Counseling antifumo in un gruppo di lavoratori ex esposti ad asbesto / Anti-smoking counseling in a group of workers with past exposure to asbestos

Background: Anti-smoking counseling is often part of healthcare protocols for workers with past asbestos exposure; nevertheless, data is lacking about the results. Objectives: To evaluate smoking habits and the effects of anti-smoking counseling in a group of workers with past asbestos exposure. Methods: Smoking was assessed in 671 subjects who voluntarily attended a health surveillance protocol. Fagerstrom\u2019s and Richmond\u2019s tests were used in order to estimate smokers\u2019 addiction and their potential will to quit. Besides anti-smoking counseling, smokers were also offered a formal cessation programme. Results: The mean age of the 671 subjects was 66 (DS= 7,9) years. The population consisted of 87 (13%) current smokers, 372 (55%) ex-smokers and 212 (32%) non smokers. According to Fagerstrom\u2019s test results, only 10% of the smokers presented a strong/very strong addiction, while Richmond\u2019s test results showed that 50% of the smokers had a strong/very strong will to quit. Only one smoker decided to join a cessation programme. Conclusions: The results of the study could present a bias, because volunteer-based protocols may promote the participation of self-motivated and health-sensitive subjects. This could be one of the reasons for the low prevalence of current smokers and high prevalence of ex-smokers. Anti-smoking counseling did not produce satisfactory effects because smokers were resistant to quitting smoking. Identification of anti-smoking counseling weak points may improve efficacy in health prevention controls made on subjects with past asbestos exposur

Features and severity of occupational asthma upon diagnosis: an Italian multicentric case review

BACKGROUND: The severity of occupational asthma (OA) at the time of diagnosis is not known. In this study we aimed to evaluate some features of the disease at the time of diagnosis, particularly looking at severity and treatment before diagnosis. METHODS: Medical records of subjects (n = 197) who had received a diagnosis of OA in six specialized centres of Northern and Central Italy in the period 1992-97 were reviewed. The severity of the disease at the time of diagnosis was determined on the basis of symptoms, peak expiratory flow (PEF, percentage predicted), forced expiratory volume in one second (FEV1, percentage predicted), and PEF variability, following the criteria of the National Institutes of Health and World Health Organizaton (NIH/WHO) guidelines on asthma. Medications used in the month before diagnosis were recorded. RESULTS: The most common etiological agents were isocyanates (41.6%), flours (19.8%), woods (9.7%) and natural rubber latex (7.6%). The level of asthma severity (AS) was mild intermittent in 23.9% patients, mild persistent in 28.9%, moderate in 41.6%, and severe in 5.6%. Asthma severity was positively associated with current or previous smoking (P < 0.05), and was not related to atopy and current exposure. A relationship with bronchial reactivity to methacholine was shown in subjects at work. Treatment before diagnosis was consistent with the NIH/WHO guidelines in only 13.2% patients, whereas 75.6% were undertreated and 11.2% were overtreated. CONCLUSIONS: In this study we found that the majority of patients had mild asthma at the time of diagnosis and that cigarette smoking was associated with a greater severity. Moreover, the majority of patients were undertreated before etiological diagnosis

Pleural malignant mesothelioma epidemic: Incidence, modalities of asbestos exposure and occupations involved from the Italian National Register

Due to the large scale use of asbestos (more than 3.5 million tons produced or imported until its definitive banning in 1992), a specific national surveillance system of mesothelioma incident cases is active in Italy, with direct and individual anamnestic etiological investigation. In the period between 1993 and 2004, a case-list of 8,868 pleural MM was recorded by the Italian National Register (ReNaM) and the modalities of exposure to asbestos fibres have been investigated for 6,603 of them. Standardized incidence rates are 3.49 (per 100,000 inhabitants) for men and 1.25 for women, with a wide regional variability. Occupational asbestos exposure was in 69.3% of interviewed subjects (N = 4,577 cases), while 4.4% was due to cohabitation with someone (generally, the husband) occupationally exposed, 4.7% by environmental exposure from living near a contamination source and 1.6% during a leisure activity. In the male group, 81.5% of interviewed subjects exhibit an occupational exposure. In the exposed workers, the median year of first exposure was 1957, and mean latency was 43.7 years. The analysis of exposures by industrial sector focuses on a decreasing trend for those traditionally signaled as "at risk" (asbestos-cement industry, shipbuilding and repair and railway carriages maintenance) and an increasing trend for the building construction sector. The systematic mesothelioma surveillance system is relevant for the prevention of the disease and for supporting an efficient compensation system. The existing experience on all-too-predictable asbestos effects should be transferred to developing countries where asbestos use is spreading. © 2011 UICC

Sanità 4.0 e medicina delle 4P. Professionisti sanitari e cittadini di fronte all’innovazione “dirompente”

La Sanità 4.0 identifica dei cambiamenti drammatici dovuti all’adozione di tecnologie ”dirompenti” e può essere esemplificata nella definizione della cosiddetta medicina delle 4P (partecipativa, personalizzata, preventiva, predittiva). Malattie croniche sempre più diffuse e una popolazione sempre più anziana richiedono una trasformazione epocale con il passaggio da una medicina basata sulla diagnosi e sui trattamenti alla medicina di prevenzione o meglio "predittiva". La crescente diffusione delle Tecnologia dell’Informazione e Comunicazione (ICT) nel sistema sanitario (fascicolo sanitario e cartella clinica elettronica, telemedicina, documentazione digitale, stampa 3D, intelligenza artificiale, robotica, sviluppo di app biomedicali, realtà aumentata, ecc.) richiede il superamento di ostacoli non solo strutturali, ma soprattutto culturali e l’interazione con sistemi di conoscenza. Risulta, infatti, necessaria una adeguata formazione e un continuo aggiornamento dei professionisti sanitari, così come il coinvolgimento attivo di cittadini e pazienti alle decisioni cliniche che può effettuarsi solo grazie ad un’adeguata educazione e informazione