Costruzione di un modello di valutazione del processo di presa in carico dei lavoratori ex esposti ad amianto nella Regione Toscana
SUMMARY (Definition of a performance assessment plan of the health surveillance programme for for... more SUMMARY (Definition of a performance assessment plan of the health surveillance programme for former asbestos workers in Tuscany Region, Italy) - In Tuscany Region (Italy), a public programme aimed at providing health surveillance for former asbestos workers recently started, following a common approach to asbestos-related diseases as defined by a regional group of experts. A performance assessment plan of the post occupational surveillance programme was drafted by the Institute for Study, Prevention and Cancer Network, and discussed within the Regional Committee, in order to monitor its equity, accessibility and to improve its effectiveness.The performance evaluation plan, partly designed with the PRECEDE-PROCEED model, provides for the periodic assessment of: structure, process and outcome indicators, obtained by the programme database; health care workers’ and patients’ perspectives, obtained by two specific questionnaires. Site visits over the regional facilities will also be performed as a tool for peer training. Expected benefits of the performance evaluation of this programme are multidisciplinary interactions between professionals, the development of audit techniques during site visits, the adequate and fair management of health needs and continuous training of involved healthcare personnel
Papers, data, figures, maps and any other material published are covered by the copyright own by ... more Papers, data, figures, maps and any other material published are covered by the copyright own by the Società Geologica Italiana. DISCLAIMER: The Società Geologica Italiana, the Editors are not responsible for the ideas, opinions, and contents of the papers published; the authors of each paper are responsible for the ideas opinions and contents published. La Società Geologica Italiana, i curatori scientifici non sono responsabili delle opinioni espresse e delle affermazioni pubblicate negli articoli: l'autore/i è/sono il/i solo/i responsabile/i.
Parole chiave: Ex-esposti; sorveglianza sanitaria; amianto summary «Identification of workers wit... more Parole chiave: Ex-esposti; sorveglianza sanitaria; amianto summary «Identification of workers with past asbestos exposure in Tuscany eligible to health surveillance programme». Background: In 2016 the Administration of the Tuscany Region, Italy, established a health surveillance programme for workers with past asbestos exposure. The programme includes two levels of activities, a local basic health evaluation, and a centralized in-depth evaluation of specific cases. Objectives: To estimate the number and identify the workers with past exposure to asbestos in Tuscan industrial settings entitled to participate in the health surveillance programme. Methods: The number of formerly-exposed workers was estimated from the records of the working population of 15,441 workers of thirteen Tuscan asbestos industrial plants and from the existing data bases of the Local Health Administrations (USLs) and the Institute for Study, Prevention and Cancer Network (ISPRO), and from national data bases such as Social Security Administration (INPS) and National Institute for Insurance against Accidents at Work (INAIL). The expected number of medical examinations per year was estimated from the adhesion rates seen in previous comparable programmes. Results: The estimated number of workers with past asbestos exposure eligible to the programme was 5,446. The estimated number of health examinations in the first and second phases of the surveillance programme during 2016-24 was 7,275 and 7,155, respectively, follow-up examinations included. The number of workers identified from local data bases was 4,713: They had been operating in 129 plants that had been using asbestos in the past. Further 1,395 workers were identified from previous health surveillance activities. Conclusions: The use of several sources of information and the cooperation between occupational health services made it possible to identify a high proportion of former asbestos workers and plants., It is, nevertheless, still necessary to complete the list of eligible workers, and to facilitate their participation by making the programme more widely known. riassunto Introduzione: Nel 2016 la Regione Toscana ha avviato un programma di sorveglianza sanitaria per gli ex-esposti ad amianto definendo i soggetti attuatori e fornendo un finanziamento ad hoc. Il programma si articola su un modello & Articolo consigliato per autoformazione ECM 08-chellini_7739.indd 46 27/02/19 10:33
Esposizione ambientale e occupazionale a silice libera cristallina: ieri, oggi e domani
L'impatto sulla salute dell'esposizione a silice libera cristallina viene consuetamente e... more L'impatto sulla salute dell'esposizione a silice libera cristallina viene consuetamente espresso in termini di mortalit\ue0 per silicosi e di riconoscimento di malattia professionale. I settori pi\uf9 colpiti sono rappresentati da attivit\ue0 estrattive, lavorazione delle pietre, industria ceramica, edilizia, fonderie. Per pervenire ad una stima pi\uf9 valida del carico di patologie associate a silice, occorrerebbe disporre di dati esaurienti sul cancro polmonare e le malattie autoimmuni silico-correlate. L'esposizione cumulativa a silice che tiene conto di entit\ue0 e durata dell'esposizione, \ue8 la variabile predittiva pi\uf9 importante nei riguardi della comparsa della malattia. Il libro curato da C.Minoia et al., presentando una trattazione coerente ed aggiornata dei molti temi in esame, consente all'operatore di sanit\ue0 pubblica di orientarsi in una materia complessa e tuttora in divenire
[Male breast tumors in railway engine drivers: investigation of 5 cases]
PubMed, 2000
The paper describes the results of the investigation carried out on five cases of male breast tum... more The paper describes the results of the investigation carried out on five cases of male breast tumours in railway engine drivers notified to the public Occupational Health Service of Florence in 1999. The aim was to evaluate the possibility of professional extremely low frequency electromagnetic fields (ELF) exposure etiology. The extent of this exposure is described with particular care to engine drivers, comparing the one measured in Italy with those reported in other countries.
[Activities of the industrial physician in a state preventive health service. The case of Italy]
PubMed, Mar 1, 1997
We analyzed the occupational health activities of physicians in a public occupational health serv... more We analyzed the occupational health activities of physicians in a public occupational health service using the Method of Organizational Congruences (MOC). Occupational health activities are changing in Italy with the application of the European Community Directives (Decreto Legislativo 626/94). We identified four major organizational constraints: a lack and difficult in interdisciplinary work, absence of worker control on the activities, limitations in planning specific industrial area studies, increased conflict between prevention and control activities. We predict for the future an increase of these constraints with a reduction in the professional level of the physicians employed in the state system of local occupational health units.
Sistemi di aspirazione localizzati con ricircolo nelle falegnamerie artigiane: valutazione della ... more Sistemi di aspirazione localizzati con ricircolo nelle falegnamerie artigiane: valutazione della loro efficacia in particolari contesti produttivi artigiani nella città di Firenze General principles of industrial hygiene don't foresee dust filtration and recycling indoor air system, especially when carcinogens, mutagenic and sensitizing substances are involved. Nevertheless some activities, like workshops in historical cities, have problems to emit pollution outdoor. In this study efficacy in dust filtration and recycling air system in two little carpentry workshops, sited in Florence's historical district, is assessed. The results show that in little carpentry workshops ultra filtration and recycling air system may assure a good compliance with industrial hygienic standard and wood dust Italian threshold limits values are respected. Some minimal features to grant recycling systems in this particular work conditions are suggested.
International Journal of Occupational and Environmental Health, 2005
At the beginning of 2002, there were 1,600,000 foreign-born persons living in Italy; the majority... more At the beginning of 2002, there were 1,600,000 foreign-born persons living in Italy; the majority from countries outside Europe. Those residing in the country for working purposes were 800,680. Italy's shift to a tertiary and service-oriented economy has considerably modified the working market, concentrating demand at two extremes: on one hand, a highly specialized workforce, and on the other, a totally unqualified, mobile, and flexible one, which includes most immigrants.
A minero-chemical investigation of dental alginates in relation to their health effects
<p>A case of severe silicosis was described in association with the product... more <p>A case of severe silicosis was described in association with the production and use of dental alginates [1]. This evidence suggests a potential underestimated source of exposure to toxicants for workers, in a professional branch where silica-related risk has not been yet considered.</p><p>In the present study, we undertook a thorough characterisation of two commercial silica-based dental alginates. X-ray Powder Diffraction (XRPD) was used to establish the mineralogical composition, in combination with SEM-EDS analysis, in order to assess particle size, morphology and chemistry of the dental alginates components. Finally, preliminary room-temperature EPR investigations were carried out to identify selected paramagnetic species, namely Fe(III) and radicals. The results point to the presence of an extensive amount of diatomaceous earth, clearly identified by micromorphology, primarily formed by cristobalite, which results as the most abundant crystalline phase in XRPD. The presence of such abundant cristobalite amount results from the high-temperature transformation of amorphous silica during the calcination process to which diatomaceous earth (originally amorphous) had been subjected. Subordinate amounts of associated phases such as gypsum, talc, magnesium oxide (besides potassium hexafluorotitanate and Na/K alginates) were observed. A relevant fraction of an amorphous-to-cryptocrystalline silica fraction was also identified. In terms of size distribution, all the different components are represented by particles of different shapes with size <100 µm [2]. While the associated phases pertain to the inhalable fraction, the presence of a significant amount of complete diatoms shells with diameter < 10 µm and abundant scattered fragments < 4 µm sets the cristobalite into the thoracic and respirable fraction categories [2].</p><p>Based on the obtained results, we warmly support the reconsideration of dental alginates in terms of the definition of their health risks, mostly consisting of a very harmful silica polymorph, as cristobalite. Interesting parallelisms can be fostered with the well-known epidemiological studies on the cohorts of workers of the diatomaceous earth [3-5]. In particular, two different contexts of exposure can be identified: the step when dry mixing of the individual components of the mixture are blended together (industrial production of commercial materials) and when workers clean the metal mould of the dental cast from the hardened alginate composite.</p><p>[1] Barbieri et al. (2020) <em>Med Lav; </em>111, 3: 222-231</p><p>[2] CEN (1993), European Standard, EN481:1993</p><p>[3] Legge & Rosencrantz (1932) <em>Am J Public Health</em>; 22: 1055-1060</p><p>[4] Ebina et al. (1952) <em>Tohoku J Exp Med</em>; 56: 214</p><p>[5] Paterni (1965) <em>Folia Med (Napoli)</em>; 48: 183-188</p>
Oxidatively damaged DNA in the nasal epithelium of workers occupationally exposed to silica dust ... more Oxidatively damaged DNA in the nasal epithelium of workers occupationally exposed to silica dust in Tuscany region, Italy
Oxidatively damaged DNA in the nasal epithelium of workers occupationally exposed to silica dust ... more Oxidatively damaged DNA in the nasal epithelium of workers occupationally exposed to silica dust in Tuscany region, Italy
[Activities of the industrial physician in a state preventive health service. The case of Italy]
La Medicina del lavoro
We analyzed the occupational health activities of physicians in a public occupational health serv... more We analyzed the occupational health activities of physicians in a public occupational health service using the Method of Organizational Congruences (MOC). Occupational health activities are changing in Italy with the application of the European Community Directives (Decreto Legislativo 626/94). We identified four major organizational constraints: a lack and difficult in interdisciplinary work, absence of worker control on the activities, limitations in planning specific industrial area studies, increased conflict between prevention and control activities. We predict for the future an increase of these constraints with a reduction in the professional level of the physicians employed in the state system of local occupational health units.
Creazione di una banca dati delle concentrazioni occupazionali e ambientali di silice libera cristallina ai fini della valutazione delle esposizioni pregresse e attuali
La Medicina del Lavoro, 2020
«Creation of a database of occupational and environmental concentrations of crystalline silica du... more «Creation of a database of occupational and environmental concentrations of crystalline silica dust for the purpose of assessing past and current exposures». Background: Professional exposure to respirable dust containing crystalline silica is of great interest for the serious lung diseases resulting from exposure. Methods: During the period 1986-2019, 3611 exposure data to crystalline silica were collected from companies in central Italy. The data were divided and statistically analyzed based on the sampling system (Cyclone Dorr Oliver, CIP 10-R, Cyclone GS3, SKC plastic selector, Cyclone Higgins-Dewell and Cyclone Lippmann) and the ATECO code (code of economic activity, Italian acronym, used to classify companies when they interface with public institutions) of the companies in which they were collected. For each ATECO code, the division was made according to the type of sampling (personal or static) and the descriptive statistics of the data were calculated. Results: Overall, for personal samples, 8.8% of the data exceeds 0.1 mg/m3, 19.6% exceeds 0.05 mg/m3 and 33.8% exceeds 0.025 mg/m3, the limit values set by the EU Directive 2019/130, suggested by the SCOEL and published by ACGIH respectively. The ATECO codes with the highest worker exposure (geometric means 0.067 and 0.069 mg/m3) were 23.31.00 (manufacture of ceramic tiles for floors and walls) and 23.42.00 (manufacture of ceramic sanitary ware), while the lowest exposure is found in 81.29.91 (cleaning and washing of public areas, removal of snow and ice including shedding of sand) with a geometric mean of 0.002 mg/m3. Discussion: Despite the general reduction over time, there are still many sectors in which data are higher than the current occupational exposure limits; especially in these sectors it is necessary to implement the measures to fully assess worker exposure.
Chronic silica exposure has been associated to cancer and silicosis. Furthermore, the induction o... more Chronic silica exposure has been associated to cancer and silicosis. Furthermore, the induction of oxidative stress and the generation of reactive oxygen species have been indicated to play a main role in the carcinogenicity of respirable silica. Therefore, we conducted a cross-sectional study to evaluate the prevalence of 3-(2-deoxy-β-D-erythro-pentafuranosyl)pyrimido[1,2-α]purin-10(3H)-one deoxyguanosine (M 1 dG) adducts, a biomarker of oxidative stress and peroxidation of lipids, in the nasal epithelium of 135 silica-exposed workers, employed in pottery, ceramic and marble manufacturing plants as well as in a stone quarry, in respect to 118 controls living in Tuscany region, Italy. The M 1 dG generation was measured by the 32 P-postlabelling assay. Significant higher levels of M 1 dG adducts per 10 8 normal nucleotides were observed in the nasal epithelium of smokers, 77.9 ± 9.8 (SE), and in those of former smokers, 80.7 ± 9.7 (SE), as compared to non-smokers, 57.1 ± 6.2 (SE), P = 0.001 and P = 0.004, respectively. Significant increments of M 1 dG adducts were found in the nasal epithelium of workers that handle artificial marble conglomerates, 184 ± 36.4 (SE), and in those of quarry workers, 120 ± 34.7 (SE), with respect to controls, 50.6 ± 2.7 (SE), P = 0.014 and P < 0.001, respectively. Null increments were observed in association with the pottery and the ceramic factories. After stratification for different exposures, silica-exposed workers that were co-exposed to organic solvents, and welding and exhaust fumes have significantly higher M 1 dG levels, 90.4 ± 13.4 (SE), P = 0.014 vs. control. Our data suggested that silica exposure might be associated with genotoxicity in the nasal epithelial cells of silica-exposed workers that handle of artificial marble conglomerates and quarry workers. Importantly, we observed that co-exposures to other respiratory carcinogens may have contributed to enhance the burden of M 1 dG adducts in the nasal epithelium of silica-exposed workers.
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