Position Paper on Asbestos of the Italian Society of Occupational Medicine

The Position Paper (PP) on asbestos of the Italian Society of Occupational Medicine (SIML) aims at providing a tool to the occupational physician to address current diagnostic criteria and results of epidemiological studies, and their consequences in terms of preventive and evaluation actions for insurance, compensation and litigation. The PP was based on an extensive review of the scientific literature and was compiled by a Working Group comprising researchers who have contributed to the international literature on asbestos-related diseases, as well as occupational physicians with extensive experience in the evaluation of risks and the medical surveillance of workers currently and formerly exposed to asbestos. The PP was drafted and reviewed between 2017 and 2018; its final version was prepared according to the guidelines of AGREE Reporting Checklist. All the members of the Working Group subscribed to the document, which was eventually approved by SIML\u2019s Executive Committee. The first section addresses industrial hygiene issues, such as methods for environmental monitoring, advantages and limitations of different microscopy techniques, the potential role of microfibers and approaches for retrospective assessment of exposure, in particular in epidemiological studies. The second section reviews the biological effects of asbestos with particular attention to the diagnostic aspects of asbestosis, pleural changes, mesothelioma and lung cancer. In the following section the criteria of causal attribution are discussed, together with different hypotheses on the form of the risk functions, with a comparison of the opinions prevalent in the literature. In particular, the models of the risk function for mesothelioma were examined, in the light of the hypothesis of an acceleration or anticipation of the events in relation to the dose. The last section discusses topics of immediate relevance for the occupational physician, such as health surveillance of former exposed and of workers currently exposed in remediation activities

Position Paper Amianto. Societ\ue0 Italiana di Medicina del Lavoro

Il Position Paper SIML dedicato all\u2019asbesto si propone di offrire uno strumento che consenta al Medico Competente un rapido orientamento sui criteri diagnostici attuali e sui risultati della ricerca epidemiologica con le conseguenti indicazioni per l\u2019azione preventiva e di valutazione in contesti previdenziali, assicurativi e medico-legali. Par- tendo da una ampia revisione della letteratura scientifica in argomento e, nel corso delle riunioni del Gruppo di lavoro, costituito sia da ricercatori che hanno fornito un apporto di livello internazionale sul tema delle patologie asbesto-correlate sia da Medici del Lavoro con ampia esperienza nella valutazione del rischio e nella sorveglianza sanitaria di esposti ed ex-esposti ad amianto, sono stati discussi tra il 2017 ed il 2018 i diversi argomenti trattati con ampie e ripetute revisioni del testo. La versione definitiva \ue8 stata sottoposta alla valutazione abituale per le Linee Guida secondo lo standard metodologico AGREE. Il documento, su cui si \ue8 registrato l\u2019unanime consenso del Gruppo di Lavoro ed \ue8 stato successivamente approvato dal Direttivo Nazionale della Societ\ue0, si articola in alcune principali sezioni. La prima riguarda gli argomenti propri dell\u2019Igiene Industriale quali le metodiche per il monitoraggio ambientale, i vantaggi e i limiti delle tecniche microscopiche disponibili, il potenziale ruolo delle mi- crofibre e gli approcci per la valutazione retrospettiva dell\u2019esposizione, specialmente a fini epidemiologici. La secon- da gli effetti biologici da amianto con particolare attenzione agli aspetti diagnostici dell\u2019asbestosi, delle alterazioni pleuriche, del mesotelioma e del tumore del polmone. La terza i criteri di attribuzione causale e discusse le diverse ipotesi sulla forma delle funzioni di rischio, vengono confrontate le principali posizioni al riguardo disponibili in letteratura. In particolare sono stati approfonditi i modelli della funzione di rischio per il mesotelioma ed affron- tato il tema dell\u2019ipotesi di un effetto acceleratore e anticipazione della frequenza degli eventi in relazione alla dose. Infine sono stati trattati gli argomenti di attualit\ue0 applicativa per il Medico Competente quali la sorveglianza sanitaria degli ex esposti ad amianto e di quella degli operatori attualmente esposti in attivit\ue0 di bonifica

Comunicazione, condivisione, coordinamento nell'attivit\ue0 della promozione della salute : la XII Conferenza Nazionale degli ospedali e servizi sanitari per la promozione della Salute

9 years after the previous HPH initiative in Milan, the Lombard network has been willing again to host the activities of the XIIth HPH National Conference, in the perspective of enhancing the Quality of organization and contents, to help participants acquire procedures and instruments more and more oriented to health promotion and to the awareness of a pathway whose contents are becoming part of the everyday activities of all the people concerned. The long. experience of the national HPH network is presenting this year some significant innovations: the international network, promoted by WHO, has recently adopted in its foundation act the orientation of supporting and fostering all the initiatives aiming at creating links among hospitals and other health services existing in "home territories" for the creation of a policy based on clear priorities of health promotion: This result has been obtained with the formulation of a Manual of Standards and HPH Specific Indicators to facilitate the services self-assessment. These are the reasons for the choice of the XIIth HPH National Conference theme, held in Milan last 16-18 October 2008; an event which has proved to be a further step in the cooperation to improve the Quality of health and life for people