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Magnani C, Mensi C, Binazzi A, Marsili D, Grosso F, Ramos-Bonilla JP, Ferrante D, Migliore E, Mirabelli D, Terracini B, Consonni D, Degiovanni D, Lia M, Cely-García MF, Giraldo M, Lysaniuk B, Comba P, Marinaccio A. The Italian Experience in the Development of Mesothelioma Registries: A Pathway for Other Countries to Address the Negative Legacy of Asbestos. Int J Environ Res Public Health 2023; 20:ijerph20020936. [PMID: 36673690 PMCID: PMC9858856 DOI: 10.3390/ijerph20020936] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 06/12/2023]
Abstract
Asbestos (all forms, including chrysotile, crocidolite, amosite, tremolite, actinolite, and anthophyllite) is carcinogenic to humans and causally associated with mesothelioma and cancer of the lung, larynx, and ovary. It is one of the carcinogens most diffuse in the world, in workplaces, but also in the environment and is responsible for a very high global cancer burden. A large number of countries, mostly with high-income economies, has banned the use of asbestos which, however, is still widespread in low- and middle-income countries. It remains, thus, one of the most common occupational and environmental carcinogens worldwide. Italy issued an asbestos ban in 1992, following the dramatic observation of a large increase in mortality from mesothelioma and other asbestos-related diseases in exposed workers and also in subjects with non-occupational exposure. A mesothelioma registry was also organized and still monitors the occurrence of mesothelioma cases, conducting a case-by-case evaluation of asbestos exposure. In this report, we describe two Italian communities, Casale Monferrato and Broni, that faced an epidemic of mesothelioma resulting from the production of asbestos cement and the diffuse environmental exposure; we present the activity and results of the Italian mesothelioma registry (ReNaM), describe the risk-communication activities at the local and national level with a focus on international cooperation and also describe the interaction between mesothelioma registration and medical services specialized in mesothelioma diagnosis and treatment in an area at high risk of mesothelioma. Finally, we assess the potential application of the solutions and methods already developed in Italy in a city in Colombia with high mesothelioma incidence associated with the production of asbestos-cement materials and the presence of diffuse environmental asbestos pollution.
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Affiliation(s)
- Corrado Magnani
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
| | - Carolina Mensi
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alessandra Binazzi
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority, 00143 Rome, Italy
| | - Daniela Marsili
- Department of Environment and Health, Istituto Superiore di Sanità, ISS (Italian National Institute of Health), 00161 Rome, Italy
| | - Federica Grosso
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Juan Pablo Ramos-Bonilla
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
- Departamento de Ingeniería Civil y Ambiental, Universidad de Los Andes, Bogotá 111711, Colombia
| | - Daniela Ferrante
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
| | - Enrica Migliore
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, 10126 Torin, Italy
| | - Dario Mirabelli
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, 10126 Torin, Italy
| | - Benedetto Terracini
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, 10126 Torin, Italy
| | - Dario Consonni
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | | | - Michela Lia
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | | | - Margarita Giraldo
- Departamento de Ingeniería Civil y Ambiental, Universidad de Los Andes, Bogotá 111711, Colombia
| | | | - Pietro Comba
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
| | - Alessandro Marinaccio
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority, 00143 Rome, Italy
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Bonafede M, Granieri A, Binazzi A, Mensi C, Grosso F, Santoro G, Franzoi IG, Marinaccio A, Guglielmucci F. Psychological Distress after a Diagnosis of Malignant Mesothelioma in a Group of Patients and Caregivers at the National Priority Contaminated Site of Casale Monferrato. Int J Environ Res Public Health 2020; 17:E4353. [PMID: 32560553 DOI: 10.3390/ijerph17124353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients of malignant mesothelioma (MM) and their caregivers face significant physical and psychological challenges. The purpose of the present study is to examine the emotional impact after the diagnosis of MM in a group of patients and familial caregivers in a National Priority Contaminated Site (NPCS). METHODS A sample of 108 patients and 94 caregivers received a sociodemographic/clinical questionnaire, the Beck Depression Inventory II, the Davidson Trauma Scale, the Coping Orientation to the Problems Experienced-New Italian Version, and the Defense style questionnaire. The risk of depressive and post-traumatic stress disorder (PTSD) symptoms in relation to the strategies of coping and defense mechanisms was estimated in patients and caregivers separately by logistic regression models. RESULTS For patients, a high risk of depression was associated with high usage of Defense Style Questionnaire (DSQ) Isolation (OR: 53.33; 95% CI: 3.22-882.30; p = 0.01) and DSQ Somatization (OR: 16.97; 95% CI: 1.04-275.90; p = 0.05). Other significant risks emerged for some coping strategies and some defenses regarding both depression and trauma in patients and caregivers. CONCLUSIONS This research suggests that for both patients and caregivers unconscious adaptive processes have a central role in dealing with overwhelming feelings related to the disease.
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Vimercati L, Cavone D, Delfino MC, Caputi A, De Maria L, Sponselli S, Corrado V, Ferri GM, Serio G. Asbestos Air Pollution: Description of a Mesothelioma Cluster Due to Residential Exposure from an Asbestos Cement Factory. Int J Environ Res Public Health 2020; 17:E2636. [PMID: 32290540 PMCID: PMC7215593 DOI: 10.3390/ijerph17082636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/12/2022]
Abstract
The study describes a cluster of 71 malignant mesothelioma cases among Bari residents without asbestos exposure other than residential exposure. This small cohort, as expected, was composed of a majority of females (56.34%) with a M/F ratio of 0.8, ages ≤ 65 years old (52.11%) and the epithelioid morphological type (78.87%). Sixty-four subjects (90.14%) lived between 10 m and 1000 m from the asbestos cement factory (Fibronit), and the latency length was longer than 55 years for 25 subjects (35.21%). The adjusted risk (adjusted OR) of observing the epithelial form of mesothelioma among subjects living at small distances from Fibronit was high (OR = 1.870 (0.353-9.905)) for people living 550-1000 m from the site and for those living less than 550 m from the site (OR = 1.470 (0.262-8.248)). Additionally, the subjects with a high length of exposure showed a relevant risk of epithelioid mesothelioma both for 21-40 years of exposure (OR = 2.027 (0.521-7.890)) and more than 40 years of exposure (OR = 2.879 (0.651-12.736)). All of the estimates were high but not significant because this transitional study has a typically low power. The adjustment for latency showed the same trend. Using detailed information collected by the regional mesothelioma registry, this study provided evidence of a continuing health impact of the Fibronit asbestos cement factory in Bari on the resident population.
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Affiliation(s)
- Luigi Vimercati
- Interdisciplinary Department of Medicine, Occupational Medicine “B. Ramazzini”, University of Bari Medical School, 11 G, Cesare Square, 70124 Bari, Italy; (D.C.); (M.C.D.); (A.C.); (L.D.M.); (S.S.); (V.C.); (G.M.F.)
| | - Domenica Cavone
- Interdisciplinary Department of Medicine, Occupational Medicine “B. Ramazzini”, University of Bari Medical School, 11 G, Cesare Square, 70124 Bari, Italy; (D.C.); (M.C.D.); (A.C.); (L.D.M.); (S.S.); (V.C.); (G.M.F.)
| | - Maria Celeste Delfino
- Interdisciplinary Department of Medicine, Occupational Medicine “B. Ramazzini”, University of Bari Medical School, 11 G, Cesare Square, 70124 Bari, Italy; (D.C.); (M.C.D.); (A.C.); (L.D.M.); (S.S.); (V.C.); (G.M.F.)
| | - Antonio Caputi
- Interdisciplinary Department of Medicine, Occupational Medicine “B. Ramazzini”, University of Bari Medical School, 11 G, Cesare Square, 70124 Bari, Italy; (D.C.); (M.C.D.); (A.C.); (L.D.M.); (S.S.); (V.C.); (G.M.F.)
| | - Luigi De Maria
- Interdisciplinary Department of Medicine, Occupational Medicine “B. Ramazzini”, University of Bari Medical School, 11 G, Cesare Square, 70124 Bari, Italy; (D.C.); (M.C.D.); (A.C.); (L.D.M.); (S.S.); (V.C.); (G.M.F.)
| | - Stefania Sponselli
- Interdisciplinary Department of Medicine, Occupational Medicine “B. Ramazzini”, University of Bari Medical School, 11 G, Cesare Square, 70124 Bari, Italy; (D.C.); (M.C.D.); (A.C.); (L.D.M.); (S.S.); (V.C.); (G.M.F.)
| | - Vincenzo Corrado
- Interdisciplinary Department of Medicine, Occupational Medicine “B. Ramazzini”, University of Bari Medical School, 11 G, Cesare Square, 70124 Bari, Italy; (D.C.); (M.C.D.); (A.C.); (L.D.M.); (S.S.); (V.C.); (G.M.F.)
| | - Giovanni Maria Ferri
- Interdisciplinary Department of Medicine, Occupational Medicine “B. Ramazzini”, University of Bari Medical School, 11 G, Cesare Square, 70124 Bari, Italy; (D.C.); (M.C.D.); (A.C.); (L.D.M.); (S.S.); (V.C.); (G.M.F.)
| | - Gabriella Serio
- Department of Emergency and Organ Transplantation (DETO), Pathology Division, University of Bari Medical School, 11 G, Cesare Square, 70124 Bari, Italy;
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Ferrari L, Carugno M, Mensi C, Pesatori AC. Circulating Epigenetic Biomarkers in Malignant Pleural Mesothelioma: State of the Art and critical Evaluation. Front Oncol 2020; 10:445. [PMID: 32318342 PMCID: PMC7146237 DOI: 10.3389/fonc.2020.00445] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/13/2020] [Indexed: 12/18/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer, which originates from the mesothelial cells of the pleura and is associated with asbestos exposure. In light of its aggressive nature, late diagnosis and dismal prognosis, there is an urgent need for identification of biomarkers in easily accessible samples (such as blood) for early diagnosis of MPM. In the last 10 years, epigenetic markers, such as DNA methylation and microRNAs (miRNAs), have gained popularity as possible early diagnostic and prognostic biomarkers in cancer research. The aim of this review is to provide a critical analysis of the current evidences on circulating epigenetic biomarkers for MPM and on their translational potential to the clinical practice for early diagnosis and for prognosis.
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Affiliation(s)
- Luca Ferrari
- EPIGET LAB, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Michele Carugno
- EPIGET LAB, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Epidemiology Unit, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carolina Mensi
- Epidemiology Unit, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angela Cecilia Pesatori
- EPIGET LAB, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Epidemiology Unit, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Visonà SD, Villani S, Manzoni F, Chen Y, Ardissino G, Russo F, Moretti M, Javan GT, Osculati A. Impact of asbestos on public health: a retrospective study on a series of subjects with occupational and non-occupational exposure to asbestos during the activity of Fibronit plant (Broni, Italy). J Public Health Res 2018; 7:1519. [PMID: 30687679 PMCID: PMC6321947 DOI: 10.4081/jphr.2018.1519] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/27/2018] [Indexed: 01/12/2023] Open
Abstract
The goal of this study is to understand more about the role of asbestos in causing human diseases, first of all mesothelioma, by investigating a large series of deaths due to asbestos-related diseases (ARDs). The main aim is to clarify if even very low amounts of asbestos can cause mesothelioma and other ARDs, as well as to find out if a different individual vulnerability can be important. This retrospective study included 188 subjects who died from asbestos related diseases in 2000-2017 in the area around Broni, Italy, where an important asbestos cement factory had been active from 1932 until 1993. In each case, a forensic autopsy has been performed. In order to perform the present study, the records were retrieved, including the clinical files, the autopsy, and the histological report. The statistical analysis performed showed that there was a significant relation between the cause of death (mesothelioma, lung cancer or asbestosis) and the kind of exposure (occupational, neighborhood or household), showing that all the subjects not exposed occupationally (and, therefore, exposed to lower amounts of asbestos) died from mesothelioma, whereas the individuals who used to work at the plant died also from other caused (asbestosis, lung cancer). Significant differences were highlighted examining the distribution of the causes of death according to the smoking habits. Moreover, among the mesothelioma patients, the survival time was shorter in the subjects with a neighborhood or household exposure than in the occupationally exposed individuals. The study provided meaningful data about the role of asbestos in causing human pathologies. In particular, the present data appear to support the hypothesis that even an exposure to a very little amount of asbestos can cause mesothelioma in hypersusceptible subjects (probably, on a genetic basis). Significance for public health The widespread production and use of asbestos have caused unprecedented human suffering and still represents a major public health problem all over the world. The particularly prolonged latency of the disease has led to the onset of a catastrophic epidemics affecting people who suffered exposure even decades ago. Even though the use of asbestos has been banned in Europe, as well as in the US, in many countries it is still allowed (e.g. Russia, Kazakhstan, Brazil, China). Asbestos is still widely used for insulation, house construction and shipbuilding, and still represents a big business. The diseases caused by asbestos can be divided in two main groups: the non-neoplastic diseases, such as the benign manifestation known as pleuric plaques and, on the other hand, asbestosis, related to the absorption of high amounts of asbestos fibers. The second group includes the malignant neoplastic diseases: lung cancer and mesothelioma. Mesothelioma has to be considered of particular importance, even though its incidence is extremely low in general population, causing, on a global scale, about the 1% of deaths due to tumors. The extreme relevance of this disease, and consequently the great need of research in this field, is owed to its known relationship with a well-defined trigger (asbestos) and its exceptionally poor prognosis.
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Affiliation(s)
| | - Simona Villani
- Section of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia
| | - Federica Manzoni
- Section of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia
| | - Yao Chen
- Section of Legal Medicine and Forensic Science
| | | | | | | | - Gulnaz T Javan
- Forensic Science Program, Department of Physical Sciences Alabama State University, Montgomery, AL, USA
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Vimercati L, Cavone D, Lovreglio P, De Maria L, Caputi A, Ferri GM, Serio G. Environmental asbestos exposure and mesothelioma cases in Bari, Apulia region, southern Italy: a national interest site for land reclamation. Environ Sci Pollut Res Int 2018; 25:15692-15701. [PMID: 29574645 PMCID: PMC5984633 DOI: 10.1007/s11356-018-1618-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/25/2018] [Indexed: 05/07/2023]
Abstract
Asbestos is an environmental carcinogen, and asbestos-related diseases are a global-scale public health issue. We report three cases (one male and two females) of pleural malignant mesothelioma (PMM) caused by environmental asbestos exposure reported by the Apulia Regional Operating Centre (COR) to the National Mesothelioma Registry (ReNaM). The patients revealed no history of asbestos exposure even after detailed assessment. The environmental (neighborhood) asbestos exposure for each of the three cases was due to both the residential history of the subjects and their workplace, close to a military barracks, at a distance of between 45 and 100 m. Moreover, in addition to this new source of pollution, an asbestos cement factory was located in the urban area of Bari municipality, in the Apulia region, southern Italy. Environmental-residential/neighborhood asbestos exposure in the city of Bari, a contaminated area classified as a site of national concern for land reclamation, is discussed also with reference to the military barracks.
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Affiliation(s)
- Luigi Vimercati
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124, Bari, Italy.
| | - Domenica Cavone
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124, Bari, Italy
| | - Piero Lovreglio
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124, Bari, Italy
| | - Luigi De Maria
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124, Bari, Italy
| | - Antonio Caputi
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124, Bari, Italy
| | - Giovanni Maria Ferri
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124, Bari, Italy
| | - Gabriella Serio
- Department of Emergency and Organ Transplantation (DETO), Pathology Division, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124, Bari, Italy
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Marinaccio A, Binazzi A, Bonafede M, Di Marzio D, Scarselli A. Epidemiology of malignant mesothelioma in Italy: surveillance systems, territorial clusters and occupations involved. J Thorac Dis 2018; 10:S221-S227. [PMID: 29507789 DOI: 10.21037/jtd.2017.12.146] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background As a legacy of the large asbestos consumption until the definitive ban in 1992, Italy is currently suffering a severe epidemic of asbestos related diseases. The aim of this paper is to describe the surveillance system for mesothelioma incidence and to provide evidences regarding the occurrence of the disease in Italy and the circumstances of asbestos exposure. Methods Italian National Register of Malignant Mesotheliomas (ReNaM) is a permanent surveillance system of mesothelioma incidence, with Regional Operating Centres (CORs) active in each Italian region, identifying incident malignant mesothelioma (MM) cases from health care structures. Occupational history, lifestyle habits and residential history are obtained using a standardised questionnaire, administered by a trained interviewer, to the subject or to the next of kin. Descriptive epidemiological figures, occupations involved in exposures and territorial maps of MM cases have been produced. Results At December 2016, ReNaM has collected 27,356 MM cases for the incidence period between 1993 and 2015. The modalities of exposure to asbestos have been investigated for 21,387 (78%) and an occupational exposure has been defined for around 70% of interviewed cases (14,818). Non-occupational exposure is still relevant with 4.9% and 4.4% of cases for which respectively a familial exposure (due to the cohabitation with an occupational exposed subject) and an environmental exposure (due to the residence near a contaminated site) has been detected. Discussion The epidemiological surveillance of MM incident cases, by the means of a national register for estimating the occurrence of the disease and identifying the circumstances of asbestos exposure, is a relevant tool for preventing asbestos exposure, for supporting the effectiveness of insurance system and for estimating reliable epidemiological figures.
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Affiliation(s)
- Alessandro Marinaccio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Occupational and Environmental Epidemiology Unit, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Alessandra Binazzi
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Occupational and Environmental Epidemiology Unit, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Michela Bonafede
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Occupational and Environmental Epidemiology Unit, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Davide Di Marzio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Occupational and Environmental Epidemiology Unit, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Alberto Scarselli
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Occupational and Environmental Epidemiology Unit, Italian Workers' Compensation Authority (INAIL), Rome, Italy
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