Pleural mesothelioma risk in the construction industry: a case-control study in Italy, 2000-2018

Objectives Workers in the construction industry have been exposed to asbestos in various occupations. In Italy, a National Mesothelioma Registry has been implemented more than 20 years ago. Using cases selected from this registry and exploiting existing control data sets, we estimated relative risks for pleural mesothelioma (PM) among construction workers. DesignCase-control study. SettingCases from the National Mesothelioma Registry (2000-2018), controls from three previous case-control studies. MethodsWe selected male PM incident cases diagnosed in 2000-2018. Population controls were taken from three studies performed in six Italian regions within two periods (2002-2004 and 2012-2016). Age-adjusted and period-adjusted unconditional logistic regression models were fitted to estimate odds ratios (OR) for occupations in the construction industry. We followed two approaches, one (primary) excluding and the other (secondary) including subjects employed in other non-construction blue collar occupations for >5 years. For both approaches, we performed an overall analysis including all cases and, given the incomplete temporal and geographic overlap of cases and controls, three time or/and space restricted sensitivity analyses. ResultsThe whole data set included 15 592 cases and 2210 controls. With the primary approach (4797 cases and 1085 controls), OR was 3.64 (2181 cases) for subjects ever employed in construction. We found elevated risks for blue-collar occupations (1993 cases, OR 4.52), including bricklayers (988 cases, OR 7.05), general construction workers (320 cases, OR 4.66), plumbers and pipe fitters (305 cases, OR 9.13), painters (104 cases, OR 2.17) and several others. Sensitivity analyses yielded very similar findings. Using the secondary approach, we observed similar patterns, but ORs were remarkably lower. ConclusionsWe found markedly increased PM risks for most occupations in the construction industry. These findings are relevant for compensation of subjects affected with mesothelioma in the construction industry

Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry

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

Minimally invasive valve surgery: pushing boundaries over the eighty

Background: Mean age of patients with valves diseases is significantly increasing, and, in the near future, cardiac surgeons will have to deal with a considerable number of patients aged more than 80 years. The remarkable results gained by the minimally invasive approach have encouraged its application in more complex and fragile patients, such as older people. This study aimed to identify the rate of early mortality and major complications, and independent predictors for mid-term mortality in octogenarians undergoing minimally invasive valve surgery. Methods: Octogenarian patients undergoing right mini-thoracotomy mitral and/or tricuspid valve surgery between 2006 and 2020 were included. Primary endpoint was to identify independent predictors for mid-term mortality, and secondary endpoints were operative morality, stroke, independent predictors for early composite outcome, and quality of life at follow-up. Results: Analysis was performed on 130 patients. Stroke occurred in one patient (0.8%), while operative mortality was 6% (eight patients). One-year and five-year survival were 86% and 64%, respectively. Logistic regression identified age and creatinine level as independent predictors of mid-term mortality, survival analysis showed that age ≥ 84 years and creatinine level ≥ 1.22 mg/dL were the cut-off points for worst prognosis. Female gender and hypertension were found to be independent predictors of early composite outcome. Conclusions: Results of the present study show that age alone should not be considered a contraindication for minimally invasive valve surgery. Identifying patients who are most likely to have survival and functional benefits after surgery is decisive to achieve optimal health outcomes and prevent futile procedures

Solar National Pizes

Esito: Primo Premio Componente dello staff di progettazione _ per le problematiche di restauro delle architetture _ del progetto "Civitavecchia Port and Waterfront Project

Il Dottorato di Ricerca: Che cos’è?

The Italian University reform, initiated in 1999 with Ministerial Decree MIUR no. 509 and subsequently evolved through various legislative measures, is grounded in three key principles: University autonomy, innovation in higher education, and harmonization with the European Higher Education Area (EHEA). The reform aims to facilitate mobility and employability of graduates within the European labor market. Rooted in decisions made by European Union governments under the "Bologna Process" and the intergovernmental agreement signed in Bologna in June 1999, the objective was to establish a European Higher Education Area based on principles of academic freedom, quality, mobility, and openness. A fundamental element of the reform is the three-cycle educational and degree structure comprising the bachelor's, master's, and doctoral levels. The bachelor's and master's degrees, known in Italy as the "3+2 educational system," each with a specific credit requirement, serve as distinct and propaedeutic educational steps leading to access to the doctoral program, representing the third cycle of studies. The doctoral program emphasizes acquiring interdisciplinary and specific skills for independent research and is a qualifying requirement for an academic career. Admission to the doctoral program is subject to public selection, and candidates must hold at least a master's degree or equivalent. The doctoral thesis, usually written in Italian and/or English, undergoes evaluation by at least two external reviewers from different Universities, whose favorable opinions are essential for the final doctoral examination. The conclusive defense for the degree takes place publicly before an expert committee. The doctoral degree is also a necessary qualification for participating in public competitions for fixed-term research positions (RTDA and RTDB), with the possibility of subsequent confirmation as tenured associate professors. In conclusion, the Italian University reform has aligned higher education with European standards, emphasizing the doctoral program as a cornerstone for cultivating high-quality researchers and accessing an academic career. This achievement is realized through harmonization with the principles of the "Bologna Process" and the adoption of a three-cycle university education system with comprehensible and comparable degrees.La riforma universitaria italiana, iniziata nel 1999 con il Decreto ministeriale MIUR n. 509 e successivamente evolutasi attraverso vari provvedimenti legislativi, si basa su 3 principi chiave: l'autonomia delle università, l'innovazione nell'istruzione superiore e l'armonizzazione con lo Spazio Europeo dell'Istruzione Superiore (EHEA), al fine di agevolare la mobilità e l'occupabilità dei laureati all'interno del mercato del lavoro europeo. Questa riforma trova le sue radici nelle decisioni assunte dai governi dell'Unione Europea nell'ambito del c.d. “Processo di Bologna” e dell'accordo intergovernativo dell’Unione Europea sottoscritto a Bologna nel giugno 1999 (Conferenza di Bologna). L'obiettivo era creare uno Spazio Europeo dell'Istruzione Superiore basato su principi di libertà accademica, qualità, mobilità e apertura all'esterno. In questo contesto, uno degli elementi fondamentali della riforma è la struttura formativa e di titoli basata su tre cicli comprendente la laurea, la laurea magistrale e il dottorato di ricerca. La laurea e la laurea magistrale, noti in Italia anche come “sistema formativo 3+2”, ciascuna con un numero specifico di crediti, fungono da gradini formativi distinti e propedeutici per l’accesso al dottorato di ricerca che corrisponde al terzo ciclo di studi. Il Dottorato di ricerca è caratterizzato dall'acquisizione di competenze trasversali e specifiche per svolgere attività di ricerca in autonomia ed è requisito qualificante per l’accesso alla carriera accademica. L'accesso al dottorato è soggetto a selezioni pubbliche e i candidati devono essere in possesso di una laurea magistrale o equivalente quale requisito minimo. La tesi di dottorato, scritta solitamente in italiano e/o inglese, viene valutata da almeno due revisori esterni all'università erogante il titolo e il cui parere favorevole è condizione indispensabile per sostenere l’esame finale di dottorato. La discussione conclusiva per il conseguimento del titolo avviene pubblicamente, davanti a una commissione di esperti. Il dottorato costituisce inoltre un titolo necessario per partecipare al concorso pubblico per ricercatori con contratto di lavoro a tempo determinato lettera A (RTDA) e di lettera B (RTDB) dopo i quali si ha la possibilità di essere confermati come professori associati a tempo indeterminato. In conclusione, la riforma universitaria italiana ha introdotto un sistema di istruzione superiore in linea con gli standard europei, ponendo un'enfasi significativa sul dottorato di ricerca come chiave di volta per la formazione di ricercatori di alta qualità e per l'accesso alla carriera accademica. Ciò è stato reso possibile attraverso l'armonizzazione con i principi indicati dal “Processo di Bologna” e l'adozione di un sistema formativo universitario con titoli comprensibili e comparabili basato sul sistema a tre cicli

Factors Affecting Asbestosis Mortality Among Asbestos-Cement Workers in Italy

Objectives This study was performed with the aim of investigating the temporal patterns and determinants associated with mortality from asbestosis among 21 cohorts of Asbestos-Cement (AC) workers who were heavily exposed to asbestos fibres. Methods Mortality for asbestosis was analysed for a cohort of 13 076 Italian AC workers (18.1% women). Individual cumulative asbestos exposure index was calculated by factory and period of work weighting by the different composition of asbestos used (crocidolite, amosite, and chrysotile). Two different approaches to analysis, based on Standardized Mortality Ratios (SMRs) and Age-Period-Cohort (APC) models were applied. Results Among the considered AC facilities, asbestos exposure was extremely high until the end of the 1970s and, due to the long latency, a peak of asbestosis mortality was observed after the 1990s. Mortality for asbestosis reached extremely high SMR values [SMR: males 508, 95% confidence interval (CI): 446–563; females 1027, 95% CI: 771–1336]. SMR increased steeply with the increasing values of cumulative asbestos exposure and with Time Since the First Exposure. APC analysis reported a clear age effect with a mortality peak at 75–80 years; the mortality for asbestosis increased in the last three quintiles of the cumulative exposure; calendar period did not have a significant temporal component while the cohort effect disappeared if we included in the model the cumulative exposure to asbestos. Conclusions Among heaviest exposed workers, mortality risk for asbestosis began to increase before 50 years of age. Mortality for asbestosis was mainly determined by cumulative exposure to asbestos

Survival and Recurrence of Endocarditis following Mechanical vs. Biological Aortic Valve Replacement for Endocarditis in Patients Aged 40 to 65 Years: Data from the INFECT-Registry

Background: Infective endocarditis (IE) is a serious disease, and in many cases, surgery is necessary. Whether the type of prosthesis implanted for aortic valve replacement (AVR) for IE impacts patient survival is a matter of debate. The aim of the present study is to quantify differences in long-term survival and recurrence of endocarditis AVR for IE according to prosthesis type among patients aged 40 to 65 years. Methods: This was an analysis of the INFECT-REGISTRY. Trends in proportion to the use of mechanical prostheses versus biological ones over time were tested by applying the sieve bootstrapped t-test. Confounders were adjusted using the optimal full-matching propensity score. The difference in overall survival was compared using the Cox model, whereas the differences in recurrence of endocarditis were evaluated using the Gray test. Results: Overall, 4365 patients were diagnosed and operated on for IE from 2000 to 2021. Of these, 549, aged between 40 and 65 years, underwent AVR. A total of 268 (48.8%) received mechanical prostheses, and 281 (51.2%) received biological ones. A significant trend in the reduction of implantation of mechanical vs. biological prostheses was observed during the study period (p < 0.0001). Long-term survival was significantly higher among patients receiving a mechanical prosthesis than those receiving a biological prosthesis (hazard ratio [HR] 0.546, 95% CI: 0.322-0.926, p = 0.025). Mechanical prostheses were associated with significantly less recurrent endocarditis after AVR than biological prostheses (HR 0.268, 95%CI: 0.077-0.933, p = 0.039). Conclusions: The present analysis of the INFECT-REGISTRY shows increased survival and reduced recurrence of endocarditis after a mechanical aortic valve prosthesis implant for IE in middle-aged patients

Rate advancement measurement for lung cancer and pleural mesothelioma in asbestos-exposed workers

Introduction: Exposure to asbestos increases the risk of lung cancer and mesothelioma. Few studies quantified the premature occurrence of these diseases in asbestos-exposed workers. Focus on premature disease onset (rate advancement or acceleration) can be useful in risk communication and for the evaluation of exposure impact. We estimated rate advancement for total mortality, lung cancer and pleural mesothelioma deaths, by classes of cumulative asbestos exposure in a pooled cohort of asbestos cement (AC) workers in Italy. Method: The cohort study included 12 578 workers from 21 cohorts, with 6626 deaths in total, 858 deaths from lung cancer and 394 from pleural malignant neoplasm (MN). Rate advancement was estimated by fitting a competitive mortality Weibull model to the hazard of death over time since first exposure (TSFE). Result: Acceleration time (AT) was estimated at different TSFE values. The highest level of cumulative exposure compared with the lowest, for pleural MN AT was 16.9 (95% CI 14.9 to 19.2) and 33.8 (95% CI 29.8 to 38.4) years at TSFE of 20 and 40 years, respectively. For lung cancer, it was 13.3 (95% CI 12.0 to 14.7) and 26.6 (95% CI 23.9 to 29.4) years, respectively. As for total mortality, AT was 3.35 (95% CI 2.98 to 3.71) years at 20 years TSFE, and 6.70 (95% CI 5.95 to 7.41) at 40 years TSFE. Conclusion: The current study observed marked rate advancement after asbestos exposure for lung cancer and pleural mesothelioma, as well as for total mortality