally associated with X-ray microanalysis, in normal and pathological tissue of ten abdominal organs.

  Methods: A scoping review has been performed by searching articles that quantified asbestos fibers in abdominal organs by electron microscopy (Scanning- SEM or Transmission- TEM).

  Results: The 12 selected studies included 204 cases, and 325 samples were analyzed. The colon and rectum, kidney, bladder, and abdominal lymph nodes were the organs with at least ten samples available with quantification of asbestos fibers. Asbestos fibers were detected in all the abdominal organs considered: the highest value (152,32 million fibers per gram of dry tissue) was found in the colon and was identified using STEM with EDS.

  Conclusion: The studies included were heterogeneous in terms of exposure and cases, type of samples, as well as analytical techniques, therefore we cannot confirm a specific pattern of distribution in any organ, based on the low homogeneity of the exposure status. The colon is the organ in which the number of fibers is the highest, probably because of exposure arising from both internal distribution of inhaled fibers and ingestion. Additional studies of the number of asbestos fibers in abdominal organs should be made to achieve better representativity.

• Recognized Occupational Diseases in Italy's Friuli-Venezia Giulia and Liguria Regions (2010-2021). F. Larese Filon, J. Granzotto, A. Bignotto, et al. 2023;114(5):e2023044. PubMed · Publisher · Free full text

  Abstract

  Background: The study of recognized occupational diseases trend is important to understand the preventive approach needed in the future, however, while numbers of occupational diseases are available on web, data on incidence are missing. The aim of our study was to analyze the trend and the incidence rate ratio (IRR) of recognized occupational diseases in Italy, in Friuli-Venezia Giulia region (FVG) and Liguria region from 2010 to 2021.

  Methods: Numbers of recognized occupational diseases by the Italian National Insurance for Occupational Diseases (INAIL) were analyzed and incidence were calculated considered the total number of workforces in the area. A Poisson regression model was used to estimate incidence trends.

  Results: FVG region presented a higher incidence of all occupational diseases compared to Italy and to Liguria in the period considered. The overall incidence in 2019 was 175, 91.8 and 108 cases for 100,000 workers, for FVG, Liguria and Italy respectively. Musculoskeletal disorders (MSDs) were the majority of occupational diseases with 100, 51 and 82.8 cases per 100,000 workers, in FVG, Liguria and Italy, respectively. Incidence of occupational cancers was 16, 10 and 4.9 cases per 100,000 workers, in FVG, Liguria and Italy, respectively. The annual change of incidence from 2010 to 2019 was positive for MSDs (IRR 1.06; 95%CI 1.06 to 1.07) and decreasing for the other causes in Italy. In FVG region the trend was positive for MSDs (IRR 1.05;95%CI 1.04 to 1.06), for respiratory diseases (IRR 1.03; 95%CI 1.00 to 1.05) and pleural plaques (IRR 1.03; 95%CI 1.00 to 1.06). In Liguria the trend was positive for MSDs (IRR 1.17; 95% CI 1.15-1.19) and for pleural plaques (IRR 1.07; 95%CI 1.03-1.12). Stable trends were found for cancers. Declining trend was shown for noise induced hearing loss and skin diseases.

  Conclusions: FVG region presented a higher incidence of recognized occupational diseases compared to Liguria region and Italian data. Results that can be explained by a higher propensity of claiming for occupational diseases in workers, mainly for MSDs disorders. For cancers and asbestos-related diseases the higher incidence can be attributable to high exposure to asbestos in FVG and Liguria workers mainly in shipyard and dock activities.

• Trends in Occupational Diseases in Italian Industry and Services From 2006 To 2019. F. Larese Filon, O. Spadola, C. Colosio, et al. 2023;114(4):e2023035. PubMed · Publisher · Free full text

  Abstract

  Background: There is a paucity of data on occupational disease incidence in Italy, and we analyzed the trend on time as an incidence rate ratio (IRR).

  Methods: Occupational diseases reported to the Italian National Insurance for Occupational Diseases (INAIL) in industrial and services sectors from 2006 to 2019 were considered and analyzed. Annual case counts were analyzed using a Poisson regression model to estimate incidence trends.

  Results: The incidence of occupational diseases in the industrial and services sectors in 2019 was 261 cases for 100,000 workers, with musculoskeletal disorders (MSDs) representing 65% of the total cases, their incidence being 169.5 cases per 100,000 workers. The incidence of ear diseases (ED) decreased to 20.8 cases for 100,000 workers. The annual change in incidence (IRR) was 1.08 (CI 95% 1.07-1.11) for MSDs, 1.08 (CI 95% 1.06-1.10) for cancers, and 1.04 (CI 95% 1.03-1.06) for respiratory diseases. The trend was significantly negative for ear diseases, 0.96 (CI 95% 0.96-0.97), and skin diseases 0.93 (CI 95% 0.92-0.93). No changes were found for asbestos and mental diseases.

  Conclusions: During the study period, occupational diseases increased in Italy, mainly for MSDs, due to a changeover in eligibility criteria from 2008. However, the overall incidence was lower than in other EU Countries. More efforts are needed to harmonize the legislation for joint action in the prevention and recognition of occupational diseases.

• A case of localized peritoneal malignant mesothelioma with ovarian metastasis and literature review. J. Wang, R. Hu, Q. He. 2022;113(4):e2022035. Case report · Review PubMed · Publisher · Free full text

  Abstract

  Peritoneal malignant mesothelioma (PMM) is a rare mesothelial cell-derived malignant tumor, which is clinically distinguished into a localized and diffuse forms, the latter being more common. The onset of PMM is insidious, so it is not easy to make a preoperative diagnosis of PMM. Clinicians must pay more attention to this disease in view of its poor prognosis. In order to improve the understanding of PMM, a case of patient with localized PMM metastasizing to the ovary is reported and discussed, along with a review of relevant literature to further explore the etiology, epidemiology, clinical manifestations, examination methods, diagnosis, treatment and prognosis of PMM.

• Computed Tomography Findings in Progressive Massive Fibrosis: Analyses of 90 Cases. G. Sarı, A. Gökçek, A. Koyuncu, et al. 2022;113(1):e2022002. PubMed · Publisher · Free full text

  Abstract

  Purpose: Radiological identification of lung masses in patients with pneumoconiosis is difficult. The aim of the study is to characterize Computed Tomography (CT) findings of Progressive Massive Fibrosis (PMF).

  Methods: The data of pneumoconiosis patients, who were diagnosed with PMF between 2014-2019 in a tertiary hospital, were collected. Demographic data, work-related data, Pulmonary Function Test results and radiological imaging results were gathered. Separate evaluations were made for the right and left lungs, and the CT findings and measurement results were recorded.

  Results: In 90% of our cases, PMF lesions were bilaterally located. Eighty-eight point five percent of the unilateral lesions were located in the upper lobe of the right lung. Enlarged lymph nodes were found in 83.3% and calcification was found in the lymph nodes in 63% of the cases. Band structures extending between the PMF lesion and the adjacent pleura were observed in 86% of the cases, and invagination in the lung parenchyma adjacent to the PMF was observed in 80% of the cases.

  Conclusion: In general, our findings were consistent with the radiologically defined PMF. In addition, pleural findings, which are not frequently studied in the literature except for asbestosis, were also described in the study.

  Methods: The data of pneumoconiosis patients, who were diagnosed with PMF between 2014-2019 in a tertiary hospital, were collected. Demographic data, work-related data, PFT results and radiological imaging results were noted. Separate evaluations were made for the right and left lungs, and the CT findings and measurement results were recorded.

  Results: In 90% of our cases, PMF lesions were bilaterally located. 88.8% of the unilateral lesions were located in the upper lobe of the right lung. Enlarged lymph nodes were found in 83.3% and calcification was found in the lymph nodes in 63% of the cases. Band structures extending between the PMF lesion and the adjacent pleura were observed in 86% of the cases, and invagination in the lung parenchyma adjacent to the PMF was observed in 80% of the cases.

  Conclusion: In general, our findings were consistent with the radiologically defined PMF. In addition, pleural findings, which are not frequently studied in the literature except asbestosis, were also described in the study.

• Identification of a new potential plasmatic biomarker panel for the diagnosis of malignant pleural mesothelioma. L. Ferrari, S. Iodice, L. Cantone, et al. 2022;113(6):e2022052. PubMed · Publisher · Free full text

  Abstract

  Background: Malignant pleural mesothelioma (MPM) is a rare highly aggressive tumor strongly associated with asbestos exposure and characterized by poor prognosis. Currently, diagnosis is based on invasive techniques, thus there is a need of identifying non-invasive biomarkers for early detection of the disease among asbestos-exposed subjects. In the present study, we measured the plasmatic concentrations of Mesothelin, Fibulin-3, and HMGB1 protein biomarkers, and of hsa-miR-30e-3p and hsa-miR-103a-3p Extracellular-Vesicles- embedded micro RNAs (EV-miRNAs). We tested the ability of these biomarkers to discriminate between MPM and PAE subjects alone and in combination.

  Methods: the study was conducted on a population of 26 patients with MPM and 54 healthy subjects with previous asbestos exposure (PAE). Mesothelin, Fibulin-3, and HMGB1 protein biomarkers were measured by the enzyme-linked immunosorbent assay (ELISA) technique; the levels of hsa-miR-30e-3p and hsa-miR-103a-3p EV-miRNAs was assessed by quantitative real-time PCR (qPCR).

  Results: the most discriminating single biomarker resulted to be Fibulin-3 (AUC 0.94 CI 95% 0.88-1.0; Sensitivity 88%; Specificity 87%). After investigating the different possible combinations, the best performance was obtained by the three protein biomarkers Mesothelin, Fibulin-3, and HMGB1 (AUC 0.99 CI 95% 0.97-1.0; Sensitivity 96%; Specificity 93%).

  Conclusions: the results obtained contribute to identifying new potential non-invasive biomarkers for the early diagnosis of MPM in high-risk asbestos-exposed subjects. Further studies are needed to validate the evidence obtained, in order to assess the reliability of the proposed biomarker panel.

• Incidence of malignant mesothelioma and asbestos exposure in the Emilia-Romagna region, Italy. L. Mangone, C. Storchi, C. Pinto, et al. 2022;113(5):e2022047. Review PubMed · Publisher · Free full text

  Abstract

  Background: The aim of this study is to describe the incidence of malignant mesothelioma (MM) and asbestos exposure in an Italian region in the period 1996-June 2021.

  Methods: The study included cases with microscopic confirmation and those with instrumental confirmation. For each case, information on sex, age, tumour site, morphology and date of diagnosis was collected, along with details of exposure to asbestos.

  Results: 3,097 cases of MM (2,233 males and 864 females) were registered: 90.8% with microscopic confirmation. A total of 2,840 cases involved the pleura (92%), 230 cases the peritoneum (7%), and a small number of cases the pericardium and testis (9 and 18, respectively). Most cases (78.0%) occurred after 65 years of age, while only 1.5% concerned individuals with age < 45 years. The standardized incidence rate for the entire period (adjusted to the 2000 Italian standard population and calculated per 100,000 person-years) was equal to 3.9 in males and 1.4 in females, and the trend showed an increase with age in both sexes. Concerning asbestos exposure, 79.7% of cases were exposed (86.7% males and 60.1% females). In 70.3%, exposure was occupational (83.4% males and 33.2% females), while 20.7% of females and 0.8% of males had familial exposure. Building construction, rolling stock manufacture/repair and metalworking were the most prevalent economic activities associated with occupational exposure.

  Conclusions: This study offers an overview of MM in an Italian region characterized by high incidence and high exposure due to its particular production activities.

• Clinical and radiological criteria for the differential diagnosis between asbestosis and idiopathic pulmonary fibrosis: Application in two cases. A. Stufano, A. Scardapane, M.P. Foschino Barbaro, et al. 2021;112(2):115-122. PubMed · Publisher · Free full text

  Abstract

  Introduction: Idiopathic pulmonary fibrosis (IPF) and asbestosis are pulmonary interstitial diseases that may present overlapping clinical aspects in the full-blown phase of the disease. For both clinical entities the gold standard for diagnosis is histological examination, but its execution poses ethical problems, especially when performed for preventive or forensic purposes.

  Objective: To evaluate the application of internationally accepted clinical, anamnestic and radiological criteria for differential diagnosis between asbestosis and IPF, and to assess the ability to discriminate between the two diseases. Even if clinically similar, the two diseases present extremely different prognostic and therapeutic perspectives.

  Methods: Two clinical cases of IPF are reported, in which the differential diagnosis was made by studying occupational exposure to asbestos, the onset and progression of clinical symptoms, and the identification of specific radiological elements by means of chest High Resolution Computed Tomography (HRCT).

  Results: The diagnosis of IPF could be made on the basis of the absence of significant exposure to asbestos, the early onset and rapid progression of dyspnea and restrictive ventilatory defects, in association with a pulmonary radiological pattern characterized by peculiar elements such as honeycombing.

  Discussion: The diagnostic procedure adopted to make a differential diagnosis with asbestosis provides practical clinical elements facilitating the differentiation between the two forms of pulmonary fibrosis, a fundamental aspect of the activity of the occupational physician.

• Methodological issues in descriptive environmental epidemiology. The example of study Sentieri. C. Ciocan, N. Franco, E. Pira, et al. 2021;112(1):15-33. Meta-analysis · Systematic review PubMed · Publisher · Free full text

  Abstract

  Background: Descriptive epidemiology identifies associations between environmental exposures and health effects that require results from methodologically stronger studies before causation can be considered.

  Objective: To critically review the methodology and results of Sentieri, a descripitive study on residence in areas with one or more industrial source of pollution.

  Methods: We systematically reviewed the literature quoted by Sentieri for the selection of health effects of nine types of pollution sources of a-priori interest. We also reviewed and meta-analyzed the results of the first report of Sentieri, that analyzed mortality in 44 polluted sites (PS), and 17 causes of deaths during 1995-2002.

  Results: Among 159 study results quoted by Sentieri, 23.9 % were supportive of an association between residence near a pollution source and a health effect, 30.2 % were partially supportive, 10.7 % were not supportive, and 35.2 % were not relevant. Among 653 standardized mortality ratios for associations between PS-specific pollution sources and causes of death, 14.4% were significantly above 1.02, and 9.0% were significantly below 0.98. Among 48 meta-analysis, seven were significantly above 1.0, including five on exposure to asbestos.

  Conclusions: Sentieri exemplifies the limitations of descriptive environmental epidemiology studies, in which most hypotheses have limited prior support, most results do not show associations, data on potential confounders and other sources of bias are not available. Such studies tend to replicate well-known associations and occasionally can identify critical situations requiring more investigation, but cannot be used to infer causality either in general or in specific circumstances.

• [Not Available]. A. Angelini, E. Chellini, D. Parducci, et al. 2020;111(2):126-132. In Italian. PubMed · Publisher · Free full text

  Abstract

  Unlabelled: «Reconstruction of the asbestos exposure in a textile company producing sewing threads through the use of an unusual information source».

  Background:: The Tuscan Regional Operating Center (ROC) of Malignant Mesotheliomas has identified a cluster of 11 cases of malignant mesothelioma occurred in a textile plant manufacturing sewing thread. Using the common research method, the ROC had not previously been able to identify the specific sources of asbestos exposure causing such a large cluster.

  Objectives:: The ROC’s objective was to review all cases of the cluster and to better identify their occupational asbestos exposures.

  Methods:: The cases’ occupational histories of asbestos exposure have been reviewed, using information deriving from the annual reports sent to the Tuscany Region since 1988 by all the asbestos removal companies according to the Law no. 257/1992, article 9, and from interviews to former employees of the plant.

  Results:: The work cycle has been reconstructed and enriched with the new information about the asbestos presence and its uses in the plant. The eleven cases were all reclassified as “certainly occupational exposed” given that the new collected information depicted a widespread asbestos pollution of the workplace during the period of employment of all cases.

  Conclusions:: Using different sources of information, in addition to those traditionally collected through questionnaires, to reconstruct past asbestos exposuresallowed us to clarify the existence of the cluster of mesothelioma cases and the highest level of occupational asbestos exposure was attributed to all cases with consequent activation of the medico-legal procedure.

• Cytological analysis of bronchoalveolar lavage fluid in asbestos-exposed workers. P. Sartorelli, S. Indini, F. Bianchi, et al. 2020;111(5):379-387. PubMed · Publisher · Free full text

  Abstract

  Background: Asbestos-related lung diseases are a group of heterogeneous disorders with different pathogenesis and prognosis. Very few studies investigated the BALF cell profile of asbestos exposed workers. The existence of a relationship between bronchoalveolar lavage fluid (BALF) cellular pattern and specific diagnosis and/or asbestos exposure biomarkers would allow the identification of effect biomarkers useful in the follow up of asbestos-exposed workers and in the diagnosis of asbestos-related diseases.

  Objectives: To assess BALF cell profile in formerly asbestos-exposed workers and its relationship with asbestos fibre (amphibole and chrysotile) and asbestos body (AB) concentrations.

  Methods: 113 male workers formerly exposed to asbestos underwent bronchoscopy with bronchoalveolar lavage and were retrospectively enrolled. 35 of them were affected by pleural plaques and 10 were affected by asbestosis. Pulmonary functional tests (PFT), BALF cellular pattern, BALF mineralogical analysis with asbestos fibres and AB counting were performed in each patient. A statistical analysis with a multivariate linear regression model was adopted.

  Results: From the statistical analysis of data a direct correlation between pack-years and BALF macrophages was found. Inversely correlation between pack-years and BALF lymphocytes was detected. There was not relationship among BALF cellular pattern, PFT values, specific diagnosis, BALF AB count or BALF asbestos fibre concentration.

  Discussion: BALF cellular pattern does not seem to be related to asbestos exposure biomarkers like AB and asbestos fibre concentration in BALF. Instead, smoke habit can induce an increase in BALF macrophages and a decrease of BALF lymphocytes count.

• Imaging and imagination in the diagnostics of asbestosis. S.M. Candura, I. Marradi. 2020;111(5):411-412. PubMed · Publisher · Free full text

  Abstract

  Two cases of asbestosis diagnosed on the basis of anamnestic, clinical, and instrumental criteria, were not confirmed by forensic autopsy ordered by the public prosecutor to ascertain the cause of death. The two cases demonstrate that a suggestive working history can be misleading, in the absence of clear radiological signs and histopathological findings, and that asbestosis must be diagnosed following the criteria consolidated in the scientific literature, as any diagnostic errors can have serious legal consequences.

2010s

• [Not Available]. E. Chellini, G. Lippi, G. Festa, et al. 2019;110(1):46-55. In Italian. PubMed · Publisher · Free full text

  Abstract

  Unlabelled: «Identification of workers with past asbestos exposure in Tuscany eligible to health surveillance programme».

  Background:: In 2016 the Administration of the Tuscany Region, Italy, established a health surveillance programme for workers with past asbestos exposure. The programme includes two levels of activities, a local basic health evaluation, and a centralized in-depth evaluation of specific cases.

  Objectives:: To estimate the number and identify the workers with past exposure to asbestos in Tuscan industrial settings entitled to participate in the health surveillance programme.

  Methods:: The number of formerly-exposed workers was estimated from the records of the working population of 15,441 workers of thirteen Tuscan asbestos industrial plants and from the existing data bases of the Local Health Administrations (USLs) and the Institute for Study, Prevention and Cancer Network (ISPRO), and from national data bases such as Social Security Administration (INPS) and National Institute for Insurance against Accidents at Work (INAIL). The expected number of medical examinations per year was estimated from the adhesion rates seen in previous comparable programmes.

  Results:: The estimated number of workers with past asbestos exposure eligible to the programme was 5,446. The estimated number of health examinations in the first and second phases of the surveillance programme during 2016-24 was 7,275 and 7,155, respectively, follow-up examinations included. The number of workers identified from local data bases was 4,713: They had been operating in 129 plants that had been using asbestos in the past. Further 1,395 workers were identified from previous health surveillance activities.

  Conclusions:: The use of several sources of information and the cooperation between occupational health services made it possible to identify a high proportion of former asbestos workers and plants., It is, nevertheless, still necessary to complete the list of eligible workers, and to facilitate their participation by making the programme more widely known.

• [Not Available]. M. Erba, S. Cantoni. 2019;110(3):202-214. In Italian. PubMed · Publisher · Free full text

  Abstract

  Unlabelled: «Asbestos in fresh water fish of a pond in Milan. Where is it coming from?».

  Introduction:: Cement-based material containing asbestos was found in the water of a pond in the city of Milan, Italy, where recreational fishing activities take place. Some fishes are in ‘no-kill’ fishing areas, others are caught and consumed.

  Objective:: To verify the presence of asbestos in water, sediments and some fish species living in the pond. To verify the presence of asbestos in fish feed and to test fish exposure by ingestion.

  Methods:: Samples of water, sediments, fish feed and fish species have been collected and the presence of asbestos fibers has been ascertained in the different matrices.

  Results:: No traces of asbestos were found in water. Instead, the asbestos content in sediments was beyond regulatory limits. Asbestos was detected also in benthic fish species, and in rainbow trout (Oncorhynchus mykiss) that does not reproduce in the pond but must be restocked periodically through aquaculture. In the meat of the grass carp (Ctenopharyngodon idella) 36,000,000 fibers/100 g of wet cloth have been found. Values up to 15,000,000 ff/100 g of wet cloth have been detected in the rainbow trout. Asbestos has also been found in animal feeds, in particular crocidolite fibers and asbestos tremolite bundles.

  Conclusions:: Benthic fish species have likely been contaminated by their close contact with the polluted bottom of the pond. Instead, the presence of asbestos in the trout is probably linked to a previous contamination during farming, since this fish spend a brief period of time in the water of the pond. Asbestos distribution and concentration exclude a risk for public health; however, some values of asbestos found in fish meat deserve attention. Accordingly, precautionary indications have been given to the Municipality of Milan and to the fishermen association. A larger scale monitoring of water, food and animal feed is worth performing to better assess exposure by ingestion.

• Position Paper on Asbestos of the Italian Society of Occupational Medicine. P. Apostoli, P. Boffetta, M. Bovenzi, et al. 2019;110(6):459-485. Consensus statement PubMed · Publisher · Free full text

  Abstract

  The Position Paper (PP) on asbestos of the Italian Society of Occupational Medicine (SIML) aims at providing a tool to the occupational physician to address current diagnostic criteria and results of epidemiological studies, and their consequences in terms of preventive and evaluation actions for insurance, compensation and litigation. The PP was based on an extensive review of the scientific literature and was compiled by a Working Group comprising researchers who have contributed to the international literature on asbestos-related diseases, as well as occupational physicians with extensive experience in the evaluation of risks and the medical surveillance of workers currently and formerly exposed to asbestos. The PP was drafted and reviewed between 2017 and 2018; its final version was prepared according to the guidelines of AGREE Reporting Checklist. All the members of the Working Group subscribed to the document, which was eventually approved by SIML's Executive Committee. The first section addresses industrial hygiene issues, such as methods for environmental monitoring, advantages and limitations of different microscopy techniques, the potential role of microfibers and approaches for retrospective assessment of exposure, in particular in epidemiological studies. The second section reviews the biological effects of asbestos with particular attention to the diagnostic aspects of asbestosis, pleural changes, mesothelioma and lung cancer. In the following section the criteria of causal attribution are discussed, together with different hypotheses on the form of the risk functions, with a comparison of the opinions prevalent in the literature. In particular, the models of the risk function for mesothelioma were examined, in the light of the hypothesis of an acceleration or anticipation of the events in relation to the dose. The last section discusses topics of immediate relevance for the occupational physician, such as health surveillance of former exposed and of workers currently exposed in remediation activities.

• Relationship between pleural plaques and biomarkers of cumulative asbestos dose. A necropsy study. P.G. Barbieri, D. Consonni, A. Somigliana. 2019;110(5):353-362. PubMed · Publisher · Free full text

  Abstract

  Background: The relationship between pleural plaques and cumulative asbestos exposure is controversial.

  Objectives: To evaluate the relationship between lung asbestos bodies (AB) and fibres (AF) and plaques presence and extension.

  Methods: In a necropsy series of shipyard workers with asbestos-related diseases, we measured counts (per g of dry lung tissue) of AB (thousands) and AF>1 µm (millions). Pleural plaques were classified into three extension grades. We fitted univariate and multivariable linear (dependent variables: AB and AF, log10 transformed) and multinomial (dependent variable: plaques grade) regression models.

  Results: We analysed 124 subjects, 13 without plaques 20 with grade 1, 69 with grade 2, and 22 with grade 3 plaques. Geometric means (GM) of AB were 10.6, 23.3, 126, and 140 in the four groups respectively (P=0.0001). GMs for AF (mostly amphiboles) were 1.2, 1.4, 7.3, and 12.9 (P=0.0001). AB and AF were strongly correlated (r=0.81). The likelihood of no plaques and grade 1 plaques decreased with increasing AB and AF doses, with a corresponding increase of grade 2 and 3 plaques. Plaque presence and extension was also associated with histologically verified asbestosis (P<0.001).

  Conclusions: Our study showed a strong positive relationship between pleural plaque presence and extension and both lung asbestos burden and asbestosis.

• [Not Available]. D. Consonni, A. Pesatori. 2018;109(6):481-483. In Italian. PubMed · Publisher · Free full text

  Abstract

  «Early lung cancer diagnosis among workers exposed to carcinogens». Following the publication of results of NLST (National Lung Screening Trial, USA) and ELCAP (Early Lung Cancer Action Project, USA), lung cancer screening with low-dose computed tomography (LDCT) in high-risk subjects has been recommended in North-America. Conversely, the European Community has been waiting for further evidence. The recently concluded Dutch-Belgian Lung Cancer Screening trial (NELSON) confirmed the efficacy of LDCT screening in reducing lung cancer mortality. Two recent studies in the USA and Italy showed positive results in occupational settings among workers formerly exposed to asbestos. The available evidence seems to suggest the need to implement lung cancer screening programs among heavy smokers and workers substantively exposed to occupational carcinogens also in Europe, following common, standardized procedures, as indicated in a recent European position statement.

• Mortality in a cohort of asbestos-exposed workers undergoing health surveillance. F. Barbiero, T. Zanin, F.E. Pisa, et al. 2018;109(2):83-86. PubMed · Publisher · Free full text

  Abstract

  Background: The coastal area of Friuli Venezia Giulia (FVG) region, north-eastern Italy, was characterized by work activities in which asbestos was used until the early 1990s, particularly in shipbuilding. A public health surveillance program (PHSP) for asbestos-exposed workers was established, although limited evidence exists about the efficacy of such programs in reducing disease occurrence and mortality.

  Objectives: To compare mortality in a cohort of 2,488 men occupationally exposed to asbestos, enrolled in a PHSP in FVG between the early 1990s and 2008, with that of the general population of FVG and Italy.

  Methods: Standardized Mortality Ratios (SMR), with 95% Confidence Interval (95% CI), for all causes, all cancers, lung (LC) and pleural cancer (PC) were estimated in the cohort and in subgroups of workers with the first hire in shipbuilding that caused asbestos exposure (<1974, 1974-1984, 1985-1994).

  Results: A strong excess in mortality for PC with reference to FVG (SMR=6.87, 95% CI 4.45-10.17) and Italian population (SMR=13.95, 95% CI 9.02-20.64) was observed. For LC, the FVG-based SMR was 1.49 (95% CI 1.17-1.89) and the Italy-based 1.43 (95% CI 1.12-1.81). Mortality among workers with the first hire in shipbuilding before 1974 was high for PC (FVG-based SMR=8.98, 95% CI 5.56-13.75; Italy-based SMR=18.41, 95% CI 11.40-28.17) and for LC (FVG-based SMR =1.60, 95% CI 1.18-2.11; Italy-based SMR=1.54, 95% CI 1.14-2.03). Further, for LC between 1974 and 1984, the FVG-based SMR was 2.45 (95% CI 1.06-4.82), and the Italy-based SMR was 2.33 (95% CI 1.01-4.60).

  Conclusions: This cohort experienced an excess mortality for pleural and lung cancer, compared with regional and national populations. For lung cancer, the excess was stronger in workers with the first hire in shipbuilding before 1985, suggesting a key role of asbestos exposure.

• Economic impact of malignant mesothelioma in Italy: an estimate of the public and social costs. G. Buresti, F. Colonna, M. Corfiati, et al. 2017;108(5):358-66. PubMed · Publisher

  Abstract

  Background: Despite their considerable interest for public health policies and for occupational disease management and assessment, the economic costs of asbestos-related diseases (ARDs) for society have not been fully estimated or even frequently discussed.

  Objectives: The aim of this study was to estimate the economic burden of mesothelioma in Italy by assessing the overall societal cost of the disease, applying an econometric model.

  Methods: We analyzed two main cost groups, public and social. The first includes expenditure borne by the State and other public bodies (medical care costs, insurance, tax and benefits), while the latter uses the human capital approach to measure the loss of productivity suffered by the economy as a whole.

  Results: We provide an estimate of euro 33,000 per patient for medical care costs and euro 25,000 for insurance and compensation; tax and benefits seem to roughly compensate. We estimated a loss of more than euro 200,000 per patient, in terms of loss of production.

  Conclusions: This study offers a practical approach for estimating the economic impact of mesothelioma, and provides empirical evidence of the huge economic burden linked to this disease, with its high etiologic fraction.

• The effects of improving the mesothelioma surveillance network on sensitivity, timeliness in reporting and asbestos exposure assessment. L. Mangone, E. Di Felice, C. Storchi, et al. 2017;108(5):367-76. PubMed · Publisher

  Abstract

  Background: In Italy, Mesothelioma Registries (MRs) have been established by law for the epidemiological surveillance of occupational cancers. MRs collect information about asbestos exposure of incident cases, through interviews. In the Emilia-Romagna region, MR was implemented in 1996 and extended its network of health professionals who report suspected mesothelioma in 2001 and 2007.

  Objectives: This study evaluated the impact of the extension of the network on MR sensitivity and timeliness.

  Methods: Mesothelioma cases were analysed in three subsequent periods: 1996-2001 (before any network extension), 2002-2007 (after first extension) and 2008-2014 (after second extension). Sensitivity was evaluated by the proportion of cases directly reported by the network out of the total number of incident cases; reporting and interview timeliness were assessed by median times between diagnosis and, respectively, reporting and interview. Pleural mesothelioma reporting timeliness was also evaluated by use of quantile regression models, stratified by diagnostic certainty and adjusted by sex and age.

  Results: Sensitivity increased from 79.4% (1996-2001), to 89.0% (2002-2007) and to 91.4% (2008-2013). For mesothelioma with diagnostic certainty, we recorded considerably reduced reporting times from the 50th percentile on, whereas for uncertain mesothelioma relevant reductions were observed also in the lower percentiles. A reduced time to interview was observed too, which was more significant for uncertain cases. The proportion of patients directly interviewed increased from 33.5% (1996-2001), to 39.1% (2002-2007), to 49.5% (2008-2014).

  Conclusions: The extended network improved the MR sensitivity and allowed shorter reporting and interview times and more frequent patient interviews, thus improving accuracy of exposure definition.

• Geographical patterns of mesothelioma incidence and asbestos exposure in Lombardy, Italy. C. Mensi, S. De Matteis, D. Catelan, et al. 2016;107(5):340-355. PubMed

  Abstract

  Background: Measuring malignant mesothelioma (MM) occurrence is a useful means to monitor the impact of past asbestos exposure and possibly identify new sources of asbestos exposure.

  Objectives: Aim of this study is to describe the results of the MM registry of the Lombardy Region, North-West Italy, the most populated (currently, 10 million inhabitants) and industrialised Italian region.

  Methods: We extracted from the Lombardy Region Mesothelioma Registry (Registro Mesoteliomi Lombardia, RML) database all incident cases of MM (pleura, peritoneum, pericardium, and tunica vaginalis testis) with first diagnosis in 2000 through 2012. For each Province, we calculated crude and standardised incidence rates using Italy 2001, European, and world (Segi's) standard populations. To examine spatial patterns of MM occurrence across municipalities we drew maps of crude rates smoothed according to the Besag, York and Mollié (BYM) method.

  Results: We recorded 4442 MM cases (2850 in men and 1592 in women), representing about one fourth of MM cases occurring in Italy. Occupational exposure was more frequent in men (73.6%) than in women (38.2%). The crude regional rates were 4.7 per 100,000 person-years in men and 2.5 per 100,000 person-years in women. The highest rates were observed in the Pavia Province (crude rates: 8.7 per 100,000 in men and 5.3 and per 100,000 person-years in women).

  Conclusions: This study documented high MM occurrence in both genders, attributable to extensive asbestos exposure in the past.

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