rubrica

Lavoro

  • Dario Consonni1

  1. Clinica del lavoro, Milano

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Ricerca bibliografica periodo dal 16 aprile 2014 al 30 giugno 2014

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Stringa: ("occupational exposure"[MeSH Terms] OR "occupational diseases"[MeSH Terms]) OR "occupational health"[MeSH Terms]) OR "workplace"[MeSH Terms]) OR "accidents, occupational"[MeSH Terms]) OR "employment"[MeSH Terms]) OR occupation[Title/Abstract]) OR occupational[Title/Abstract]) OR worker[Title/Abstract]) OR workers[Title/Abstract]) AND epidemiol*[All fields] AND ("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2014/04/16"[PDAT] : "2014/06/30"[PDAT])
1. Consonni D(1), Matteis SD, Pesatori AC, Bertazzi PA, Olsson AC, Kromhout H, Peters S, Vermeulen RC, Pesch B, Brüning T, Kendzia B, Behrens T, Stücker I, Guida F, Wichmann HE, Brüske I, Landi MT, Caporaso NE, Gustavsson P, Plato N, Tse LA, Yu IT, Jöckel KH, Ahrens W, Pohlabeln H, Merletti F, Richiardi L, Simonato L, Forastiere F, Siemiatycki J, Parent ME, Tardón A, Boffetta P, Zaridze D, Chen Y, Field JK, 't Mannetje A, Pearce N, McLaughlin J, Demers P, Lissowska J, Szeszenia-Dabrowska N, Bencko V, Foretova L, Janout V, Rudnai P, Fabiánová E, Stanescu Dumitru R, Bueno-de-Mesquita B, Schüz J, Straif K. Lung cancer risk among bricklayers in a pooled analysis of case-control studies. Int J Cancer. 2014 May 27. doi: 10.1002/ijc.28986. [Epub ahead of print]
(1)Epidemiology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.

Abstract
Bricklayers may be exposed to several lung carcinogens, including crystalline silica and asbestos. Previous studies that analyzed lung cancer risk among these workers had several study design limitations. We examined lung cancer risk among bricklayers within SYNERGY, a large international pooled analysis of case-control studies on lung cancer and the joint effects of occupational carcinogens. For men ever employed as bricklayers we estimated odds ratios (OR) and 95% confidence intervals (CI) adjusted for study center, age, lifetime smoking history and employment in occupations with exposures to known or suspected lung carcinogens. Among 15,608 cases and 18,531 controls, there were 695 cases and 469 controls who had ever worked as bricklayers (OR: 1.47; 95% CI: 1.28-1.68). In studies using population controls the OR was 1.55 (95% CI: 1.32-1.81, 540/349 cases/controls), while it was 1.24 (95% CI: 0.93-1.64, 155/120 cases/controls) in hospital-based studies. There was a clear positive trend with length of employment (p < 0.001). The relative risk was higher for squamous (OR: 1.68, 95% CI: 1.42-1.98, 309 cases) and small cell carcinomas (OR: 1.78, 95% CI: 1.44-2.20, 140 cases), than for adenocarcinoma (OR: 1.17, 95% CI: 0.95-1.43, 150 cases) (p-homogeneity: 0.0007). ORs were still elevated after additional adjustment for education and in analyses using blue collar workers as referents. This study provided robust evidence of increased lung cancer risk in bricklayers. Although non-causal explanations cannot be completely ruled out, the association is plausible in view of the potential for exposure to several carcinogens, notably crystalline silica and to a lesser extent asbestos.

Breve commento a cura di Dario Consonni
il progetto SYNERGY (http://synergy.iarc.fr/) riunisce diversi studi caso-controllo sul tumore polmonare effettuati in diversi paesi, inclusi diversi paesi europei (Francia, Germania, Gran Bretagna, Italia, Olanda, Polonia, Repubblica Ceca, Romania, Russia, Slovacchia, Spagna, Svezia, Ungheria), Canada, Cina (Hong Kong) e Nuova Zelanda. Obiettivo principale è la valutazione di effetti sinergici di cancerogeni occupazionali (amianto, silice cristallina, idrocarburi policiclici aromatici, composti cromo-nickel). L’Italia partecipa con studi effettuati a Torino, a Roma, in Veneto e in Lombardia. Numerosi sottoprogetti sono stati pubblicati o sono in corso. Il presente articolo ha valutato il rischio di tumore polmonare tra i muratori, evidenziando un eccesso di rischio di circa il 50%, con una evidente relazione con la durata di lavoro. L’associazione è plausibile vista l‘esposizione quotidiana a silice libera cristallina e (saltuaria e limitata ad alcune operazioni) ad amianto. I risultati suggeriscono la necessità di introdurre adeguate misure tecniche per ridurre le esposizioni a polveri di quarzo e di un giusto riconoscimento della natura professionale del tumore polmonare nei muratori (e in altre occupazioni del settore edilizio) da parte degli istituti assicuratori.

2. Consonni D(1), Barone-Adesi F(2), Mensi C(1). Comment on 'The latency period of mesothelioma among a cohort of British asbestos workers (1978-2005)': methodological problems with case-only survival analysis. Br J Cancer. 2014 Apr 29. doi: 10.1038/bjc.2013.823. [Epub ahead of print]
(1)Epidemiology Unit, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via San Barnaba 8, 20122 Milan, Italy. (2)Division of Population Health Sciences and Education, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK.

Breve commento a cura di Dario Consonni
Un recente studio inglese ha valutato la latenza del mesotelioma nei soli casi, trascurando l’intera coorte. Ma secondo molti è sbagliato trarre inferenza su età alla diagnosi o latenza da una serie di casi, trascurando la popolazione da cui provengono. L’articolo ha suscitato critiche da parte di vari epidemiologi e statistici italiani. Ci sembra utile riportare qui la serie dei contributi: 1. Frost G. The latency period of mesothelioma among a cohort of British asbestos workers (1978-2005). Br J Cancer 2013;109:1965-1973. doi: 10.1038/bjc.2013.514 2. Mirabelli D, Zugna D. Comment on 'The latency period of mesothelioma among a cohort of British asbestos workers (1978-2005)'. Br J Cancer 2014. doi: 10.1038/bjc.2014.111 3. Consonni D, Barone-Adesi F, Mensi C. Comment on 'The latency period of mesothelioma among a cohort of British asbestos workers (1978-2005)': methodological problems with case-only survival analysis. Br J Cancer 2014. doi: 10.1038/bjc.2013.823 4. Farioli A, Mattioli S, Curti S, Violante FS. Comment on 'The latency period of mesothelioma among a cohort of British asbestos workers (1978-2005)': the effect of left censoring. Br J Cancer 2014. doi: 10.1038/bjc.2014.440 5. Frost G. Response to comment on 'The latency period of mesothelioma among a cohort of British asbestos workers (1978-2005)' Br J Cancer. 2014. doi: 10.1038/bjc.2014.441 Si segnala anche un articolo pertinente all’argomento, apparso nella rubrica “Con Metodo” di E&P: • Consonni D. Manca qualcosa: cosa c’è di sbagliato nell’usare l’età alla diagnosi/decesso o la latenza nei casi. Epidemiol Prev 2013;37(1):85-88

3. Cecilia Pesatori A(1), Consonni D(2), Grillo P(2), Alberto Bertazzi P(1). Cancer risk in oil refinery workers: a mortality study in four Italian plants. Occup Environ Med. 2014 Jun;71 Suppl 1:A63. doi: 10.1136/oemed-2014-102362.195.
Author information: (1)Department of Clinical Sciences and Community Health, University of Milan, Milan, ItalyEpidemiology Unit, Department of Preventive Medicine, IRCCS Ca' Granda Foundation, Milan, Italy. (2)Epidemiology Unit, Department of Preventive Medicine, IRCCS Ca' Granda Foundation, Milan, Italy.

Abstract
OBJECTIVES: To examine the mortality experience of workers employed in four Italian oil refineries. METHOD: The cohort included 5112 male workers ever employed between 1949 and 2011. The average follow-up period was 49 years. SMR and 95% CI were calculated using as reference age-gender-calendar specific regional rates. Analyses by duration of employment and latency were performed. RESULTS: In the whole cohort, pleural (6 deaths, SMR 1.59; 95% CI 0.7-3.5), brain cancers (14 deaths, SMR 1.47; 95% CI 0.9-2.5) and lymphatic leukaemia (LL) (8 deaths, SMR 1.81; 95% CI 0.9-3.6) showed increased risks. All pleural cancers occurred after 10 years of latency and the highest risk was observed among workers with duration ≥ 20 years; the brain cancer excess was confined in the shortest duration and latency. The LL excess regarded workers with latency and duration longer than 10 years. Mortality from Non-Hodking lymphoma (NHL) (13 deaths) and acute myeloid leukaemia (AML) did not differ from the expectation. All AML cases (4 deaths) occurred after 20 years of latency (SMR 1.55, 95% CI 0.6-4.1) and a two fold-increased risk was observed in the longest duration. Mortality for NHL + LL (recently classified as subtypes of NHL) showed increased risks among workers with duration and latency longer than 20 years. CONCLUSIONS: Our findings confirmed recent epidemiological evidences of an increased risk for pleural cancer and are coherent with most recent meta-analyses suggesting a limited evidence of an increased risk for lymphatic neoplasms in refinery workers possibly due to past exposure to benzene.

4. Bonzini M(1), Zanetta L(2), Bertù L(3), Parassoni D(4), Turri Zanoni M(2), Lepera D(2), Castelnuovo P(5), Ferrario MM(1). Sinonasal cancers: is intestinal type adenocarcinoma the only related to occupational exposures? Results from an Italian case-control study. Occup Environ Med. 2014 Jun;71 Suppl 1:A21-2. doi: 10.1136/oemed-2014-102362.67.
(1)Epidemiology and Preventive Medicine Research Centre, Insubria University, Varese, ItalyInsubria University, Varese, Italy. (2)Ospedale Di Circolo, Fondazione Macchi, Varese, Italy. (3)Epidemiology and Preventive Medicine Research Centre, Insubria University, Varese, Italy. (4)Ospedale Di Circolo, Fondazione Macchi, Varese, ItalySchool of Specialisation in Occupational Health, University of Brescia, Brescia, Italy. (5)Ospedale Di Circolo, Fondazione Macchi, Varese, ItalyInsubria University, Varese, Italy.

Abstract
OBJECTIVES: Epithelial sinonasal cancers (SNC) are rare, severe diseases associated to the exposure to several well-established carcinogens (IARC). The etiologic role of these carcinogens in different histological subtypes is still disputed, with several studies focusing on intestinal-type adenocarcinoma (ITAC) as the most (and maybe the only) occupational-related subtype. To assess the role of occupational exposures in SNC aetiology we designed a case control study, in which occupational exposures prevalence in two group of ITAC cases and non-ITAC were compared to controls. METHOD: In a large Italian hospital we enrolled 50 consecutive surgical non-ITAC cases (mainly squamous-cell carcinoma), 50 consecutives ITAC cases and 50 non-neoplastic patients (controls). Previous occupational exposures to wood and leather dust, solvents, metals, formaldehyde were investigated through a standardised interview. Gender, age, residence area and smoking were collected as potential confounders. Multivariate logistic regression was applied. RESULTS: Considering all tumours together, we observed large increased risks for wood exposure (OR=6.9, 95% CI=3.0-16.3) and leather (prevalence 24% in tumours, 0% among controls) only. Compared to controls, we observed an increased risk for wood exposure [OR=7.7 (95% CI=2.6-22.5)] in ITAC cases, but not in non-ITAC cases [OR=0.8 (95% CI=0.2-3.1)]. Prevalence of leather exposure was 42% among ITAC and 6% in non-ITAC. CONCLUSIONS: Our case control study confirmed that ITAC cases but not other histotypes were strongly related to occupational exposures, and in particular to leather and wood dusts. Grouping together all SNC types reduce the causal role of occupation exposures. Larger samples size are needed to investigate other work-related carcinogens.

5.Bonzini M(1), Bertù L(2), Conti M(3), D'Amato A(2), Veronesi G(2), Coggon DN(4), Ferrario MM(1). Somatising tendency, occupational strain and musculoskeletal symptoms: results from a longitudinal study among Italian nurses. Occup Environ Med. 2014 Jun;71 Suppl 1:A21. doi: 10.1136/oemed-2014-102362.66.
(1)Epidemiology and Preventive Medicine Research Centre, Insubria University, Varese, ItalyMRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. (2)Epidemiology and Preventive Medicine Research Centre, Insubria University, Varese, Italy. (3)MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. (4)Ospedale Di Circolo Fondazione Macchi, Varese, Italy.

Abstract
OBJECTIVES: Musculoskeletal symptoms are a common cause of disability, with major impact on workforce wellbeing, absenteeism and productivity. Several, mainly cross-sectional, studies have linked such symptoms to physical workload, and also to psychological and socio-cultural factors. We investigated whether prolonged or increasing job strain, tendency to somatise and other individual characteristics, are associated with worsening musculoskeletal pain. METHOD: As part of the CUPID study, we investigated a cohort of nurses employed on medical wards at the Varese University Hospitals (Italy). Participants were asked, at baseline and after one year of follow-up, about individual and occupational risk factors, psychological characteristics (including tendency to somatise), occupational strain (by Siegrist's Effort/Reward Imbalance Questionnaire-ERI), and musculoskeletal symptoms. Associations of worsening musculoskeletal pain with perceived job strain were assessed by multivariate log-binomial regression. RESULTS: Occupational stress was associated with pain in the lower back (LBP) and neck/shoulder (NSP) in both cross-sectional questionnaires. Comparing baseline and follow-up answers, workers who reported an increase in perceived stress showed more frequent worsening of both LBP (prevalence of worsening symptoms=41%, OR when compared with not stressed=1.7, 95% CI=1.1-2.7) and NSP (prevalence of worsening=51%, OR=1.2, 95% CI=0.8-1.8). This relationship persisted after adjustment for gender, age and BMI, and exposure to physical workload, and was more evident among subjects with a tendency to somatise (OR=2.8. 95% CI=1.0-7.4 for LBP; OR=1.6, 95% CI=0.8-3.2 for NSP). CONCLUSIONS: Our observation suggests that tendency to somatise modifies individual responses to "triggering exposures", such as psychological workload, with important implications for the health, and productivity of workers.

6. Andreotti G(1), Hoppin J(2), Savage S(1), Hou L(3), Baccarelli A(4), Hoxha M(4), Koutros S(1), Sandler D(2), Alavanja M(1), Beane Freeman L(1). Pesticide use and relative telomere length in the Agricultural Health Study. Occup Environ Med. 2014 Jun;71 Suppl 1:A14-5. doi: 10.1136/oemed-2014-102362.45.
Author information: (1)NCI, Rockville, MD, USA. (2)NIEHS, Research Triagngle, NC, USA. (3)Northwestern University, Chicago, IL, USA. (4)University of Milan, Milan, Italy.

Abstract
OBJECTIVES: Epidemiologic studies have linked pesticide use to various health outcomes, including cancer, but underlying mechanisms remain unclear. In a previous analysis from the Agricultural Health Study (AHS), a prospective cohort study of pesticide applicators in the US, use of certain pesticides was linked to shorter relative telomere length (RTL) measured in buccal cell DNA. In this analysis we examined the associations between occupational pesticide use and RTL measured in blood DNA. METHOD: We conducted an analysis of 80 pesticides and RTL in 568 cancer-free male participants aged 31-94 years in the AHS. We used self-reported pesticide use information collected at study enrollment (1993-1997) and two follow-up questionnaires administered approximately 5 years apart to construct exposure metrics, including intensity-weighted lifetime days (lifetime days*intensity score). Blood samples were collected in 2006-2008, and RTL was measured in DNA using qPCR. Multivariable linear regression was used to evaluate the associations between individual pesticide use and RTL, adjusting for age at blood draw and other pesticides associated with RTL. RESULTS: Increasing tertiles of intensity-weighted days of alachlor were associated with longer RTL (p-trend = 0.01). In contrast, increasing tertiles of intensity-weighted days of 2,4-D (p-trend = 0.05), diazinon (p-trend = 0.01) and aldrin (p-trend = 0.01) were associated with shorter RTL. CONCLUSIONS: We found two herbicides (alachlor, 2,4-D) and two insecticides (diazinon, aldrin) significantly associated with alterations in RTL. These pesticides have been linked to increased cancer risk in epidemiological and/or animal studies. Consistent with our finding, shorter RTL with 2,4-D use was previously observed in an analysis of buccal cells in the AHS.

7. Montella E, Schiavone D, Apicella L, Di Silverio P, Gaudiosi M, Ambrosone E, Moscaritolo E, Triassi M. Cost-benefit evaluation of a preventive intervention on the biological risk in health: the accidental puncture during the administration of insulin in the University Hospital "Federico II" of Naples. Ann Ig. 2014 May-Jun;26(3):272-8. doi: 10.7416/ai.2014.1985.
Author information: Department of Public Health, University of Naples "Federico II", Naples, Italy.

Abstract
BACKGROUND: The occupational exposure to biological risk is a frequent event that affects millions of workers in the health sector. Operators are exposed to accidental contact with blood and other potentially infectious biological materials with a frequency higher than that observed in the population (occupational exposure). The pathogens most frequently implicated are the human immunodeficiency virus (HIV), hepatitis C (HCV) and hepatitis B (HBV) viruses. The World Health Organization estimates that each year more than 3 million health workers hurt themselves with an object/edge definitely contaminated with at least one HIV (about 170,000 exposures), hepatitis B (approximately 2,000,000 exposures) and hepatitis C (approximately 900,000 exposures). In Italy approximately 100,000 percutaneous exposures/year are estimated to take place. The needlestick injuries in health care workers are, in large part, preventable by adopting measures such as the use of instrumental needlesticks Prevention Devices - NPDs. The adoption of the NPDs is extremely effective in reducing occupational exposure to biological risk (from 63 % to 100 % reduction). METHODS: The aim of this study was to evaluate whether the adoption of NPDs for insulin therapy is costeffective in terms of prevention of accidents by Biohazard, compared to administration of insulin with traditional methods (syringe + vial). The estimation is carried out both in the light of current legislation (European Directive 2010/32 and 81/08 Italian Law) and epidemiological data and cost of accidents (according to frequency) and alternative interventions. RESULTS: The evaluation of cost-effectiveness included the construction of an economic model that would allow the weighting of the costs of accidents that can occur following the administration of insulin therapy with traditional methods. The economic model was developed taking into account the international literature on the phenomenon of "accidental puncture" and allowed the financial quantification of the event. Then we calculated the cost of insulin therapy using the traditional methodology and the cost has been converted to the cost of insulin therapy when administered by NPDs. The period of the study was the year 2010. CONCLUSIONS: The data thus obtained were used to evaluate the benefits of implementing NPDs for insulin therapy, in terms not only of economic advantage but also of preventive efficacy and on the cost of the accident.

8. Salerno C(1), Sacco S(2), Panella M(1), Berchialla P(3), Vanhaecht K(4), Palin LA(1). Cancer risk among farmers in the Province of Vercelli (Italy) from 2002 to 2005: an ecological study. Ann Ig. 2014 May-Jun;26(3):255-63. doi: 10.7416/ai.2014.1983.
Author information: (1)Department of Translational Medicine, University of Eastern Piedmont "Amedeo Avogadro", Novara, Italy. (2)Department of Brain and Behavioural Sciences, Section of Biostatistics, Neurophysiology and Psychiatry, Unit of Medical Statistics and Computational Genomics - Clinical Epidemiology and Health Planning Laboratory, University of Pavia, Italy. (3)Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy. (4)Health Services Research Group, School of Public Health, Faculty of Medicine, University of Leuven, Belgium.

Abstract
BACKGROUND: As the link between agricultural pesticides and numerous types of human cancers is wellknown. Farmers living in the Province of Vercelli (Italy) were observed to verify if they have a higher cancer risk than the rest of the local employed population. Literature showed a well-known excess of cancer morbidity and mortality in the Province of Vercelli, but only few studies focused on cancer incidence in local farmers. Studying farmers could allow to assess the causal importance respectively of environmental pressure and professional exposure factors in explaining cancer excesses in the above-mentioned area. MATERIALS AND METHODS: The present ecological study considered all cancer new cases recorded among the mean employed population with a range of age from 25 to 84 years and resident in the Province of Vercelli during the four-year period 2002-2005. Cancer odds ratios, by gender and type of cancer, between farmers and non-farmers were calculated. RESULTS: Farmers showed a higher risk for the following tumors: colorectal (OR 2.38, IC95%: 1,76-2,87), leaukaemia (OR 2.65, IC95%:2,12-2,89), digestive system (OR 2.16, IC95% 1,92-2,33), lymphoma OR 2.08, IC95%:1,99-2,23), melanoma (OR 2.90, IC95%:2,54-3,15), myeloma OR 3.55, IC95%:3,23-3,70), pancreas OR 3.38, IC95%:3,14-3,61), lung (1.59, IC95%:1,12-2,38) and kidney (2.70, IC95%:2,41-2,99). Males showed a higher risk for lung cancer, females for liver neoplasm, melanoma and lymphoma. CONCLUSIONS: Farmers showed a higher risk for several cancers. Further studies are needed, in order to examine in detail the issue, to encourage the use of personal protective equipment and to promote a more responsible pesticides use.

9. Sancini A(1), De Sio S(1), Gioffrè PA(1), Casale T(1), Giubilati R(1), Pimpinella B(1), Scala B(1), Suppi A(1), Bonomi S(1), Samperi I(1), Rosati MV(1), Tomei G(2), Tomei F(1), Caciari T(1) Correlation between urinary nickel and testosterone plasma values in workers occupationally exposed to urban stressors. Ann Ig. 2014 May-Jun;26(3):237-54. doi: 10.7416/ai.2014.1982.
Author information: (1)Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, Sapienza University of Rome, Italy. (2)Psychiatric and Psychological Science, Sapienza University of Rome, Italy.

Abstract
BACKGROUND: The purpose of this study is to assess whether occupational exposure to low doses of nickel (Ni) present in urban air can cause alterations in the concentration of plasma testosterone in workers of the Municipal Police of a large Italian city assigned to different types of outdoor tasks. METHODS: 359 male subjects were included in the study and divided on the basis of job, age, length of service and smoking habits. The dosage of the atmospheric Ni was performed by personal dosimetries on a sample of the workers included in the study. For each worker included in the study the dosage of whole blood Ni and of the plasma testosterone was carried out. The total sample was subjected to the independent-samples T-test and the Mann-Whitney U test for variables with 2 modes (smoking cigarette) and the ANOVA test and the Kruskal Wallis test for variables with more than 2 modes (age, length of service and job function). The correlation of Pearson with p at 2 wings between the variables was evaluated in the total sample and after subdivision on the basis of smoking and on the basis of the job. After taking into account the major confounding factors the multiple linear regression was performed on the total sample and after breakdown by tasks. RESULTS: The correlation between the values of urinary Ni and the values of plasma testosterone on the total sample and for all classes of subdivision was found constantly negative. These results were confirmed by multiple linear regression, which indicated the Ni as the only significant variable that can contribute to the alterations of the testosterone. CONCLUSIONS: Based on the results, the Authors suggest that occupational exposure to low doses of Ni present in the urban environment is able to influence some lines of the hypothalamic-pituitary-gonadal axis in exposed workers.

10. Rota M(1), Bosetti C, Boccia S, Boffetta P, La Vecchia C. Occupational exposures to polycyclic aromatic hydrocarbons and respiratory and urinary tract cancers: an updated systematic review and a meta-analysis to 2014. Arch Toxicol. 2014 Aug;88(8):1479-90. doi: 10.1007/s00204-014-1296-5. Epub 2014 Jun 17.
Author information: (1)Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via La Masa 19, 20156, Milan, Italy.

Abstract
Exposure to polycyclic aromatic hydrocarbons (PAHs) has been associated with an excess risk of respiratory tract and bladder cancers in several industries, but the issue requires further quantification. We updated a previous systematic review by reviewing in details cohort studies on workers employed in selected industries with potential PAH exposure published between 2006 and 2014, and we summarized through a meta-analytic approach the main results of all available cohort studies published between 1958 and 2014 investigating cancers of the respiratory and urinary tracts. Thirteen papers on cohort studies investigating cancer risk in workers exposed to PAHs were retrieved through the literature search. These included workers from aluminum production industries (seven studies), iron and steel foundries (two studies), asphalt workers (two studies), and carbon black production (two studies). In the meta-analysis, an excess risk of respiratory tract cancers (mainly lung cancer) was found in iron and steel foundries [pooled relative risk (RR) 1.31, 95 % confidence interval (CI) 1.08-1.59 from 14 studies], while a weak excess risk (pooled RR 1.08, 95 % CI 0.95-1.23 from 11 studies) emerged for aluminum production. A borderline increase risk was also observed for cancer of the bladder in the aluminum production (pooled RR 1.28, 95 % CI 0.98-1.68 from 10 studies) and in iron and steel foundries (pooled RR 1.38, 95 % CI 1.00-1.91 from 9 studies). This updated review and meta-analysis confirm the increased risk from respiratory tract and bladder cancers in selected PAH-related occupations. It cannot be ruled out whether such excesses are due, at least in part, to possible bias or residual confounding.

11. Mandrioli J(1), Biguzzi S, Guidi C, Venturini E, Sette E, Terlizzi E, Ravasio A, Casmiro M, Salvi F, Liguori R, Rizzi R, Pietrini V, Chierici E, Santangelo M, Granieri E, Mussuto V, Borghi A, Rinaldi R, Fini N, Georgoulopoulou E, De Pasqua S, Vinceti M, Bonvicini F; Errals Group, Ferro S, D'Alessandro R. Epidemiology of amyotrophic lateral sclerosis in Emilia Romagna Region (Italy): A population based study. Amyotroph Lateral Scler Frontotemporal Degener. 2014 Jun;15(3-4):262-8. doi: 10.3109/21678421.2013.865752. Epub 2014 Feb 7.
Author information: (1)Department of Neuroscience, St. Agostino-Estense Hospital , Modena.

Abstract
Our objective was to describe incidence and clinical features of ALS from a prospective population-based study in Emilia Romagna Region (ERR). From 2009 onwards, a prospective registry recorded all incident cases of ALS among residents in the ERR (population, 4.4 million inhabitants), involving 17 neurological departments. For each patient, detailed demographic and clinical information was collected by caring physicians. Results showed that from 1 January 2009 to 31 December 2011, 347 patients received a new diagnosis of ALS with a crude incidence rate of 2.63/100,000/year. There was micro-geographic heterogeneity throughout ERR, with higher incidence rates in the low density population (3.27/100,000) (p < 0.01). ALS patients have been more frequently employed in agriculture than the general ERR population (8.64% vs. 4.6%, p < 0.01). Clinical features were similar to those described in previous population based studies. In conclusion, we report incidence rates similar to those reported by European registries, reflecting good accuracy of our prospective study. We confirmed previous studies reporting higher incidence rates in rural areas and among agricultural workers. Although genetics has been gaining increasing importance in ALS aetiology, some epidemiological data are still unexplained. Identifying geographical areas or populations with high incidence rates can be a starting point for identifying environmental risk factors. Further studies having this specific aim can shed light on these topics.

16. Gilberson T(1), Peluso ME(2), Munia A(2), Luján-Barroso L(1), Sánchez MJ(3), Navarro C(4), Amiano P(5), Barricarte A(6), Quirós JR(7), Molina-Montes E(3), Sánchez-Cantalejo E(3), Tormo MJ(4), Chirlaque MD(4), Ardanaz E(6), Dorronsoro M(5), Confortini M(8), Bonet C(1), Sala N(9), González CA(1), Agudo A(10). Aromatic adducts and lung cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) Spanish cohort. Carcinogenesis. 2014 Apr 29. pii: bgu098. [Epub ahead of print]
Author information: (1)Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona 08908, Spain. (2)Cancer Risk Factor Branch, ISPO-Cancer Prevention and Research Institute, Florence 50131, Italy. (3)Granada Cancer Registry, Andalusian School of Public Health, Granada 18080, Spain, CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. (4)CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain, Department of Epidemiology, Murcia Health Council, Murcia 30003, Spain. (5)CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain, Public Health Division of Gipuzkoa, BIODonostia Research Institute, Department of Health of the regional Government of the Basque Country, San Sebastian 48902, Spain. (6)CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain, Public Health Institute of Navarra, Pamplona 31003, Spain. (7)Public Health Directorate, Asturias 31003, Spain. (8)Unit of Analytical Citology and Bimolecular, ISPO-Cancer Prevention and Research Institute, Florence 50131, Italy and. (9)Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona 08908, Spain, Molecular Epidemiology Group, Translational Research Laboratory, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona 08908, Spain. (10)Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona 08908, Spain, a.agudo@iconcologia.net.

Abstract
In this case-cohort study, we examined the association between bulky DNA adducts and the risk of lung cancer within the European Prospective Investigation into Cancer and Nutrition (EPIC) Spanish cohort with an average 7-year follow-up, including 98 cases of primary lung cancer and 296 subjects randomly selected from the cohort. Aromatic adducts were measured using (32)P-postlabeling in leukocyte DNA from blood samples collected at enrollment. The association between DNA adducts and the risk of lung cancer was estimated using a Cox proportional hazards model with a modified partial likelihood. There was an overall significant increased risk for developing lung cancer when DNA adduct concentrations were doubled, with relative risk (RR) adjusting for all relevant confounders of 1.36 with 95% confidence interval (CI) 1.18-157. There was a significant increased risk for developing lung cancer when DNA adduct concentrations were doubled for current smokers and among subjects exposed to PAH at work; there was also a slightly higher increase among males than females. However, no statistically significant differences were observed for the effect of adduct levels across smoking status, sex or occupational exposure to PAH. A meta-analysis combined four prospective studies, including this study, resulting in a significant association among current smokers, with an overall estimate of 34% increase in the risk of lung cancer when doubling the level of aromatic DNA adducts in leukocytes.

17. Reid A(1), de Klerk NH(2), Magnani C(3), Ferrante D(3), Berry G(4), Musk AW(5), Merler E(6). Mesothelioma risk after 40 years since first exposure to asbestos: a pooled analysis. Thorax. 2014 May 19. pii: thoraxjnl-2013-204161. doi: 10.1136/thoraxjnl-2013-204161. [Epub ahead of print]
Author information: (1)School of Public Health, Curtin University, Bentley, Western Australia. (2)School of Population Health, The University of Western Australia, Crawley, Western Australia The Telethon Institute for Child Health Research and the Centre for Child Health Research, The University of Western Australia, Crawley, Western Australia. (3)Cancer Epidemiology Unit, CPO Piemonte and Department of Translational Medicine of the University of Eastern Piedmont, Novara, Italy. (4)The School of Public Health, University of Sydney, Sydney, Australia. (5)School of Population Health, The University of Western Australia, Crawley, Western Australia. (6)Venetian Mesothelioma Registry, Occupational Health Unit, Local Health Authority of Padua, Padua, Italy.

Abstract
BACKGROUND: The risk of malignant mesothelioma (MM) increases proportionally to the cumulative exposure, and to the 3rd or 4th power of time since first exposed, to asbestos. However, little is known about the risk of MM after more than 40 years since first exposure because most epidemiological studies do not have follow-up for sufficient periods of time. METHODS: The data from six cohort studies of exposed workers and two cohorts with residential exposure have been pooled. A nested case control design matched cases and controls on calendar period and age. Conditional logistic regression modelled the relationship between time since first exposure and risk of MM. RESULTS: The combined data consisted of 22 048 people with asbestos exposure (5769 women), 707 cases of pleural MM (165 in women) and 155 cases of peritoneal MM (32 in women). Median time since first exposure for pleural MM cases was 38.4 years (IQR 31.3-45.3). Median duration of exposure for pleural MM cases was 3.75 years (IQR 0.7-18.2). The rate and risk of pleural MM increased until 45 years following first exposure and then appeared to increase at a slower power of time since first exposure. The rate of increase in peritoneal MM over the 10-50 years since first exposure continued to increase. CONCLUSIONS: Exposure to asbestos confers a long-term risk of developing pleural and peritoneal mesothelioma which increases following cessation of exposure. While the rate of increase appears to start to level out after 40-50 years no one survives long enough for the excess risk to disappear.

18. Cantone L(1), Angelici L(1), Bollati V(1), Bonzini M(2), Apostoli P(3), Tripodi A(4), Bertazzi PA(1), Baccarelli AA(5). Extracellular histones mediate the effects of metal-rich air particles on blood coagulation. Environ Res. 2014 Jul;132:76-82. doi: 10.1016/j.envres.2014.03.029. Epub 2014 Apr 16.
Author information: (1)Center of Molecular and Genetic Epidemiology, Department of Clinical Sciences and Community, Università di Milano and Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy. (2)Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy. (3)Occupational Medicine and Industrial Hygiene, University of Brescia, Department of Experimental and Applied Medicine, Brescia, Italy. (4)Angelo Bianchi-Bonomi Haemophilia and Thrombosis Centre, Department of Medicine and Medical Specialties, IRCCS Maggiore Hospital, Mangiagalli and Regina Elena Foundation, Milan, Italy. (5)Laboratory of Environmental Epigenetics, Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA. Electronic address: abaccare@hsph.harvard.edu.

Abstract
BACKGROUND: Epidemiological studies have shown associations of particulate matter (PM) exposure with hypercoagulability and thrombosis. Extracellular circulating histones have recently been identified as novel mediators of inflammatory and procoagulant responses. The potential roles of extracellular histones in PM-related hypercoagulability have yet not been investigated. OBJECTIVES: In 63 steel workers, we evaluated the effects of exposure to PM and PM metal components on two extracellular histone modifications (H3K4me3 and H3K9ac); and the association of H3K4me3 and H3K9ac with coagulation markers. METHODS: Extracellular H3K4me3 and H3K9ac were determined in plasma through enzyme-linked immunosorbent assays. Coagulation markers included endogenous thrombin potentials (ETPs), tissue-type plasminogen activator antigen (t-PA) and D-dimer. Exposure to PM with aerodynamic diameters <1 μm (PM1) or <10 μm (PM10) and PM10 metal components were estimated for each participant. RESULTS: The coagulation marker ETP, measured in the presence of soluble thrombomodulin (ETP TM+), showed significant positive associations with PM1 (β=107.84, p=0.03), PM10 (β=83.06, p=0.02), and zinc (β=75.14, p=0.03); and a marginal association with iron (β=122.58, p=0.07). Additional PM effects were observed on t-PA, D-dimer, and ETP TM+. PM1 exposure was associated with increased plasma H3K4me3 and H3K9ac (β=0.20, p=0.02; β=0.16, p=0.05, respectively). H3K4me3, but not H3K9ac, was associated with zinc (β=0.13, p=0.03) and iron (β=0.32, p=0.01) contained in PM. ETP TM+ was increased in association with higher plasma H3K4me3 (β=0.50, p=0.05) and H3K9ac (β=0.54, p=0.05). CONCLUSIONS: This observational study suggests potential roles of extracellular histones in PM-induced hypercoagulability. Experimental studies are warranted to further characterize these findings.

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