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D Consonni

Publications and source records attributed to D Consonni.

36 records · Page 2Linked to original sources
PubMed1993

Cancer in a young population in a dioxin-contaminated area.

An industrial accident in Seveso, Italy, in 1976, caused contamination of the residential community with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). We investigated cancer occurrence in the first post-accident decade (1977-1986) among nearly 20,000 subjects aged 0-19 years. People who left the area were actively followed with a 99% follow-up rate. For reported cancer cases confirmation was obtained through consultation with original medical records. Two ovarian cancers were observed versus none expected. A suggestive increase was seen for Hodgkin's lymphoma (relative risk [RR] = 2.0; 95% confidence interval [CI] = 0.5-7.6). Myeloid leukaemia showed a clear, but not statistically significant increase (RR = 2.7; 95% CI = 0.7-11.4). The most prominent result concerned thyroid cancer, not just for the magnitude of the increase (two cases, RR = 4.6; 95% CI = 0.6-32.7), but also for its consistency with experimental findings and previous observations in humans. Any conclusive interpretation would be premature because of the short time since initial exposure, ecological definition of exposure status, and limited number of events.

Adolescent↗
PubMed1993

Cancer incidence in a population accidentally exposed to 2,3,7,8-tetrachlorodibenzo-para-dioxin.

In 1976, an accident in a plant near Seveso, Italy, exposed the local population to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Persons residing in three zones of decreasing TCDD contamination (A, B, and R) and a reference population were followed up for cancer occurrence in 1977-1986. The most exposed subgroup (A) was small, and only 14 cancer cases were observed. In zone B, hepatobiliary cancer was elevated, especially for those living in the area for > 5 years [relative risk (RR) = 2.8; 95% confidence interval (CI) = 1.2-6.3]. Men exhibited an increase in hematologic neoplasms, most notably lymphoreticulosarcoma (RR = 5.7; 95% CI = 1.7-19.0). Women experienced an increased incidence of multiple myeloma (RR = 5.3; 95% CI = 1.2-22.6) and myeloid leukemia (RR = 3.7; 95% CI = 0.9-15.7). In zone R, the incidence of soft tissue tumors and non-Hodgkin's lymphomas was elevated, particularly among persons living in the area for > 5 years (RR = 3.5; 95% CI = 1.2-10.4 for sarcomas, and RR = 2.0; 95% CI = 1.2-3.6 for non-Hodgkin's lymphomas). Breast cancer among females was below expectations in the most contaminated zones, and a clear deficit for endometrial cancer was observed in zones B and R.

Adult↗
PubMed1992

Mortality of a young population after accidental exposure to 2,3,7,8-tetrachlorodibenzodioxin.

The mortality experience of 19,637 people aged 1-19 years living in an area around Seveso, Italy, contaminated by 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) after an accidental explosion in a chemical plant was examined for the period 1976-1986. For comparison, the mortality of the population of nearly 100,000 people living in the surrounding districts was examined. People who left the study area were followed up. Vital status ascertainment was successful in over 99% of the cases. A group of 186 children who contracted chloracne, a reversible marker of TCDD intoxication, shortly after the accident were in the study: none of them died during the observation period. Among the exposed, mortality owing to all causes, to all accidents and to all cancers failed to show major departure from expectations. Five leukaemia deaths were observed, four among males and one among females; the corresponding relative risks were 2.1 (95% confidence interval (CI): 0.7-6.9), and 2.5 (95% CI: 0.2-27.0), respectively. Two lymphatic leukaemias among males yielded a RR = 9.6 (95% CI: 0.9-106.0). Mortality owing to congenital anomalies showed a nearly twofold increase in the contaminated area; however, five out of seven observed cases were born before the accident. Interpretation is limited by the small number of deaths, short latency period and low validity of death certificate information for certain causes, and by the definition of exposure which was based merely on residence. The follow-up is continuing. A cancer morbidity study is in progress.

Adolescent↗
PubMedDate not supplied

[IARC multicenter study on neoplastic disease caused by man-made vitreous mineral fibers (MMVF)].

Man-made vitreous fibres (MMVF) showed carcinogenic potential in experimental animals. Epidemiological data suggested an increased mortality from lung cancer among production workers, but the interpretation is still a matter of controversy. A European study encompassing 13 plants in 7 countries pointed towards a moderate excess of lung cancer among workers employed longer than 1 year in the production of rock/slag wool (SMR = 1.34, 95% CI = 1.08-1.63) and glass wool (SMR = 1.27, 95% CI = 1.07-1.50); the latter increase was not confirmed after applying local rates to calculate expected deaths. The elevated risk among rock/slag wool producers was present even in comparison with local rates, and was associated with increasing time from first exposure, and duration of exposure. Glass wool results exhibited a less definite pattern. Smoking was excluded, although indirectly, as a sufficient alternative explanation of the increased lung cancer risk. In a few plants, exposure to asbestos had occurred in limited periods for some workers, and might have contributed to the findings. Case-control studies are under way to thoroughly investigate the relative and possibly combined role of the different exposures, either occupational or not. Cohort studies in the USA produced results closely consistent with those of the European study.

Ceramics↗
PubMedDate not supplied

[The application of a synthetic index of exposure in the manual lifting of patients: the initial validation experiences].

Via a multicentre study coordinated by the EPM research group carried out in 216 wards in a total of 56 hospitals, old peoples homes and geriatric departments, it was possible to quantify exposure to patient handling (classified in 4 classes: 0-1.5 negligible, 1.51-5 slight to average, 5.01-10 average to high, > 10 elevated), and at the same time identify the damage to the lumbosacral spine thus caused. Both assessment of exposure and identification of health impairment were carried out using homogeneous methods. Subjects with work seniority in the job of less than 6 months and subjects who had been transferred because of back trouble were excluded from the study. It was therefore possible to carry out two types of study to assess the association between exposure and impairment. In study A, covering 3021 subjects, an analysis was performed of the association between exposure index, positive response to the anamnestic threshold for lumbosacral disorders and acute low back pain using the method of logistic analysis to obtain the prevalence odds ratios. In study B, covering 418 subjects, the analysis of association was performed on the incidence rates of episodes of acute low back pain and pharmacologically controlled acute low back pain, assuming that exposure in the wards had remained constant. The technique used was Poisson regression, thereby calculating the relative incidence rate ratios. Both for PORs and IRRs the reference group consisted of the exposure class judged as negligible (exposure index 0-1.5). The results showed that the PORs calculated for positive lumbar threshold were significant for increasing exposure classes with a positive trend for the second and third exposure class but not for the last, presumably due to a healthy worker selection effect. Neither in Study A nor in Study B were any associations observed between exposure and acute low back pain occurring in the previous 12 months: this may be due to the fact that the impairment indicator does not appear to be appropriate in terms of latency period. A different result was obtained in Study B which showed a good association between exposure and incidence rates of episodes of acute low back pain and pharmacologically controlled acute low back pain according to department. The IRRs showed a positive trend both for acute episodes (IRR: 1.932, 2.439, 2.847) and for acute plus pharmacologically controlled acute episodes (1.798, 1.830, 4.523). On the basis of these results, even with the caution required for the reasons explained in the text, it seems to be possible to identify three grades of exposure which correspond to increasing probability of impairment of the lumbosacral region of the spine: the first where risk seems negligible corresponds to an exposure level between 0 and 1.5. The second, where the episodes of low back pain may occur with an incidence 3.8 times greater, corresponds to an exposure level between 1.51 and 5, and the third corresponds to exposure levels exceeding 5, where the episodes of low back pain may occur with an incidence up to 5.6 times greater than expected.

Acute Disease↗
PubMedDate not supplied

[Occupational epidemiology and new challenges in occupational medicine].

Epidemiology has greatly contributed in the past to the recognition of work-related ill health. Working life, work organisation and labour markets are now rapidly changing. Does epidemiology still have a relevant role in this evolving context? New exposures at the workplace and related health and behavioural changes currently prevailing in industrialized countries are reviewed. It appears that epidemiology might in the future play an even greater role than in the past, when the mere observation of a few subjects could sometimes lead to the identification of occupation-related risks. In order to examine the relations between complex and low-level exposures and subtle and long-term risks in working populations, epidemiology appears essential. Controlled, longitudinal population studies are especially needed to clarify, for prevention purposes, the meaning and the predictive role of the increasing number of markers of exposure, of effect and of individual susceptibility; to describe and model in quantitative terms exposure-response relations; to assist with risk assessment and evaluation. Although occupational health research has a long tradition of inter-disciplinary co-operation, this remains a major challenge for the future.

Animals↗
PubMedDate not supplied

[Neuropathies caused by vibrating instruments: clinico-diagnostic study of a group of symptomatic subjects].

In order to evaluate the risk connected with hand-arm vibration exposure and associated disorders of the peripheral nervous system a study was made to assess the relationship between nervous symptoms and laboratory data to determine the kind of disorder. 40 male subjects with hand-arm vibration exposure for more than 5 years and nervous symptoms of the hands for more than 1 year and 2 control groups of non-symptomatic non-exposed subjects were considered. An electroneurophysiological study of the exposed subjects revealed 18 nerve conduction speed changes (12 median nerve, 4 ulnar nerve, 2 median and ulnar nerve), most of which were sensitivity-motor changes; only 9 Carpal Tunnel Syndromes were diagnosed. Some statistically significant differences between exposed subjects with negative results of the electroneurophysiological study and non-exposed subjects were observed. Prolonged vibration exposure seems to induce a hand-arm nerve suffering, initially with a progressive nerve conduction speed change and non-specific symptoms, but subsequently a peripheral nervous system disorder associated or not to a Carpal Tunnel Syndrome may occur.

Humans↗
PubMedDate not supplied

[Occupational epidemiology: from analysis of the apparent to investigation of the unknown].

This paper, as a contribution for the centenary celebration of the establishment of the "Clinica del Lavoro Luigi Devoto" in Milan (Italy), presents a brief 30 year history of the activities of its Department of Occupational Epidemiology. Studies and methodological contributions that characterized the first decade of activity are presented and grouped under the heading of analysis of known health effects. The second decade was dominated by the studies and activities that originated from the Seveso accident (dioxin), with an initial interest towards molecular epidemiology, which became increasingly relevant during the third decade when we addressed topics like melanoma, lung cancer, and benzene, in addition to dioxin. More traditional occupational approaches were not dismissed and cohort mortality studies are currently under way (textile dyeing and finishing industry, sulfuric acid, tetrafluoroethylene). Pros and cons of the epidemiologic approach are discussed in the context of occupational health and the strength of its methodological apparatus is suggested as a fundamental tool for studying adverse occupational health effects. In contrast, it is stressed how occupational epidemiology has been poorly used in the application of law 626/94. Considering that contemporary epidemiology is much more inclined towards the discovery of new work-related risks (electromagnetic fields, air pollution) than the description of known health effects, the paper suggests that occupational epidemiology enlarge its interests: people and environment outside the factories might be good candidates for study.

Ambulatory Care Facilities↗
PubMedDate not supplied

[European multicenter cross-sectional study on exposure to low doses of benzene].

A cross-sectional multicenter european study has been carried out to evacuate the relations between exposure to low level of benzene and biological markers of internal dose (t,t-MA, S-PMA) and early biological effect (DNA-SSB). The research has shown significantly increased levels (adjusted for smoking habits) of the urinary excretion of t,t-MA, S-PMA and DNA-SSB in petrochemical workers (mean benzene level = 5,694 micrograms/m3) but not in filling station attendants, traffic police officers, and bus drivers compared to referent workers. Dose-response relations were detected between benzene air levels, t,t-MA, S-PMA and DNA-SSB in petrochemical workers, with significantly increased levels of DNA-SSB detected for benzene exposure levels in the range 391-1,800 micrograms/m3 (0.12-0.58 ppm).

Benzene↗
PubMedDate not supplied

[The role of biological monitoring in health and epidemiological surveillance: the epidemiological approach].

A fundamental pre-requisite for the realization of biological monitoring programs for health surveillance is the availability of sufficiently accurate tests and adequate knowledge of the relationship between biomarkers and health effects. In this respect, epidemiology plays an essential role: in conjunction with other disciplines (industrial hygiene, toxicology, occupational medicine), it provides a conceptual and methodological framework for many biological monitoring activities. Compared to biomarkers of dose and effect, susceptibility markers (for example, metabolic polymorphisms), for which we have seen an explosion of research in recent years, need a specific consideration in that they pose (or may pose in a non-remote future) special problems. For different reasons, the use of genetic tests for predictive aims at the individual level should now be avoided; their use should be restricted to the research field for a better understanding of etiopathogenetic mechanisms.

Biomarkers↗
PubMedDate not supplied

[DNA methylation analysis in environmental and occupational cancer research].

The present paper reviews recent laboratory methods and experimental evidence concerning epigenetic biomarkers involved in carcinogenesis mechanisms. We introduce DNA methylation and its role in gene expression control. DNA methylation analysis may allow to identify early changes leading to cancer and other chronic diseases. We describe here strategies for laboratory analyses and their possible applications. We examine results from recent experimental studies suggesting that the effects of certain occupational agents are mediated by alterations in DNA methylation. Planning and conducting investigations on exposed human subjects will allow to verify whether DNA methylation changes identified in animal and in-vitro studies may be used as early-effect and susceptibility biomarkers. DNA methylation analysis has the potential for future applications in risk assessment and prevention programs conducted on subjects exposed to human carcinogens.

Animals↗
PubMedDate not supplied

[Urinary MTBE as biological marker of exposure to traffic exhaust fumes].

Methyl tert-butyl ether (MTBE) is an oxygenated compound added to Italian fuel in quantity of about 3% v/v. In the present study the excretion of urinary MTBE (U-MTBE) was evaluated as biomarker of exposure to traffic exhaust fumes. With this aim 127 Milan urban policemen, working as traffic wardens, were investigated. Spot urine samples were obtained prior to and at the end of the work shift, in different seasons. Median U-MTBE varied from 74 to 164 ng/L (range 60-657 ng/L). Comparing the pre-shift and end-shift samples an increase of about 14% in the U-MTBE level during the workshift was observed. An influence of the different seasons was observed, with lower values in spring and higher values in winter. Smoking did not affect the excretion of U-MTBE. The results of this study suggest that U-MTBE is a sensitive and specific marker for the assessment of exposure to traffic exhaust fumes.

Adult↗
PubMedDate not supplied

[Questionnaire for the mobbing risk: CDL2.0].

The aim of the study is to develop and validate a questionnaire able to evaluate the risk of mobbing at the workplace. A multiple-choice questionnaire has been developed which contains, among the different items, only one revealing a mobbing situation. The questionnaire has been administered to two groups (group A--243 subjects in a mobbing situation and group B--63 subjects without exposure to mobbing) and the differences in the scores obtained have been analysed. The questionnaire has proved to be valid and reliable. The results show that the presence of five mobbing actions is sufficient to define the workplace situation as potentially at risk for mobbing. The study reveals some limits in the selection of the two samples thus needing some adjustment. However, the questionnaire, also in the present form, can be considered a tool able to detect the mobbing situations.

Adult↗
PubMedDate not supplied

[Mortality study in a cohort of workers employed in a plant producing sulphuric acid ].

BACKGROUND: In 1992, the International Agency for Research on Cancer (IARC) classified sulphuric acid mists as human carcinogen, based primarily on human data showing increased risk for larynx cancer. Uncertainties still exist about other respiratory cancers. OBJECTIVES: We carried out a historical mortality study among workers ofa plant producing sulphuric acid in Tuscany, Italy. METHODS: We reconstructed a cohort of 1372 male and 37female workers with at least one year of employment at the plant in the period 1962-97; 46% ofthe workers had previously been working in pyrite mines in the area where rocks have a high silica content. Environmental measurements of sulphuric acid and sulphur dioxide from the 1970's were generally below the TLVs. Mortality was investigated as of August 2000; Standardized Mortality Ratios (SMR) were calculated using Tuscany reference rates. RESULTS: Overall mortality was below expectation (SMR 77). In labourers, larynx cancer deaths were 4 vs 3.1 expected (SMR 130, 95% CI 35-333), while mortality from lung cancer was below expectation (27/32.8, SMR 82, 95% CI 54-120). An excess of myeloid leukaemia was observed mainly in workers without previous experience in mines (3/0.6, SMR 523, 95% CI 108-1527). Mortality from silicosis, but not from lung cancer, was remarkably high among workers with previous employment in mines. CONCLUSIONS: Among workers employed in sulphuric acid production, with or without previous experience in mines, we did not observe increased mortality from larynx or lung cancer. The increased mortality from myeloid leukaemia cannot be attributed to any of the exposures documented in the study plant and requires further investigation.

Air Pollutants, Occupational↗
PubMedDate not supplied

[Carcinogenic risk for resin producers exposed to formaldehyde: extension of follow-up].

A significant increase in lung cancer was observed in a previous study on the mortality experience of a cohort of 1332 male workers employed between 1959 and 1980 in a resin manufacturing plant. Due to the limited exposure and an inadequate follow-up, it was not possible to make a thorough analysis of the potential association of this elevated risk with exposure to formaldehyde. The study was therefore continued and extended for a further six years (1980-1986), in order to overcome the limitations. Despite these attempts, however, there were still 219 workers whose specific exposure could not be identified. Lung cancer risk in the whole cohort (27,202 person-years) was equal to that of the local population (observed = 24; expected = 23.9). Among those definitely exposed to formaldehyde, 6 lung cancer cases were observed and 8.7 were expected, while those with non-specified exposure exhibited an increase risk (observed = 9; SMR = 211); they were mainly short-term workers employed at the beginning of operations. The previously suggested increase in haematologic neoplasms was confirmed (observed = 7; SMR = 143); the risk was highest among formaldehyde-exposed workers (observed = 3; SMR = 173). Five deaths due to primary liver cancer were observed, while 2.0 would have been expected from the local population rates (SMR = 244); the increased risk was fairly evenly distributed across the exposure categories (exposed to formaldehyde, SMR = 244; non-exposed to formaldehyde, SMR = 227; non-specified exposure = 287); however, all cases were first exposed at the age of 45 years or older. A noteworthy finding was a 50% increase in mortality from respiratory diseases. The increase was mainly apparent among those with longest and earliest exposure, employed in operations classified as involving exposures other than formaldehyde (observed = 9; SMR = 224). Overall, the results of this extended study do not provide sufficient grounds for associating work in formaldehyde resin production in this plant with increased carcinogenic risk; however, limitations in the individual exposure classification and suggestions of an increased risk for certain tumours preclude considering the study as negative. The numerous airborne irritative agents present in the plant environment appeared to have increased the risk of respiratory disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Mortality rate and its statistical properties].

The rate is an epidemiologic measure which has a widespread use in describing the occurrence of diseases. In this paper, with a didactic approach, the definition of the mortality (morbidity) rate is introduced following two ways of reasoning: firstly, in the context of survival analysis, as an instantaneous conditional probability of failure (either disease or death) (instantaneous risk) and, secondly, as a traditional measure of rapidity of change in time. We then proceed to highlight the differences, in terms of definition, interpretation, and application, between the concepts of rate and risk. As a next step the statistical properties of the rate are explored and it is explained why the variability of the measure is simply associated with the numerator (events) and not with the denominator (person-times) of the rate. In this context the Poisson distribution is commonly considered the probability distribution which better describes the statistical variability of the observed events, and examples of such a distribution are presented. When the number of deaths is sufficiently elevated the Poisson distribution can be adequately approximated by the Gauss distribution, which is simpler and in common use in occupational medicine, and formulas are presented to compute mean and variance of the rate in this situation. When the number of deaths is small a suggestion is made of making a log transformation of the rate (or of the deaths) before using the Gauss distribution: formulas are proposed for this situation, too. As a practical application of the statistical properties presented and as a concluding example, a confidence interval for the rate is computed. Numerical and graphical comparisons of the results deriving from the use of different formulas are described.

Confidence Intervals↗