30 research outputs found
Past trends and future prediction of mesothelioma incidence in an industrialized area of Italy, the Veneto Region
Background Malignant Mesothelioma (MM) is so associated with (professional, familial or environmental) asbestos exposure that trends in incidence and mortality parallel, after 30–40 years, the trend in asbestos consumption. In recent decades, the industrialized countries have witnessed a steady growth of pleural MM (MPM), following a stabilization or decline in rates in the countries that first adopted restrictive policies. The aim of this study was to evaluate the temporal variations of pleural MM incidence in the Veneto Region of Italy in the period 1987–2010. Methods We included only MPM with histological or cytological diagnosis. Age-Period-Cohort (APC) models were used to assess the trend in the incidence of MPM in both genders. Future predictions were evaluated by using a Bayesian APC model. Results In the period 1987–2010, 1600 MPMs have occurred. We observe a positive trend in the incidence in the whole period considered. The APC model showed that in both genders the cohort at higher risk is the one born between the years 1940–1945. Future projections indicate that the trend will decrease after the incidence peak of 2010; yet 1234 men are expected to develop a mesothelioma between 2011 and 2026. Among women, the future MPM rates will be stable or slightly decreasing. Conclusions The asbestos ban introduced in Italy in the year 1992 as a prospective result will certainly determine a decreasing incidence. However, the extremely long latency of MPM means that its influence is not yet observable
0203 The lung burden of Asbestos Fibres (AF) and Asbestos Bodies (AB) and the risk of mesothelioma (MM) for exposures ceased 30 years ago
Objectives To estimate the risk of MM according to AF and AB
in the lungs.
Method Freeze dried lung samples from 309 MM and 41 controls have been analysed for AF (Scanning Electronic Microscopy) and AB (Optical Microscopy) from subjects investigated
and classified for probability and circumstances of asbestos exposure. Odds Ratios (OR) were obtained using logistic regression.
Results 254 (82%) MMs have been classified as occupationally
and 25 (8%) as non-occupationally exposed: Geometric Mean
(GM) for AF burden was 1 950 000 and 608 000 ff/g dlt,
respectively; and 39 300 and 3300 for AB. 75% and 58% of the
AF respectively were amphibole.
Controls reported a GM of 269 000 AF and 28 of AB g/dlt.
For any increase of 100.000 ff/g dlt, we computed an OR of
1.7 (1.3–2.3) for amphibole, 1.1 (1.0–1.3) for chrysotile, among
occupational MMs; an OR of 1.3 (1.0–1.7) and 1.1 (1.0–1.1)
among non-occupational MMs.
The 1997 Helsinki criteria for attribution to occupational
exposure would have excluded more than 30% of MMs under
study: here occupational exposures ceased on average 26 years
before the disease, and therefore clearance and time since last
exposure must be taken into account because are relevant determinants of the retained amount of fibres.
Conclusions The risk of MM increases with the amount of
retained amphibole, and to a lesser extent, of chrysotile fibres.
Because occupational and non-occupation asbestos exposures
have been to mixture of fibres, the lungs of MM patients are still
loaded with amphibole AF
Increased risk of mesothelioma and lung cancer among workers exposed to asbestos who could require an anticipated retirement
OBJECTIVES: to assess the association among malignant pleural mesothelioma (MPM) and lung cancer (LC) among workers who have been exposed to asbestos and have or not have required an anticipated leave from work, a possibility offered by the 1992 law banning asbestos in Italy, in the framework of the health surveillance programmes on going in the Veneto Region (Northern Italy).
SETTING AND PARTICIPANTS: a cohort of asbestos workers derived from the rosters of selected factories and alive in 1992, followed from 1992 to 2012.MPMcases have been identified through the Regional Mesothelioma Registry, while LC cases through a link with the Regional Cancer Registry, hospital discharges, and death certificates. Risks related to asbestos exposure were calculated by mixed effects Poisson regression model.
RESULTS: the risk of MPMand LC increases at any additional duration of work, up to very high values for long term durations of work for MPM, and up to a three fold increase for LC. Early retirements have been requested by a fraction only in the position of submitting it.
CONCLUSION: subjects who have been exposed to asbestos should be the target of a post-occupational surveillance, and further work is suggested to identify subjects at high risk of LC because of smoking habits and more heavy exposure to asbestos, in order to develop programmes for primary and secondary cancer prevention
Italian pool of asbestos workers cohorts: mortality trends of asbestos-related neoplasms after long time since first exposure
Objective Asbestos is a known human carcinogen, with
evidence for malignant mesothelioma (MM), cancers of
lung, ovary, larynx and possibly other organs. MM rates
are predicted to increase with a power of time since first
exposure (TSFE), but the possible long-term attenuation
of the trend is debated. The asbestos ban enforced in
Italy in 1992 gives an opportunity to measure long-term
cancer risk in formerly exposed workers.
Methods Pool of 43 previously studied Italian asbestos
cohorts (asbestos cement, rolling stock, shipbuilding),
with mortality follow-up updated to 2010. SMRs were
computed for the 1970–2010 period, for the major
causes, with consideration of duration and TSFE, using
reference rates by age, sex, region and calendar period.
Results The study included 51 801 subjects (5741
women): 55.9% alive, 42.6% died (cause known
for 95%) and 1.5% lost to follow-up. Mortality was
significantly increased for all deaths (SMR: men: 1.05,
95% CI 1.03 to 1.06; women: 1.17, 95% CI to 1.12 to
1.22), all malignancies combined (SMR: men: 1.17, 95%
CI to 1.14 to 1.20; women: 1.33, 95% CI 1.24 to 1.43),
pleural and peritoneal malignancies (SMR: men: 13.28
and 4.77, 95% CI 12.24 to 14.37 and 4.00 to 5.64;
women: 28.44 and 6.75, 95% CI 23.83 to 33.69 and
4.70 to 9.39), lung (SMR: men: 1.26, 95% CI 1.21 to
1.31; women: 1.43, 95% CI 1.13 to 1.78) and ovarian
cancer (SMR=1.38, 95% CI 1.00 to 1.87) and asbestosis
(SMR: men: 300.7, 95% CI 270.7 to 333.2; women:
389.6, 95% CI 290.1 to 512.3). Pleural cancer rate
increased during the first 40 years of TSFE and reached a
plateau after.
Discussion The study confirmed the increased risk for
cancer of the lung, ovary, pleura and peritoneum but
not of the larynx and the digestive tract. Pleural cancer
mortality reached a plateau at long TSFE, coherently with
recent reports
Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study
BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223
Tendenze della moralità e valutazione della moralità evitabile nell'Ulss 17 di Este periodo 1995-2001
Past trends and future prediction of mesothelioma incidence in an industrialized area of Italy, the Veneto Region
BACKGROUND: Malignant Mesothelioma (MM) is so associated with (professional, familial or environmental) asbestos exposure that trends in incidence and mortality parallel, after 30-40 years, the trend in asbestos consumption. In recent decades, the industrialized countries have witnessed a steady growth of pleural MM (MPM), following a stabilization or decline in rates in the countries that first adopted restrictive policies. The aim of this study was to evaluate the temporal variations of pleural MM incidence in the Veneto Region of Italy in the period 1987-2010. METHODS: We included only MPM with histological or cytological diagnosis. Age-Period-Cohort (APC) models were used to assess the trend in the incidence of MPM in both genders. Future predictions were evaluated by using a Bayesian APC model. RESULTS: In the period 1987-2010, 1600 MPMs have occurred. We observe a positive trend in the incidence in the whole period considered. The APC model showed that in both genders the cohort at higher risk is the one born between the years 1940-1945. Future projections indicate that the trend will decrease after the incidence peak of 2010; yet 1234 men are expected to develop a mesothelioma between 2011 and 2026. Among women, the future MPM rates will be stable or slightly decreasing. CONCLUSIONS: The asbestos ban introduced in Italy in the year 1992 as a prospective result will certainly determine a decreasing incidence. However, the extremely long latency of MPM means that its influence is not yet observable
Increased risk of mesothelioma and lung cancer among workers exposed to asbestos who could require an anticipated retirement
OBIETTIVI: valutare l\u2019associazione tra mesotelioma maligno pleurico (MMP) e tumore del polmone (TP) in ex-esposti ad amianto che avevano la possibilit\ue0 di richiedere il prepensionamento, grazie alla legge n.257 del 1992 che ha bandito l\u2019amianto, nel quadro dei programmi per la loro sorveglianza epidemiologica in corso in Regione Veneto. SETTING E PARTECIPANTI: in una coorte di lavoratori esposti all\u2019amianto e vivi nel 1992, composta da addetti di un insieme di aziende, seguiti dal 1992 al 2012, sono stati identificati i casi di mesotelioma utilizzando il Registro regionale veneto dei casi di mesotelioma, e i casi di tumore del polmone attraverso il Registro tumori del Veneto, le schede di dimissione ospedaliere e le schede di morte. Il rischio di tumore connesso con l\u2019esposizione all\u2019amianto \ue8 stato calcolato attraverso regressione di Poisson a effetti misti. RISULTATI: sia il rischio di mesotelioma pleurico sia quello per il tumore del polmone risultano aumentare all\u2019incremento della durata del lavoro. Il rischio dimesotelioma raggiunge valori estremamentemarcati con le durate lavorative pi\uf9 lunghe, mentre triplica in queste stesse condizioni il rischio per il tumore del polmone. Le domande di prepensionamento sono molto inferiori a quelle potenziali e il rischio non \ue8 risultato circoscritto a chi ha avanzato domanda. CONCLUSIONE: l\u2019insieme dei soggetti che sono stati esposti ad amianto dovrebbe essere oggetto di sorveglianza epidemiologica e di approfondimenti che portino a identificare i soggetti amaggior rischio di tumore del polmone sulla base dell\u2019intensit\ue0 dell\u2019esposizione ad amianto e dell\u2019abitudine al fumo, attualmente non note, con l\u2019obiettivo di sviluppare, per quanto possibile, attivit\ue0 di contrasto del rischio accumulato e di diagnosi precoce. Parole chiave: amianto, esposizione lavorativa, mesotelioma, tumore del polmone, studio di coorte OBJECTIVES: to assess the association among malignant pleural mesothelioma (MPM) and lung cancer (LC) among workers who have been exposed to asbestos and have or not have required an anticipated leave from work, a possibility offered by the 1992 law banning asbestos in Italy, in the framework of the health surveillance programmes on going in the Veneto Region (Northern Italy). SETTING AND PARTICIPANTS: a cohort of asbestos workers derived from the rosters of selected factories and alive in 1992, followed from 1992 to 2012.MPMcases have been identified through the Regional Mesothelioma Registry, while LC cases through a link with the Regional Cancer Registry, hospital discharges, and death certificates. Risks related to asbestos exposure were calculated by mixed effects Poisson regression model. RESULTS: the risk of MPMand LC increases at any additional duration of work, up to very high values for long term durations of work for MPM, and up to a three fold increase for LC. Early retirements have been requested by a fraction only in the position of submitting it. CONCLUSION: subjects who have been exposed to asbestos should be the target of a post-occupational surveillance, and further work is suggested to identify subjects at high risk of LC because of smoking habits and more heavy exposure to asbestos, in order to develop programmes for primary and secondary cancer prevention