Return to work after organ transplantation: a cross-sectional study on working ability evaluation and employment status.

INTRODUCTION: Organ transplantation has increased in Italy over the last decade. Thus, an increasing number of workers may face the problem of returning to work. The aim of this study was to provide an assessment of working ability of transplant recipients in comparison with their actual employment status. METHODS: This study was based on 150 patients who underwent transplantation since 1994 and who underwent periodic post-transplantation examination during 2012. Fifty patients who had undergone heart transplantation (HT), 50 liver transplantation (LT), and 50 kidney transplantation (KT) and survived at least 12 months after surgery were eligible for this study. All patients underwent the International Classification of Functioning, Disabilities and Health (ICF) questionnaire; ten questions were further applied to those who were employed at the time of the study. X(2) statistics were used to compare working ability evaluation and employment status and for internal comparison among different organ recipients. RESULTS: The employment status was as follows: 92 (61%) patients were in paid employment, 6 (4%) were students or housewives, 36 (24%) were unemployed, and 17 (11%) were retired because of invalidity benefits. According to our fitness evaluation only 4% to 10% of the patients were unfit for any job. When we excluded retired subjects, the X(2) statistics for correlated observations showed a highly significant statistical difference (P < .0001) between unemployed and unfit. As a result of the ICF questionnaire administration, there was a marked difference, although not statistically significant, in the fitness for previously performed jobs between KT and LT recipients (62% and 58%, respectively) and HT recipients (42%). DISCUSSION AND CONCLUSION: In this cross-sectional study we found a relatively high rate of unemployment as compared with the working ability evaluation by ICF questionnaire and other questions. This may be due to several factors including health status and the possibility of gaining an adequate job. The ICF questionnaire proved to be a useful framework that can be used for research but also by occupational physicians in their usual practice after specific training.

[The evaluation of biological effects of exposure to respirable crystalline silica in building industry]. / Esposizione a Silice Libera Cristallina in edilizia: valutazione degli effetti biologici.

The building industry entails the exposure to Respirable Crystalline Silica (RCS), though there is a large variability among different sectors. The environmental values reported for the current conditions seem to be relatively low. For example the mean exposure estimated by IOM for all industrial sectors in the EU is 0.07 mg/m3. There are few studies in the building sector which show similar values. This is obviously not representative of past exposure. Moreover, the problems of sampling and analysis techniques are still at issue. The well known effect of RCS exposure is silicosis. The carcinogenicity of RCS is still under debate, especially regarding the question of whether RCS is carcinogenic "per se" or whether the risk of developing lung cancer is mediated by silicosis. Although the IARC includes RCS in the Group I (human carcinogen), the reference should be the CLP regulation, of which carcinogen definition criteria allow to state that today there are not sufficient data to classify RCS as a carcinogen and that it seems more appropriate to include RCS in different STOT.RE categories. This is valid for building industry as well as for the other industrial sectors. In Italy the recommended exposure limit is the ACGIH value of 0.025 mg/m3. At EU level it is still debated which is the best choice, based on cost/benefits evaluation, among the following limit values: 0.2, 0.1 and 0.05 respectively. The authors obviously believe that the most protective value should be adopted.

Mortality from cancer and other causes in the Balangero cohort of chrysotile asbestos miners.

OBJECTIVES: To provide further information on mortality from cancer and other causes among chrysotile asbestos miners several years after exposure ceased, we updated the analyses from the Balangero mine worker cohort with follow-up to the end of 2003. METHODS: The cohort included 1056 men, for a total of 34 432 man-years of observation. We obtained employment data from factory personnel records, and ascertained vital status and causes of death through population registers and death certificates from municipal registration offices. We computed expected numbers of deaths and standardised mortality ratios (SMRs) for relevant causes using the province of Turin and national death rates, for each 5-year calendar period and age group. RESULTS: We found a significant excess mortality from pleural cancer only (4 deaths, SMR 4.67) and pleural and peritoneal cancers combined (5 deaths, SMR 3.16). All pleural and peritoneal cancer deaths occurred 30 or more years after first exposure. The SMRs were 1.27 for lung cancer (45 deaths), 1.82 for laryngeal cancer (8 deaths) and 1.12 for all cancers (142 deaths). Cumulative dust exposure and the various time factors considered did not show a clear pattern of risk associated with mortality from lung cancer. There were 57 deaths from cirrhosis (SMR 2.94) and 54 from accidents and violence (SMR 1.88). Overall, we observed a total of 590 deaths as compared to 412.9 expected (SMR 1.43). CONCLUSIONS: This updated analysis, with almost 60% of the cohort having died, confirmed the excess mortality from pleural and peritoneal cancers and from several alcohol-related causes.

First and subsequent asbestos exposures in relation to mesothelioma and lung cancer mortality.

We analysed data from a cohort of 1966 subjects (889 men and 1,077 women) employed by an Italian asbestos (mainly textile) company in the period 1946-1984, who were followed-up to 2004. A total of 62,025 person-years of observation were recorded. We computed standardised mortality ratios (SMR) for all causes and selected cancer sites using national death rates for each 5-year calendar period and age group. There were 68 deaths from mesothelioma (25 men and 43 women, 39 pleural and 29 peritoneal) vs 1.6 expected (SMR=4,159), and 109 from lung cancer vs 35.1 expected (SMR=310). The SMRs of pleural/peritoneal cancer were 6661 for subjects exposed only before 30 years of age, 8,019 for those first exposed before 30 and still employed at 30-39 years of age and 5,786 for those first exposed before 30 and still employed at 40 or more years of age. The corresponding SMRs for lung cancer were 227, 446 and 562. The SMR of mesothelioma was strongly related to time since first exposure. The SMR of lung cancer, but not of mesothelioma, appeared to be related to subsequent exposures.

[IARC evaluations: how are they conducted and what suggestions are derived therefrom?]. / Le valutazioni IARC: come sono condotte e quali implicazioni ne derivano?

The IARC Monographs on the Evaluation of Carcinogenic Risks to Humans are considered by several Institutions a point of reference for the prevention of adverse effects (namely cancer) of occupational exposures. The conclusions which lead to the Classification of a substance or an industrial process are the results of a vote within a Working Group of experts and are expressed in terms of "evidence" based on both epidemiological and experimental data or "other relevant data". Several points are discussed which include the methods of identification of the experts, the criteria of evaluation of the available data, the meaning of some definitions and finally the impact of IARC conclusions and Classification on Public Health regulations and secondarily on compensation procedures or trial decisions. Three recent examples regarding the Classification of Free Crystalline Silica, Shift-Work and Vinyl Chloride Monomer, which cannot be accepted as such without some criticism, are reported. In conclusion the Authors appreciate the effort of the IARC to provide a source of information which "may assist national and international authorities in making risk assessments and in formulating decisions concerning any necessary preventive measures". However, they suggest that the IARC "overall evaluation" should not be taken as confidently as if no doubt at all would exist on the final statement and the consequent Classification. Some suggestions as to the solution of the question are also provided.

[Asbestosis and microfiber role]. / Patologia da asbesto e ruolo delle microfibre.

Based on the predominant content of thin and short asbestos fibres in lung and mesothelioma tissues, it was recently stated (2005) that such fibres "appear to contribute to the causation of human malignant mesothelioma". In another study of the same year it was stated that fibres in the order of few microm length and 0.2 microm diameter are the sole able to induce mesothelioma. This scientific conclusions entail some implications from practical point of view. The enormous amount of information gained on asbestos in the last decades is based on the definition of a fibre as an alongated particle with an aspect-ratio of at least 3:1, a diameter < or = 3 microm and a length > or = 5 microm. These parameters were used up today to define occupational and in some case non-occupational limits. In which way can "reference" values be established if all lengths or only fibres shorter than 5 microm are considered? Nowadays we have no answer. Secondly, assuming a prevalent role of such fibres especially in mesothelioma cases, how can reliable estimates of past exposure obtained in a medico-legal context, since they have never been counted? Morever, how might he the employer responsibility assessed since short fibres were not measured by definition pathogenic, and this not measured, nor were there appropriate filtering systems up to the middle of the '80?

[A rapid model of risk assessment of the biomechanical overload to the whole skeletal system]. / Metodo semplificato per l'individuazione del rischio di sovraccarico biomeccanico del sistema osteoarticolare.

A tool easy to apply is presented that can be used in ergonomic analysis of 1st level to identify the risk factors of biomechanical overload of the skeletal structures. The model is an evolution of a previous proposal, published in 2001, which was aimed at evaluation of the only upper arms: the present model also permits the evaluation of the spine (cervical and torso-lumbar tract) and of the inferior arms. A red flag judgement criterion has been maintained and, if an item is marked, there is the possibility to recognise the cause of the ergonomic criticality and to plan the correction according to a scale of ergonomic priority. The aim of this communication is to stimulate a wide participation in the project to develop a model for the risk assessment of biomechanical overload to the whole skeletal system.

Cancer mortality in a cohort of asbestos textile workers.

A cohort of 889 men and 1077 women employed for at least 1 month between 1946 and 1984 by a former Italian leading asbestos (mainly textile) company, characterised by extremely heavy exposures often for short durations, was followed up to 1996, for a total of 53,024 person-years of observation. Employment data were obtained from factory personnel records, while vital status and causes of death were ascertained through municipality registers and local health units. We observed 222 cancer deaths compared with 116.4 expected (standardized mortality ratio, SMR=191). The highest ratios were found for pleural (SMR=4105), peritoneal (SMR=1817) and lung (SMR=282) cancers. We observed direct relationships with duration of employment for lung and peritoneal cancer, and with time since first employment for lung cancer and mesothelioma. Pleural cancer risk was independent from duration (SMR=3428 for employment <1 year, 7659 for 1-4 years, 2979 for 5-9 years and 2130 for > or =10 years). Corresponding SMRs for lung cancer were 139, 251, 233 and 531. Nonsignificantly increased ratios were found for ovarian (SMR=261), laryngeal (SMR=238) and oro-pharyngeal (SMR=226) cancers. This study confirms and further quantifies the central role of latency in pleural mesothelioma and of cumulative exposure in lung cancer.

[Asbestos fibres and reference values]. / Fibre di amianto e V.R.

Biological RV for asbestos implies several problems, due to the difficult interpretation of values obtained from various biological samples (sputum, BALF, lung tissue). Therefore, it seems it advisable to refer to environmental concentrations (ERC), which are not avoidable, since asbestos is an ubiquitous contaminant. On the basis of the available studies the 1 f/L value is usually reported as the most representative, although more recent and reliable studies would indicate lower values, at least for outdoor concentrations, as determined by SEM. However, further studies are needed: standardized methods based on SEM (author's opinion) should be adopted; the accuracy of such technique is sufficient for air concentrations from 0.05-0.1 f L-1 upwards, with the advantage of lower costs and time as compared to TEM.

Cancer mortality among rice growers in Novara Province, northern Italy.

Some excess of non-Hodgkin lymphomas (NHL) and soft tissue sarcomas (STS) was reported in the literature among agricultural workers, mainly in relation to exposure to phenoxyacids and chlorophenols. In this study, information was analyzed for a cohort of rice growers that comprised 1,493 subjects, and for a follow-up that was more than 99% complete with regard to both traced subjects and known causes of deaths. A total of 960 subjects (65%) died during the observation period (1957-1992). Lower than expected standardized mortality ratios (SMRs) were found for all causes, for cardiovascular diseases (especially ischemic heart disease) and for all cancers. Slightly increased SMRs were found for some cancer sites (oral cavity, esophagus, liver, intestines, pancreas, bladder, STS, and NHL), although none of these was statistically significant in the overall analysis. An excess risk of close to statistical significance was found for NHL among workers with longer exposure during the period when phenoxyacid herbicide was in use (1950-1992). Thus, a prolonged follow-up is advisable. At present the study should be evaluated in the context of the data set suggesting a tendency toward an increased risk of NHL among farmers.