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Biomedical subjects

D Mirabelli

Publications and source records attributed to D Mirabelli.

17 recordsLinked to original sources
PubMed2001

Increased risk of malignant mesothelioma of the pleura after residential or domestic exposure to asbestos: a case-control study in Casale Monferrato, Italy.

The association of malignant mesothelioma (MM) and nonoccupational asbestos exposure is currently debated. Our study investigates environmental and domestic asbestos exposure in the city where the largest Italian asbestos cement (AC) factory was located. This population-based case-control study included pleural MM (histologically diagnosed) incidents in the area in 1987-1993, matched by age and sex to two controls (four if younger than 60). Diagnoses were confirmed by a panel of five pathologists. We interviewed 102 cases and 273 controls in 1993-1995, out of 116 and 330 eligible subjects. Information was checked and completed on the basis of factory and Town Office files. We adjusted analyses for occupational exposure in the AC industry. In the town there were no other relevant industrial sources of asbestos exposure. Twenty-three cases and 20 controls lived with an AC worker [odds ratio (OR) = 4.5; 95% confidence interval (CI), 1.8-11.1)]. The risk was higher for the offspring of AC workers (OR = 7.4; 95% CI, 1.9-28.1). Subjects attending grammar school in Casale also showed an increased risk (OR = 3.3; 95% CI, 1.4-7.7). Living in Casale was associated with a very high risk (after selecting out AC workers: OR = 20.6; 95% CI, 6.2-68.6), with spatial trend with increasing distance from the AC factory. The present work confirms the association of environmental asbestos exposure and pleural MM, controlling for other sources of asbestos exposure, and suggests that environmental exposure caused a greater risk than domestic exposure.

Aged↗
PubMed2000

Multicentric study on malignant pleural mesothelioma and non-occupational exposure to asbestos.

Insufficient evidence exists on the risk of pleural mesothelioma from non-occupational exposure to asbestos. A population-based case-control study was carried out in six areas from Italy, Spain and Switzerland. Information was collected for 215 new histologically confirmed cases and 448 controls. A panel of industrial hygienists assessed asbestos exposure separately for occupational, domestic and environmental sources. Classification of domestic and environmental exposure was based on a complete residential history, presence and use of asbestos at home, asbestos industrial activities in the surrounding area, and their distance from the dwelling. In 53 cases and 232 controls without evidence of occupational exposure to asbestos, moderate or high probability of domestic exposure was associated with an increased risk adjusted by age and sex: odds ratio (OR) 4.81, 95% confidence interval (CI) 1.8-13.1. This corresponds to three situations: cleaning asbestos-contaminated clothes, handling asbestos material and presence of asbestos material susceptible to damage. The estimated OR for high probability of environmental exposure (living within 2000 m of asbestos mines, asbestos cement plants, asbestos textiles, shipyards, or brakes factories) was 11.5 (95% CI 3.5-38.2). Living between 2000 and 5000 m from asbestos industries or within 500 m of industries using asbestos could also be associated with an increased risk. A dose-response pattern appeared with intensity of both sources of exposure. It is suggested that low-dose exposure to asbestos at home or in the general environment carries a measurable risk of malignant pleural mesothelioma.

Adult↗
PubMed2000

Occupational exposures and lung cancer in Buenos Aires, Argentina.

The main objective of this study was to analyze the risks associated with occupational exposures in an industrializing country where lung cancer is the primary neoplastic cause of death in men. A full occupational history was collected through interviewing 199 men with lung cancer and 393 control subjects. Exposure to arsenic, asbestos, chromium, dust, nickel, and polynuclear aromatic hydrocarbons was assessed by means of a job-exposure matrix. Elevated odds ratios were observed for employment in the alcoholic beverages industry (5.2; 95% confidence interval [CI], 1.1 to 23.1), sawmills and wood mills (4.8; 95% CI, 1.2 to 19.0), water transport (3.3; 95% CI, 1.1 to 12.1), and chemicals/plastics manufacturers (1.9; 95% CI, 1.1 to 3.3). A small, non-significant increased risk was observed after long-term exposure to arsenic and chromium, with a dose-response for chromium. Although some of the present results may result from chance, most are consistent with those of previous investigations in other countries.

Adult↗
PubMed2000

Occupational exposure to carcinogens in the European Union.

OBJECTIVES: To construct a computer assisted information system for the estimation of the numbers of workers exposed to established and suspected human carcinogens in the member states of the European Union (EU). METHODS: A database called CAREX (carcinogen exposure) was designed to provide selected exposure data and documented estimates of the number of workers exposed to carcinogens by country, carcinogen, and industry. CAREX includes data on agents evaluated by the International Agency for Research on Cancer (IARC) (all agents in groups 1 and 2A as of February 1995, and selected agents in group 2B) and on ionising radiation, displayed across the 55 industrial classes. The 1990-3 occupational exposure was estimated in two phases. Firstly, estimates were generated by the CAREX system on the basis of national labour force data and exposure prevalence estimates from two reference countries (Finland and the United States) which had the most comprehensive data available on exposures to these agents. For selected countries, these estimates were then refined by national experts in view of the perceived exposure patterns in their own countries compared with those of the reference countries. RESULTS: About 32 million workers (23% of those employed) in the EU were exposed to agents covered by CAREX. At least 22 million workers were exposed to IARC group 1 carcinogens. The exposed workers had altogether 42 million exposures (1.3 mean exposures for each exposed worker). The most common exposures were solar radiation (9.1 million workers exposed at least 75% of working time), environmental tobacco smoke (7.5 million workers exposed at least 75% of working time), crystalline silica (3.2 million exposed), diesel exhaust (3.0 million), radon (2.7 million), and wood dust (2.6 million). CONCLUSION: These preliminary estimates indicate that in the early 1990s, a substantial proportion of workers in the EU were exposed to carcinogens.

Carcinogens↗
PubMed1998

Occupational risk factors of lung cancer in São Paulo, Brazil.

OBJECTIVES: This study estimated the risk of occupational exposure for lung cancer in the metropolitan region of São Paulo, the largest urbanized and industrialized area in Brazil. METHODS: In this hospital-based case-referent study of 398 cases and 860 referents, the cases were matched to referents according to age, gender, and hospital and personally interviewed for information on lifetime job history, smoking habits, passive smoking exposure, cancer in relatives, socioeconomic status, and migratory history. The analysis concerned industrial titles and occupational categories. With the use of a job-exposure matrix, exposure to asbestos, polynuclear aromatic hydrocarbons, arsenic, dust, nickel and chromium was assessed. RESULTS: For the men in the 56 industrial and 122 occupational categories examined, an excess risk of lung cancer was found in the machinery industry [odds ratio (OR) 1.62, 95% confidence interval (95% CI) 1.02-2.55). In pottery manufacturing the risk (OR 2.21, 95% CI 1.00-4.87) was increased for workers exposed > or = 10 years (OR 6.43, 95% CI 1.12-37.01). Textile workers employed for > or = 10 years with a latency of > or = 40 years had an elevated risk (OR 21.93, 95% CI 1.96-245.0). In the analysis using the job-exposure matrix no risk was detected for the specific lung cancer carcinogens examined. For the women, no significantly elevated risk was observed. CONCLUSIONS: The results of this study revealed risks of lung cancer for men in the machinery industry and for pottery and textile workers with long-term exposure.

Adult↗
PubMed1993

Myeloid leukemias and myelodysplastic syndromes: chemical exposure, histologic subtype and cytogenetics in a case-control study.

We conducted a case control study of 50 acute myeloid leukemias (AML), 17 chronic myeloid leukemias (CML), 19 myelodysplastic syndromes (MDS), and 246 controls. The cases were classified according to the French-American-British (FAB) classification, and chromosome aberrations were recorded according to the International System for Human Cytogenetic Nomenclature. Exposure to suspected leukemogenic agents was assessed blindly by an industrial hygienist. Increased risks were noted for mechanics, welders, electricians, and drivers among men and among farmers and textile workers among women. Increased SMRs for leukemias in a census-based cohort study conducted in the same area (Torino) were previously reported for electricians and drivers among men and for textile workers among women. We detected nonstatistically significant increased relative risks for exposure to benzene (odds ratio, OR = 1.7), petrol refining products (1.9), polycyclic aromatic hydrocarbons (1.7), and electromagnetic fields (1.6) in men; in women, a statistically significant association with exposure to pesticides was detected [OR = 4.4; 95% confidence interval (CI) 1.7-11.5]. Although exposure to pesticides was confined to AML, MDS cases included a high proportion of subjects exposed to benzene and electromagnetic fields. No particular histologic subtype of AML was associated with chemical exposures except for that of pesticides with the M4 category. Chromosome aberrations were not associated with chemical exposures (OR = 1.0), but a nonstatistically significant excess was noted in association with electromagnetic fields (OR = 2.1).

Adolescent↗
PubMed1988

Occupation and lung cancer in two industrialized areas of northern Italy.

A population-based case-control study on lung cancer was conducted in 2 industrialized areas of northern Italy. Cases (126) were all males who died from lung cancer between 1976 and 1980. Controls (384) were a random sample of males dying from other causes during the same period. Jobs held during working life have been analyzed according to a list of occupations already known to be causally associated with lung cancer (list A) and a list of occupations suspected of being so (list B). Attributable risk percentages in the population for occupations included in either list A or B were about 36% and 12% in the 2 areas. Welders or workers in industries in which welding is common showed elevated odds ratios: 2.9 for welders (95% CI 0.9-9.8); 4.9 (1.1-22.9) for structural metal workers; 11.4 (2.6-49.9) for workers in structural metal production. Other job categories associated with lung cancer included: electricians and workers in electrical machine production, woodworkers (in furniture or cabinet making, but not in carpentry or joinery) and cleaning services. Smoking did not seem to exert a substantial confounding effect. Attributable risk percentages for tobacco smoking were about 78% and 76% in the population of the 2 areas.

Adult↗
PubMedDate not supplied

[Epidemiological surveillance of occupational pathology: a program of the Piedmont region (PRiOR). The PRiOR Protection Group].

A surveillance programme of exposures and health impairment from work (PRiOR) was developed in Piedmont Region during 1996-97, aiming to: (i) experiment and make available to the health and safety at work services methods and tools to detect currently under-reported cases of work related diseases (disease surveillance); (ii) and build up tools to predict exposure to occupational hazards (hazard surveillance). Within the framework of the disease surveillance system, an active search was carried out in hospital departments for sino-nasal cancer, pleuro-pericardial malignant mesotheliomas, bronchial asthma, and contact dermatitis (the last two diseases only when associated with hypersensitivity to agents possibly entailing occupational exposure). The programme tested and showed the feasibility of such a detection system on a regional basis; a pilot system was set up in order to collect the cases, assess them, and bring them to the attention of the health and safety at work services of the local health authorities. Case detection seems to have been rather complete, and time elapsed from first diagnosis has been kept to a minimum. The exposure histories of the collected cases show exposure patterns not only of historical, but also of current relevance. Evaluating the exposure status either by the occupational histories (neoplastic diseases) or by the hypersensitivity pattern and job title (allergic diseases), the proportion of occupationally exposed cases was remarkably high. At the end of the PRiOR programme, the active search procedures were considered to have yielded positive results. and are going to become a permanent surveillance system.

Feasibility Studies↗
PubMedDate not supplied

[A system for the active surveillance of occupational bronchial asthma: the results of 2 years of activity of the PRiOR program].

A surveillance programme of work-related hazards and diseases (PRiOR) was developed in the Piedmont region of Italy during 1996-97, including an active surveillance system for asthma. Incidence estimation, early information to the patient, identification of responsible workplaces were the main objectives of the programme. A network of 18 clinical centers (allergologists, chest physicians, occupational physicians) from whole the Piedmont region provides information on newly diagnosed cases to a surveillance center that receives and analyzes reports and disseminates surveillance results to clinicians and occupational health and safety services, responsible for intervention. Between 1 March 1996 and 31 December 1997 67 new cases were reported, which corresponds to an incidence rate of 24 (C.I. 95%: 18-30) per million workers per year. The incidence was higher among bakers (540 per million), among workers employed in the leather and shoe industry (214 per million), in health care services (205 per million), in the pharmaceutical industry (199 per million) and among hairdressers (196 per million). The agents to which workers were exposed at the time of diagnosis were generally well recognised (latex 51%; flour 27%). Procedures and results of the PRiOR programme are comparable with those from surveillance systems operating in other countries. Nevertheless, continued efforts are needed to increase the proportion of collaborating physicians, to standardize the use of tests for diagnosis and to improve the communication between clinical centers and occupational health and safety services. Like most surveillance systems based on similar methods, PRiOR underestimates the true incidence of work-related asthma in the Piedmont Region. Despite this limitation, the PRiOR active surveillance system of work-related asthma has proven successful in identifying more new cases of asthma than official sources do. It can therefore be permanently implemented in the prevention system regional.

Asthma↗
PubMedDate not supplied

[Air pollution and daily mortality in Turin, 1991-1996].

A time series study was carried out to assess the relationship between the air pollutants measured by the air quality monitoring network and daily mortality in Turin, Italy. We used TSP, SO2, NO2, O3, and CO concentrations measured from 1-1-1991 to 31-12-1996 at three stations of the city network, chosen to represent different, typical circumstances of exposure to air pollution in the town. The analysis was performed by robust Poisson regression model including loss smoothing functions to allow for long-time trend, seasons, temperature and relative humidity. Dummy variables for the days of the week and holidays were also included. The relative risk of death for a unit increase in the pollutant concentration either during the same day (lag 0) in the previous ones (lag up to 5) was computed. The unit increase was 50 micrograms/m3 for TSP, SO2, NO2, O3, and 2 mg/m3 for CO. The average daily number of deaths for natural causes was 21. The relative risks for total mortality were 1.04 for TSP (lag 1), 1.10 for SO2 (lag 2), 1.06 for NO2 (lag 1), 1.01 for O3 (lag 0), 1.03 for CO (lag 1). The relative risks were 1.05 for TSP (lag 0), 1.12 for SO2 (lag 2), 1.07 for NO2 (lag 1), 1.03 for O3 (lag 0), 1.03 for CO (lag 1) for cardiovascular mortality, and 1.08 for TSP (lag 2), 1.20 for SO2 (lag 2), 1.12 for NO2 (lag 2), 1.03 for O3 (lag 2), 1.05 for CO (lag 2) for respiratory mortality.

Adolescent↗
PubMedDate not supplied

[Estimated number of workers exposed to carcinogens in Italy, within the context of the European study CAREX].

CAREX is an international information system on occupational exposure to known or suspected carcinogens, built within the framework of the Europe Against Cancer Programme of the European Union. It provides estimates of the number of exposed workers by country, industry, and agent, including data about 139 agents evaluated by the International Agency for Research on Cancer (group 1 and 2A agents, plus selected group 2B ones), across 55 industries classified according to UN-ISIC revision 2. The 1990-3 occupational exposures to these agents were estimated for the fifteen countries of the European Union in two steps. At first, estimates were generated on the basis of the national workforce data, and of the exposure prevalence estimates from two reference countries: Finland and the USA. These estimates are adjusted by economic structure, but they do not take into account country specific patterns of exposure to carcinogens. For selected countries, among which Italy, it was possible to correct these estimates by national experts, who were invited to allow for the exposure patterns that they considered specific to their countries. According to the estimates for Italy, there were about 4.2 million workers, i.e. 24% of the work force, exposed to the agents included in CAREX, with some 5.5 million exposures. The most common exposures were: environmental tobacco smoke (770,000 exposed workers), solar radiation (550,000), diesel engine exhaust (550,000), asbestos (350,000), wood dust (300,000), crystalline silica (260,000), lead and inorganic lead compounds (220,000), benzene (180,000), hexavalent chromium and compounds (130,000) and PAHs (130,000).

Carcinogens↗
PubMedDate not supplied

[Database of occupations and industrial activities that involve the risk of pulmonary tumors].

Lists of occupations and industries associated with lung cancer are a useful tool to estimate attributable risks for occupational exposures. They were first published in 1982, based on IARC Monographs. List A included industries, processes and occupations definitely entailing carcinogenic risk, list B those probably/possibly carcinogenic. In 1995 the lists had been updated. We carried out a further update, reviewing IARC Monographs Volumes 62-75, focusing on Group 1, 2 A, and 2 B agents, and coded the lists according to widely used classifications: ISIC Rev. 2, ISIC Rev. 3, NACE Rev. 1, and ISTAT ATECO 1991 (for economic activities); ILO-ISCO 1968 and ISTAT-Classificazione delle professioni 1991 (for occupations). In order to evaluate temporal and geographical variations in attributable risk, exposure assessment must be performed consistently across different studies and standard tools to identify exposures, such as the one we propose here, are needed. The lists can also help to develop maps of industrial activities entailing carcinogenic risk at local, regional, and national level, and to identify economic activities that deserve priority action to control occupational exposures to carcinogens. The classifications were originally developed for economic and demographic purposes, and some exposure circumstances cannot be coded with sufficient specificity. This applies to productions or processes (i.e.: PVC production) that could be classified only by codes corresponding to wide groups of economic activities and/or occupations: in these instances we associated no code, so as not to inflate the estimates of exposed workers. As a consequence, however, certain exposures are not represented in the coded version of the lists. Even keeping in mind such limitations, coding makes the lists easier to apply, and increases the comparability of studies on lung cancer and occupation, as well as of surveys on exposure prevalence.

Databases as Topic↗