rubrica

Lavoro

  • Dario Consonni1

  1. Clinica del lavoro, Milano

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Ricerca bibliografica periodo dal 16 febbraio 2015 al 30 aprile 2015

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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 ("2015/02/16"[PDAT] : "2015/04/30"[PDAT])
1. Corfiati M(1), Scarselli A(2), Binazzi A(3), Di Marzio D(4), Verardo M(5), Mirabelli D(6), Gennaro V(7), Mensi C(8), Schallemberg G(9), Merler E(10), Negro C(11), Romanelli A(12), Chellini E(13), Silvestri S(14), Cocchioni M(15), Pascucci C(16), Stracci F(17), Romeo E(18), Trafficante L(19), Angelillo I(20), Menegozzo S(21), Musti M(22), Cavone D(23), Cauzillo G(24), Tallarigo F(25), Tumino R(26), Melis M(27), Iavicoli S(28), Marinaccio A(29); ReNaM Working Group. Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry. BMC Cancer. 2015 Apr 15;15(1):286. [Epub ahead of print]
Author information: (1)Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy. m.corfiati@inail.it. (2)Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy. a.scarselli@inail.it. (3)Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy. a.binazzi@inail.it. (4)Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy. d.dimarzio@inail.it. (5)Regional Operating Center of Valle d'Aosta (COR Valle d'Aosta), Valle d'Aosta Health Local Unit, Aosta, Italy. mverardo@ausl.vda.it. (6)COR Piedmont, Unit of Cancer Prevention, University of Turin and CPO-Piemonte, Torino, Italy. dario.mirabelli@cpo.it. (7)COR Liguria, Epidemiology and Prevention Department, National Cancer Research Institute (IST), Genova, Italy. valerio.gennaro@istge.it. (8)COR Lombardy, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan, Milano, Italy. carolina.mensi@unimi.it. (9)COR Province of Trento, Provincial Unit of Health, Hygiene and Occupational Medicine, Trento, Italy. gert.schallenberg@apss.tn.it. (10)COR Veneto, Occupational Health Unit, Department of Prevention, Padua, Italy. enzo.merler@sanita.padova.it. (11)COR Friuli-Venezia Giulia, University of Trieste -Trieste General Hospitals, Clinical Unit of Occupational Medicine, Trieste, Italy. negro@units.it. (12)COR Emilia-Romagna, Health Local Unit, Public Health Department, Reggio Emilia, Italy. romanellia@ausl.re.it. (13)COR Tuscany, Cancer Prevention and Research Institute, Unit of Environmental and Occupational Epidemiology, Firenze, Italy. e.chellini@ispo.toscana.it. (14)COR Tuscany, Cancer Prevention and Research Institute, Unit of Environmental and Occupational Epidemiology, Firenze, Italy. s.silvestri@ispo.toscana.it. (15)COR Marche, Environmental and Health Sciences Department, University of Camerino, Hygienistic, Camerino, Italy. mario.cocchioni@unicam.it. (16)COR Marche, Environmental and Health Sciences Department, University of Camerino, Hygienistic, Camerino, Italy. cristiana.pascucci@unicam.it. (17)COR Umbria, University of Perugia, Department of Hygiene and public health, Perugia, Italy. fabs@unipg.it. (18)COR Lazio, Department of Experimental Medicine, University La Sapienza, Roma, Italy. e.romeo@deplazio.it. (19)COR Abruzzo, Health Local Unit, Occupational Medicine Unit, Pescara, Italy. medlav.tocco@virgilio.it. (20)COR Campania, Department of Experimental Medicine, Second University of Naples, Napoli, Italy. italof.angelillo@unina2.it. (21)COR Campania, Department of Experimental Medicine, Second University of Naples, Napoli, Italy. simonamenegozzo@alice.it. (22)COR Puglia, Department of Internal Medicine and Public Medicine, University of Bari, Section of Occupational Medicine "B. Ramazzini", Bari, Italy. m.musti@medlav.uniba.it. (23)COR Puglia, Department of Internal Medicine and Public Medicine, University of Bari, Section of Occupational Medicine "B. Ramazzini", Bari, Italy. d.cavone@medlav.uniba.it. (24)COR Basilicata, Epidemiologic Regional Center, Potenza, Italy. gabriella.cauzillo@regione.basilicata.it. (25)COR Calabria, Public Health Unit, Crotone, Italy. federicotallarigo@libero.it. (26)COR Sicily, "Civile - M.P. Arezzo" Hospital, Ragusa Cancer Register Unit, Ragusa, Italy. rtumino@tin.it. (27)COR Sardegna, Regional Epidemiological Center, Cagliari, Italy. massimelis@gmail.com. (28)Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy. s.iavicoli@inail.it. (29)Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy. a.marinaccio@inail.it.

Abstract
BACKGROUND: Previous ecological spatial studies of malignant mesothelioma cases, mostly based on mortality data, lack reliable data on individual exposure to asbestos, thus failing to assess the contribution of different occupational and environmental sources in the determination of risk excess in specific areas. This study aims to identify territorial clusters of malignant mesothelioma through a Bayesian spatial analysis and to characterize them by the integrated use of asbestos exposure information retrieved from the Italian national mesothelioma registry (ReNaM). METHODS: In the period 1993 to 2008, 15,322 incident cases of all-site malignant mesothelioma were recorded and 11,852 occupational, residential and familial histories were obtained by individual interviews. Observed cases were assigned to the municipality of residence at the time of diagnosis and compared to those expected based on the age-specific rates of the respective geographical area. A spatial cluster analysis was performed for each area applying a Bayesian hierarchical model. Information about modalities and economic sectors of asbestos exposure was analyzed for each cluster. RESULTS: Thirty-two clusters of malignant mesothelioma were identified and characterized using the exposure data. Asbestos cement manufacturing industries and shipbuilding and repair facilities represented the main sources of asbestos exposure, but a major contribution to asbestos exposure was also provided by sectors with no direct use of asbestos, such as non-asbestos textile industries, metal engineering and construction. A high proportion of cases with environmental exposure was found in clusters where asbestos cement plants were located or a natural source of asbestos (or asbestos-like) fibers was identifiable. Differences in type and sources of exposure can also explain the varying percentage of cases occurring in women among clusters. CONCLUSIONS: Our study demonstrates shared exposure patterns in territorial clusters of malignant mesothelioma due to single or multiple industrial sources, with major implications for public health policies, health surveillance, compensation procedures and site remediation programs.

Breve commento a cura di Dario Consonni
L’amianto continua a produrre vittime a decenni di distanza dal suo utilizzo. Mentre sono ben documentati gli effetti tra i lavoratori esposti ad amianto e i loro familiari (anche se le continue ricerche sono necessarie per quantificare l’impatto), minori sono le informazioni disponibili sulle esposizioni ambientali, molto più difficili da identificare e quindi analizzare. In questo articolo, utilizzando i dati raccolti dal Registro Nazionale Mesoteliomi (ReNaM), gli autori hanno identificato 32 clusters di mesoteliomi sull’intero territorio italiano e hanno dettagliato il contributo delle esposizioni occupazionali, familiari e ambientali.

2. Stenehjem JS(1), Kjærheim K(1), Bråtveit M(2), Samuelsen SO(3), Barone-Adesi F(4), Rothman N(5), Lan Q(5), Grimsrud TK(1). Benzene exposure and risk of lymphohaematopoietic cancers in 25 000 offshore oil industry workers. Br J Cancer. 2015 Apr 28;112(9):1603-12. doi: 10.1038/bjc.2015.108. Epub 2015 Mar 24.
Author information: (1)Department of Research, Cancer Registry of Norway, P.O. Box 5313 Majorstuen, Oslo N-0304, Norway. (2)Department of Global Public Health and Primary Care, University of Bergen, Bergen N-5020, Norway. (3)Department of Mathematics, University of Oslo, Oslo N-0316, Norway. (4)1] Population Health Research Institute, St George's University of London, London SW17 0RE, UK [2] Department of Pharmaceutical Sciences, University of Eastern Piedmont, Novara 28100, Italy. (5)Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA.

Abstract
BACKGROUND: The aim of this work was to examine the risk of lymphohaematopoietic (LH) cancer according to benzene exposure among offshore workers. METHODS: Cancer registry data were used to identify 112 cancer cases diagnosed during 1999-2011 in a cohort of 24 917 Norwegian men reporting offshore work between 1965 and 1999. Analyses were conducted according to a stratified case-cohort design with a reference subcohort of 1661 workers. Cox regression was used to estimate hazard ratios with 95% confidence intervals, adjusted for other benzene exposure and smoking. RESULTS: Most workers were exposed to benzene for <15 years. The upper range values of average intensity and cumulative exposure were estimated to 0.040 p.p.m. and 0.948 p.p.m.-years, respectively. Risks were consistently elevated among exposed workers for all LH cancers combined and for most subgroups, although case numbers were small and yielded imprecise risk estimates. There was evidence of dose-related risk patterns according to cumulative exposure for acute myeloid leukaemia (AML), multiple="multiple" myeloma (MM) (P trends 0.052 and 0.024, respectively), and suggestively so for chronic lymphocytic leukaemia (CLL) according to average intensity (P trend 0.094). CONCLUSIONS: Our results support an association between cumulative and intensity metrics of low-level benzene exposure and risk for AML, MM, and suggestively for CLL.

Breve commento a cura di Dario Consonni
Mentre sono ben noti da decenni gli effetti leucemogeni di alte esposizioni a benzene, più incerti sono gli effetti causati da basse esposizioni protratte e vi è dibattito sui tipi di tumori linfoemopoietici coinvolti. Questo articolo presenta uno studio caso-coorte effettuato su quasi 25.000 lavoratori offshore in Norvegia utilizzando i dati del registro tumori. I risultati suggeriscono un’associazione tra esposizione a bassi livelli di benzene e vari tipi di tumori linfoemopietici (leucemia mieloide acuta, mieloma multiplo, leucemia linfatica cronica).

3. Lamberti M(1), Uccello R(1), Monaco MG(1), Muoio M(1), Sannolo N(1), Arena P(1), Mazzarella G(2), Arnese A(1), La Cerra G(2). Prevalence of latent tuberculosis infection and associated risk factors among 1557 nursing students in a context of low endemicity. Open Nurs J. 2015 Feb 27;9:10-4. doi: 10.2174/1874434601509010010. eCollection 2015.
Author information: (1)Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy. (2)Department of Cardio-Thoracic and Respiratory Science, Second University of Naples, Naples, Italy.

Abstract
INTRODUCTION: The risk of tuberculosis (TBC) in nurses is related to its incidence in the general population. Nursing students involved in clinical training could be exposed to occupational risks similar to those of healthcare workers (HCWs). To better understand the epidemiology of nosocomial TBC among nurses in a context of low endemicity, we recruited a cohort of young nursing trainees at the Second University of Naples. METHODS: A screening programme for LTBI in nursing students was conducted between January 2012 and December 2013, at the Second University of Naples, with clinical evaluations, tuberculin skin test (TST) and, in positive TST student, the interferon-g release assays (IGRA). Putative risk factors for LTBI were assessed by a standardized questionnaire. RESULTS: 1577 nursing students attending the Second University of Naples have been submitted to screening programme for TBC. 1575 have performed TST as first level test and 2 Quantiferon test (QFT). 19 students were TST positive and continued the diagnostic workup practicing QFT, that was positive in 1 student. Of the 2 subjects that have practiced QFT as first level test only 1 was positive. In 2 students positive to QFT test we formulated the diagnosis of LTBI by clinical and radiographic results. CONCLUSION: The prevalence of LTBI among nursing students in our study resulted very low. In countries with a low incidence of TBC, the screening programs of healthcare students can be useful for the early identification and treatment of the sporadic cases of LTBI.

4. Schepisi MS(1), Sotgiu G(2), Contini S(1), Puro V(1), Ippolito G(3), Girardi E(1). Tuberculosis Transmission from Healthcare Workers to Patients and Co-workers: A Systematic Literature Review and Meta-Analysis. PLoS One. 2015 Apr 2;10(4):e0121639. doi: 10.1371/journal.pone.0121639. eCollection 2015.
Author information: (1)Department of Epidemiology and Preclinical Research, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy. (2)Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy. (3)Office of the Scientific Director, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy.

Abstract
Healthcare workers (HCWs) are at risk of becoming infected with tuberculosis (TB), and potentially of being infectious themselves when they are ill. To assess the magnitude of healthcare-associated TB (HCA-TB) transmission from HCWs to patients and colleagues, we searched three electronic databases up to February 2014 to select primary studies on HCA-TB incidents in which a HCW was the index case and possibly exposed patients and co-workers were screened.We identified 34 studies out of 2,714 citations. In 29 individual investigations, active TB was diagnosed in 3/6,080 (0.05%) infants, 18/3,167 (0.57%) children, 1/3,600 (0.03%) adult patients and 0/2,407 HCWs. The quantitative analysis of 28 individual reports showed that combined proportions of active TB among exposed individuals were: 0.11% (95% CI 0.04-0.21) for infants, 0.38% (95% CI 0.01-1.60) for children, 0.09% (95% CI 0.02-0.22) for adults and 0.00% (95% CI 0.00-0.38) for HCWs. Combined proportions of individuals who acquired TB infection were: 0.57% (95% CI 7.28E-03 - 2.02) for infants, 0.9% (95% CI 0.40-1.60) for children, 4.32% (95% CI 1.43-8.67) for adults and 2.62% (95% CI 1.05-4.88) for HCWs. The risk of TB transmission from HCWs appears to be lower than that recorded in other settings or in the healthcare setting when the index case is not a HCW. To provide a firm evidence base for the screening strategies, more and better information is needed on the infectivity of the source cases, the actual exposure level of screened contacts, and the environmental characteristics of the healthcare setting.

5. Peluso ME(1), Munnia A(2), Giese RW(3), Chellini E(4), Ceppi M(5), Capacci F(6). Oxidatively damaged DNA in the nasal epithelium of workers occupationally exposed to silica dust in Tuscany region, Italy. Mutagenesis. 2015 Mar 14. pii: gev014. [Epub ahead of print]
Author information: (1)Cancer Risk Factor Branch, Cancer Prevention Laboratories, Cancer Prevention and Research Institute, Via Cosimo il Vecchio 2, Florence, Italy, Department of Pharmaceutical Sciences in the Bouve College of Health Sciences, Barnett Institute, Northeastern University, 360 Huntington Avenue, Boston, MA, USA, Environmental and Occupational Epidemiology Unit, Cancer Prevention and Research Institute, Via delle Oblate 4, Florence, Italy, IRCSS San Martino Hospital - National Cancer Research Institute, Largo R. Benzi 10, Genoa 16132, Italy and Functional Unit for Prevention, Health and Safety in the Workplace, ASL10, Via della Cupola 64, Florence, Italy m.peluso@ispo.toscana.it. (2)Cancer Risk Factor Branch, Cancer Prevention Laboratories, Cancer Prevention and Research Institute, Via Cosimo il Vecchio 2, Florence, Italy, Department of Pharmaceutical Sciences in the Bouve College of Health Sciences, Barnett Institute, Northeastern University, 360 Huntington Avenue, Boston, MA, USA, Environmental and Occupational Epidemiology Unit, Cancer Prevention and Research Institute, Via delle Oblate 4, Florence, Italy, IRCSS San Martino Hospital - National Cancer Research Institute, Largo R. Benzi 10, Genoa 16132, Italy and Functional Unit for Prevention, Health and Safety in the Workplace, ASL10, Via della Cupola 64, Florence, Italy. (3)Department of Pharmaceutical Sciences in the Bouve College of Health Sciences, Barnett Institute, Northeastern University, 360 Huntington Avenue, Boston, MA, USA. (4)Environmental and Occupational Epidemiology Unit, Cancer Prevention and Research Institute, Via delle Oblate 4, Florence, Italy. (5)IRCSS San Martino Hospital - National Cancer Research Institute, Largo R. Benzi 10, Genoa 16132, Italy and. (6)Functional Unit for Prevention, Health and Safety in the Workplace, ASL10, Via della Cupola 64, Florence, Italy.

Abstract
Chronic silica exposure has been associated to cancer and silicosis. Furthermore, the induction of oxidative stress and the generation of reactive oxygen species have been indicated to play a main role in the carcinogenicity of respirable silica. Therefore, we conducted a cross-sectional study to evaluate the prevalence of 3-(2-deoxy-β-D-erythro-pentafuranosyl)pyrimido[1,2-α]purin-10(3H)-one deoxyguanosine (M1dG) adducts, a biomarker of oxidative stress and peroxidation of lipids, in the nasal epithelium of 135 silica-exposed workers, employed in pottery, ceramic and marble manufacturing plants as well as in a stone quarry, in respect to 118 controls living in Tuscany region, Italy. The M1dG generation was measured by the (32)P-postlabelling assay. Significant higher levels of M1dG adducts per 10(8) normal nucleotides were observed in the nasal epithelium of smokers, 77.9±9.8 (SE), and in those of former smokers, 80.7±9.7 (SE), as compared to non-smokers, 57.1±6.2 (SE), P = 0.001 and P = 0.004, respectively. Significant increments of M1dG adducts were found in the nasal epithelium of workers that handle artificial marble conglomerates, 184±36.4 (SE), and in those of quarry workers, 120±34.7 (SE), with respect to controls, 50.6±2.7 (SE), P = 0.014 and P < 0.001, respectively. Null increments were observed in association with the pottery and the ceramic factories. After stratification for different exposures, silica-exposed workers that were co-exposed to organic solvents, and welding and exhaust fumes have significantly higher M1dG levels, 90.4±13.4 (SE), P = 0.014 vs.CONTROL: Our data suggested that silica exposure might be associated with genotoxicity in the nasal epithelial cells of silica-exposed workers that handle of artificial marble conglomerates and quarry workers. Importantly, we observed that co-exposures to other respiratory carcinogens may have contributed to enhance the burden of M1dG adducts in the nasal epithelium of silica-exposed workers.

6. Costas L(1), Infante-Rivard C(2), Zock JP(3), Van Tongeren M(4), Boffetta P(5), Cusson A(6), Robles C(7), Casabonne D(8), Benavente Y(8), Becker N(9), Brennan P(10), Foretova L(11), Maynadié M(12), Staines A(13), Nieters A(14), Cocco P(15), de Sanjosé S(1). Occupational exposure to endocrine disruptors and lymphoma risk in a multi-centric European study. Br J Cancer. 2015 Mar 31;112 Suppl:1251-6. doi: 10.1038/bjc.2015.83.
Author information: (1)1] Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, 08908 Barcelona, Spain [2] Department of Medicine, University of Barcelona, 08036 Barcelona, Spain [3] CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain. (2)Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada H3A 1A2. (3)1] CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain [2] Netherlands Institute for Health Services Research (NIVEL), 3500 Utrecht, The Netherlands [3] Centre for Research in Environmental Epidemiology (CREAL), 08003 Barcelona, Spain [4] Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain. (4)Centre for Human Exposure Science (CHES), Institute of Occupational Medicine, EH14 4AP Edinburgh, UK. (5)Tisch Cancer Institute and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, 10029 NY, USA. (6)Centre de Recherche, CHU Sainte-Justine, Montréal, QC, Canada H3T 1C4. (7)Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, 08908 Barcelona, Spain. (8)1] Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, 08908 Barcelona, Spain [2] CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain. (9)Division of Cancer Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany. (10)IARC, International Agency for Research on Cancer, 69372 Lyon, France. (11)Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute and MF MU, 65653 Brno, Czech Republic. (12)Biological Hematology Unit, CRB Ferdinand Cabanne, Universitary Hospital of Dijon and EA4184, University of Burgundy, EA 4184 Dijon, France. (13)Public Health University College, Dublin, Ireland. (14)Centre of Chronic Immunodeficiency, Molecular Epidemiology, University Medical Center Freiburg, 79106 Freiburg, Germany. (15)Department of Public Health, Clinical and Molecular Medicine, Occupational Health Section, University of Cagliari, 09124 Cagliari, Italy.

Abstract
BACKGROUND: Incidence rates of lymphoma are usually higher in men than in women, and oestrogens may protect against lymphoma. METHODS: We evaluated occupational exposure to endocrine disrupting chemicals (EDCs) among 2457 controls and 2178 incident lymphoma cases and subtypes from the European Epilymph study. RESULTS: Over 30 years of exposure to EDCs compared to no exposure was associated with a 24% increased risk of mature B-cell neoplasms (P-trend=0.02). Associations were observed among men, but not women. CONCLUSIONS: Prolonged occupational exposure to endocrine disruptors seems to be moderately associated with some lymphoma subtypes.

7. Chellini E(1), Martino G(2), Grillo A(3), Fedi A(3), Martini A(4), Indiani L(2), Mauro L(3). Malignant Mesotheliomas in Textile Rag Sorters. Ann Occup Hyg. 2015 Feb 19. pii: meu114. [Epub ahead of print]
Author information: (1)Unit of Environmental and Occupational Epidemiology, Cancer Prevention and Research Institute, Firenze I-50141, Italy; e.chellini@ispo.toscana.it. (2)Specialization School in Hygiene and Public Health, University of Florence, Florence I-50139, Italy; (3)Occupational Health Service, Local Health Authority of Prato, Prato I-59100, Italy. (4)Unit of Environmental and Occupational Epidemiology, Cancer Prevention and Research Institute, Firenze I-50141, Italy;

Abstract
OBJECTIVES: To analyse the asbestos exposure characteristics and mesothelioma trend in textile workers operating in the larger Tuscan textile industrial province of Prato between 1988 and 2012. METHODS: All cases of textile workers recorded by the Tuscan mesothelioma register are considered. The demographic and clinical characteristics and asbestos exposure of cases working in the province of Prato are examined. Crude incidence rates between 1988 and 2012 and their 95% confidence intervals (CI) are calculated in rag sorters and other textile workers. The trends of standardized rates are also evaluated, as well as the sources of occupational asbestos exposure from occupational histories of cases affected by other asbestos-related diseases in rag sorters. RESULTS: One hundred and seventy-two malignant mesotheliomas (MMs) have been diagnosed in textile workers in Tuscany. Among these, 46.5% were residents in the province of Prato at the time of diagnosis, half of whom working as rag sorters. All rag sorters with MM are classified as occupationally asbestos exposed, while 71.7% are other textile workers exposed to asbestos. The estimated crude incidence rate in rag sorters in Prato ranges from 74.1×100000 (95% CI: 52.5-101.8) to 166.8×100000 (95% CI: 118.1-229.0). The standardized rates in Prato rag sorters appeared higher throughout the 1990s while in other Prato textile workers the rates increased later on, at the very end of the 1990s. Another 40 cases of asbestos-related diseases in rag sorters were also collected. CONCLUSIONS: A very high incidence of MMs was observed in textile workers in Prato, especially among rag sorters. This result, together with the high number of other asbestos-related diseases in rag sorters, strongly supports the hypothesis of diffuse asbestos exposure in rag sorting, in the absence of any other relevant aetiological factor for malignant mesothelioma.

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