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Objectives: The first asbestos fiber cement plant in Spain operated in Cerdanyola, in the Barcelona metropolitan area, between 1907 and 1997. We describe clinical and epidemiological characteristics of patients diagnosed with the malignant asbestosrelated disease (ARD) in the area of the plant between 2007 and 2016. Methods: A prospective, descriptive study was undertaken in the 12 municipalities of the county of Barcelona most proximate to the plant. We describe malignant ARD cases by time of diagnosis, source of exposure, periods of exposure and latency, and distribution by sex. Cumulative incidence and age‐standardized incidence rates (ASIR) are calculated. Results: Of 477 patients diagnosed with ARD between 2007 and 2016, 128 (26%) presented with asbestos‐associated malignancy. Pleural mesothelioma was noted in 105 patients (82.0%) with a linear trend Z‐score of −0.2 (NS) in men and 2.7 (P < .01) in women. The highest ASIRs for malignant ARD (6.1/100 000 residents/year; 95% confidence interval [CI], 2.2‐13.3) and pleural mesothelioma (4.8/100 000 residents/ year; 95% CI, 1.5‐11.6) occurred in municipalities closest to the focal point of contamination. The origin of malignant ARD was nonoccupational in 32.2% of men and 81.6% of women (P < .001). Conclusions: More than 20 years after the closure of the fiber cement plant, the grave consequences of exposure to asbestos remain. The detection of cases of pleural mesothelioma in men seems to have plateaued whereas in women an ascending trend continues, which principally has its origin in nonoccupational exposures.

Objective To investigate the long-term mortality of a cohort of Italian asbestos miners. Methods The cohort included 1056 men employed in a chrysotile mine between 1930 and 1990, who were followed up during 1946-2014, for a total of 37 471 person-years of observation. Expected deaths and SMRs were computed using national and local (after 1980, when available) reference. Results A total of 294 (27.8%) subjects were alive and at the end of follow-up, 722 (68.4%) were dead and 40 (3.8%) were lost to follow-up. The SMR for overall mortality was 1.35 (95%CI 1.25 to 1.45). The SMR for pleural cancer, based on seven observed deaths, was 5.54 (95% CI 2.22 to 11.4) and related to time since first exposure, but not to duration of employment, cumulative exposure or time since last exposure. The SMR for lung cancer was 1.16 (95% CI 0.87 to 1.52; 53 observed deaths), with no excess among workers with cumulative exposure below 100 fibre/mL-years (SMR 0.82; 95% CI 0.44 to 1.40). Conclusions The update of the follow-up of this cohort confirmed an increased mortality from pleural cancer mortality in miners exposed to chrysotile and a lack of significant increase in lung cancer mortality. © Article author(s) 2017 (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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.

[cat] INTRODUCCIÓ: L’amiant o asbest es un mineral que ha estat molt utilitzat per la industria de l’estat espanyol durant el segle XX, la inhalació d’aquest silicat pot provocar patologia pleuropulmonar a Cerdanyola del Vallès, comarca del Vallès Occidental de la província de Barcelona es va instal·lar i va estar en funcionament durant 90 anys la major fabrica del país de fibrociment, del que l’amiant és un dels principals components. OBJECTIU: L’objectiu principal ha estat valorar si l’activitat industrial d’aquesta fàbrica de fibrociment ha condicionat l’estat de salut de les poblacions properes. Altres objectius han estat elaborar un protocol d’estudi que fos d’utilitat per a futurs treballs i contribuir a establir els factors determinants de la distribució dels mesoteliomes pleurals d’origen ambiental en aquesta comarca. MÈTODE: Aquesta memòria de tesi s’estructura mitjançant l’anàlisi de dos articles prèviament publicats en revistes científiques indexades. RESULTATS: En la primera publicació s’ha posat de manifest que davant de la presencia d’un focus emissor de fibres d’amiant que actua com agent contaminador, la distància i els factors meteorològics locals són els determinants de la distribució dels pacients afectats de mesotelioma pleural d’origen ambiental. En la segona publicació cal significar què es presenta un protocol d’estudi de les patologies per amiant i que aquest, constitueix una eina per aprofundir en la investigació d’aquestes afeccions. CONCLUSIONS: La conclusió general és que els resultats exposats confirmen la hipòtesi global de que l’activitat de la fàbrica de fibrociment ha condicionat l’estat de salut dels habitants de la comarca, no tant sols dels treballadors de la factoria sinó també dels convivents amb treballadors i també dels ciutadans que residien a prop de la mateixa. En aquest últim grup de exposats les conclusions han estat què la distancia del seu domicili al focus emissor i les característiques dels vents locals (direcció i intensitat) tenen un marcat impacte en el risc de desenvolupar un mesotelioma d’origen ambiental. Del segon article la conclusió es de que ara disposem d’un protocol d’estudi científic què és podrà utilitzar per a futurs treballs de investigació., [eng] INTRODUCTION; Asbestos or asbestos is a mineral that has been widely used by industry in Spain during the 20th century, the inhalation of this silicate can cause pleuropulmonary disease in Cerdanyola del Vallès, the region of the Vallès Occidental in the province of Barcelona It was installed and was operating for 90 years the largest factory in the country of cement, of which asbestos is one of the main components. OBJECTIVE: The main objective was to assess whether the industrial activity of this fibrocement factory has conditioned the health status of nearby populations. Other objectives have been to elaborate a study protocol that would be useful for future work and contribute to establishing the determinants of the distribution of pleural mesotheliomas of environmental origin in this region. METHOD: This thesis report is structured through the analysis of two articles previously published in indexed scientific journals. RESULTS: In the first publication it has been shown that in view of the presence of an asbestos-emitting spotlight that acts as a contaminating agent, distance and local weather factors are the determinants of the distribution of affected patients of pleural mesothelioma of environmental origin. In the second publication, it is necessary to indicate what is presented as a protocol for the study of pathologies for asbestos, and that this is a tool to deepen in the investigation of these conditions. CONCLUSIONS: The general conclusion is that the results shown confirm the global hypothesis that the activity of the fibrocement factory has conditioned the state of health of the inhabitants of the region, not only of the workers of the factory but also of the coexistence with workers and also of the citizens who resided near it. In the latter group of exposures, the conclusions have been that the distance from home to the emitting focus and the characteristics of local winds (direction and intensity) have a marked impact on the risk of developing mesothelioma of environmental origin. From the second article, the conclusion is that we now have a scientific study protocol which can be used for future research work.

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’s 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.

OBJECTIVE: The aim of the study was to assess the risk of asbestosis death based on the temporal pattern of exposure to asbestos. METHODS: We followed up a cohort of asbestos textile workers, employed in 1946 to 1984, until November 2013. We measured the duration of the employment, the time since last employment (TSLE), the age, and the year of first employment. Hazard ratios (HR) were estimated through multivariable Cox regression models. RESULTS: We observed 51 asbestosis deaths among 1823 workers. The HR of asbestosis death increased with exposure duration (HR 2.4 for ≥15 years compared with

Il contributo si propone di riflettere sui mutamenti della raffigurazione letteraria dell’operaio tra la fine del XX secolo e l’inizio del XXI. Con il tramonto delle grandi ideologie novecentesche e la frammentazione crescente del mondo del lavoro, sono apparsi anche nella letteratura italiana numerosi testi che evidenziano la condizione sociale ed esistenziale tragica del lavoro operaio. Si tratta sia di opere che interrogano il nostro presente sia anche di récits de filiation ambientati nel cuore del Novecento, scritti da figli di operai che la fabbrica ha minato negli ideali e nel fisico, causandone in molti casi la morte. In quest’ultima tipologia di testi emergono due figure egualmente tragiche: i padri, sconfitti e malati ma pur sempre working class heroes (cfr. Amianto [2012] di Alberto Prunetti), e i figli, tragicamente coscienti del loro ruolo di testimoni-superstites di quegli ‘eroi negati’. Tra i testi presi in esame, Il nemico (2009) di Emanuele Tonon, Amianto (2012) di Alberto Prunetti, Il fuoco a mare (2015) di Andrea Bottalico, Ilva Football Club (2016) di Fulvio Colucci e Lorenzo d’Alò., Between, V. 7, N. 14 (2017): Maschere del tragico

Il contributo si propone di riflettere sui mutamenti della raffigurazione letteraria dell’operaio tra la fine del XX secolo e l’inizio del XXI. Con il tramonto delle grandi ideologie novecentesche e la frammentazione crescente del mondo del lavoro, sono apparsi anche nella letteratura italiana numerosi testi che evidenziano la condizione sociale ed esistenziale tragica del lavoro operaio. Si tratta sia di opere che interrogano il nostro presente sia anche di récits de filiation ambientati nel cuore del Novecento, scritti da figli di operai che la fabbrica ha minato negli ideali e nel fisico, causandone in molti casi la morte. In quest’ultima tipologia di testi emergono due figure egualmente tragiche: i padri, sconfitti e malati ma pur sempre working class heroes (cfr. Amianto [2012] di Alberto Prunetti), e i figli, tragicamente coscienti del loro ruolo di testimoni-superstites di quegli ‘eroi negati’. Tra i testi presi in esame, Il nemico (2009) di Emanuele Tonon, Amianto (2012) di Alberto Prunetti, Il fuoco a mare (2015) di Andrea Bottalico, Ilva Football Club (2016) di Fulvio Colucci e Lorenzo d’Alò., The paper aims at exploring how the literary representation of the worker has changed between the end of 20th-century and the beginning of the 21st-century. With the fall of the 20th-century ideologies and raising the fragmentation of labour, texts have emerged in Italian literature which illustrated the tragic social and existential condition of the working class. Among these texts we can find some récits de filiation written by sons and daughters of workers whose health and ideals have been undermined even down to death. These typology of texts let emerged two equally tragic characters: fathers, ill and defeated but still working class heroes and sons, tragically conscious of their roles witnesses-superstites of those ‘denied heroes’. Among the texts being tackled in the paper Il nemico (2009) by Emanuele Tonon, Amianto (2012) by Alberto Prunetti, Il fuoco a mare (2015) by Andrea Bottalico, Ilva Football Club (2016) by Fulvio Colucci and Lorenzo d’Alò

We show how Bruno de Finetti''s fundamental theorem of prevision has computable applications in statistical problems that involve only partial information. Specifically, we assess accuracy rates for median decision procedures used in the radiological diagnosis of asbestosis. Conditional exchangeability of individual radiologists'' diagnoses is recognized as more appropriate than independence which is commonly presumed. The FTP yields coherent bounds on probabilities of interest when available information is insufficient to determine a complete distribution. Further assertions that are natural to the problem motivate a partial ordering of conditional probabilities, extending the computation from a linear to a quadratic programming problem.

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.

This study aims at investigating, in asbestos exposed workers, the time trend of their risk of mesothelioma and of other neoplasm after very long latency and after the cessation of asbestos exposure. We pooled a large number of Italian cohorts of asbestos workers and updated mortality follow-up. The pool of data for statistical analyses includes 51,988 workers, of which 6,058 women: 54.2% was alive at follow-up, 42.6% was dead, and 2.8%was lost. Cause of death is known for 94.3%: 2,548 deaths from lung cancer, 748 frompleural cancer, 173 fromperitoneal cancer, and 434 from asbestosis. An exposure index is being developed to compare the different cohorts. Data analysis is in progress. This study will have the size for analysing not only time trends in mesothelioma, but also the occurrence of rarer diseases and cancer specific mortality in women.

Background: Italian law requires an extensive health surveillance of workers after cessation of their employment status in the case of occupational exposure to carcinogens, including asbestos. Nonetheless, Italian law does not specify the timeframe of these clinical checks, nor who has financial and organizational responsibility for this surveillance. A literature search confirmed a lack of consensus around the objectives and methods to follow up workers with past occupational exposure to asbestos. Objectives: To develop an updated evidence-based methodology for an appropriate health surveillance programme. Methods: We present an overview of the field experience developed by the Veneto Region from 2000 to 2011, and new studies that could contribute to establishing a national policy for the medical surveillance of workers with past asbestos exposure. Results: There were three specific topics: (1) definition of a reliable method to identify asbestos workers (through multiple sources and procedures that meet current confidentiality regulations); (2) detection of asbestos fibres in biological media (to support the etiological diagnosis of asbestos-related diseases); (3) creation of a national protocol of health surveillance (through the assessment of policies developed by other Regions in this field, and recruiting from these regions a cohort of past-exposed workers: the epidemiological study should offer relevant suggestions for specific surveillance approaches, based on either estimated cumulative asbestos exposure or detection of x-ray patterns of pleural plaques and/or asbestosis). Conclusions: These studies will support the Regions in setting up health care policies directed at workers with past asbestos exposure.

Background Osteopontin (OPN) is a plasma protein/cytokine produced in excess in several malignancies. In a recent study OPN was reported as being related to the duration of asbestos exposure and presence of benign asbestos-related diseases; however, it was unclear whether this protein was an indicator of exposure or effect. Methods In 193 workers, 50 with pleural plaques (PP), in whom different indicators of past asbestos exposure were estimated, OPN plasma levels were assessed using commercial quantitative sandwich enzyme immunoassays according to the manufacturer's instructions. Results Osteopontin increased with increasing age and several aspects of asbestos exposure, without differences related to the presence of pleural plaques. At multivariable regression analysis, the explanatory variables with a significant independent influence on OPN were length of exposure (positive correlation) and time elapsed since last exposure (positive correlation). Conclusions Since asbestos in lung tissue tends to wane over time, OPN should decrease (rather than increase) with time since last exposure. Therefore, OPN cannot be a reliable biomarker of exposure nor effect (presence of pleural plaques).

Las consecuencias clínicas secundarias a la exposición a fibras de asbesto son bien conocidas desde hace varios años La afectación pulmonar, de carácter progresivo y de pronóstico grave, constituye una de las neumoconiosis inorgánicas de origen mineral mejor etiquetadas y recogidas en los textos de medicina laboral y preventiva; las localizaciones pleurales que puedan asociarse, en forma de engrosamientos fibrosos o de calcificaciones, son, a su vez, manifestaciones típicas. Últimamente, la asociación del asbesto con los tumores malignos, (pulmonares, pleurales y peritoneales, Mesoteliomas malignos, digestivos, hemopoyéticos y ováricos) se ha añadido a la trágica lista de las complicaciones provocadas por esta sustancia mineral. Motivados por nuestra personal experiencia en el manejo e interpretación de las curvas de flujo-volumen en diversos procesos patológicos pulmonares y estimulados por la incógnita que planteaba la posible existencia de localización bronquiolar del asbesto, con obstrucción secundaria, hemos aplicado la sistemática de esta técnica al estudio funcional clásico de un grupo de individuos expuestos al asbesto. De ahí que el objetivo primordial de esta Tesis Doctoral consista en dilucidar si existe o no obstrucción bronquial en los estadios iniciales de la exposición, obstrucción que, a su vez, podría ser considerada como "señal de alarma" en la valoración de los riesgos de exposición al asbesto". Para ello han sido estudiados una serie de individuos expuestos en mayor o menor grado al asbesto, cuyo control médico-periódico ha dado pie, en un momento dado de su evolución, a la sospecha de afectación pulmonar y/o pleural de naturaleza asbestósica, siendo remitidos para su estudio y diagnóstico al Pneumoconiosis Medical Panel (PNP) del Brompton Hospital, Londres. En la primera parte de esta Tesis se expone, tras una introducción acerca de la epidemiología del asbesto, una revisión crítica exhaustiva de la bibliografía mundial sobre el estudio-funcional pulmonar de los individuos expuestos y afectados por-el asbesto. Un recuerdo histórico de la historia natural de la asbestosis completa este primer apartado. A continuación, se exponen las bases teóricas de las curvas de flujo-volumen, dentro del contexto de la detección precoz de la obstrucción bronquial cuya técnica y resultados contribuyen, a nuestro juicio, de manera fundamental en las conclusiones elaboradas. En la segunda parte, presentamos el material y los métodos empleados, así como la sistemática de estudio. A continuación se ofrecen los diversos resultados, su valoración, correlación, clasificación y tratamiento estadístico. Por último, elaboramos la discusión que abocará a nuestras conclusiones definitivas. Se ha considerado muy oportuno presentar un pequeño capítulo inicial dedicado al problema de la nomenclatura empleada a lo largo de este trabajo, que esperamos ayudará a paliar el siempre áspero tema de las siglas y la terminología fisiopatológica pulmonar, en general.

[spa] La inhalación de fibras de asbesto lesiona el pulmón produciendo una fibrosis difusa. Las manifestaciones clínicas, radiológicas y funcionales guardan relación con la intensidad de la exposición. La acción combinada de otros tóxicos tales como el tabaco y el alcohol acentúa la acción nociva del mineral. El tabaco aumenta la obstrucción de la vía aérea y favorece la aparición de acropaquías. El alcohol incrementa algunos síntomas y modifica la capacidad de difusión de los gases en el pulmón. La salud de los trabajadores del amianto no depende tan solo de la inhalación de fibras, sino de la acción superpuesta de otros tóxicos. Por ello deben dedicarse esfuerzos tanto al control de la polución ambiental como a la disminución del hábito tabáquico y alcóholico.