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Asbestos fibre counting by phase-contrast microscope is subject to many sources of variation, including those dependent on the analyst. In this study, asbestos sample slides prepared with relocatable coverslips have been used for fibre counting among voluntary analysts to evaluate their proficiency. One slide of amosite and one of chrysotile were distributed to all the analysts, and three proficiency testing rounds were conducted for amosite and four for chrysotile. Each relocatable coverslip has a report in which are reported for each viewing field both the number of certified fibres (Verified Fibres) and a drawing representing the shape and position of the individual fibres. In the first round, the analysts were asked to report only the number of fibres counted in each of the predesignated fields of view. In the other rounds, subsequently developed, the analysts had to report the number and the position of the fibres for each field. The reported number of fibres and their position in each of the designed fields were evaluated against their respective verified fibres, to identify types of error. Discrepancies between reported fibres and verified fibres in each field of view have been used to evaluate the proficiency of the analysts. The discrepancies can be positive (D+) or negative (D−) depending on whether the analyst counts, for a specific field of view, more or less fibres compared to the verified fibres. The score is calculated using the following equation: Score = (1 − ∑D+ + ∑│D−│/VF) × 100. An analyst obtaining a score of ≥60, which corresponds to (∑ D + + ∑│ D −│)/VF ≤ 0.40, is proficient. The number of laboratories that participating in this study varied from 13 to 17 depending on the rounds. For amosite fibre counts, the results were generally good compared to a proficiency score of 60. The major error made by analysts was the counting of fibres shorter than 5 µm, where this error was of 62% of extra fibres and accounted for 8% over-estimation of amosite fibres. For chrysotile, a score of ≥50 has been used to consider an analyst as proficient. The results of chrysotile fibres showed that in the first round all analysts counted less than fifty per cent of the verified fibres. In the second round 10 analysts out of 13 reached a score of ≥50, 8 of 16 in the third and 10 of 12 in the fourth. For chrysotile fibres, the error relating to the counting of fibres shorter than 5 µm was of 56% of extra fibres, but the error that most influenced the results was the number of oversight-missing fibres. This type of error accounted for 97% of the missing fibres and for the 29% under-estimation of the chrysotile fibres. For amosite fibre counting, results of this study show an improvement of the analyst's performance. For the chrysotile fibre count, although there is a significant improvement in the comparison between some rounds, this is not continuous over time. [ABSTRACT FROM AUTHOR]

It is well known that male ceramic workers have elevated risks of chronic silicosis. The objective of this study was to assess whether female ceramic workers also have an increased risk of silicosis and whether these women have decreased lung function related to silica exposure. Ceramic workers from Civitacastellana, Italy, were enrolled in health surveillance during the 1970s. A total of 642 women were under surveillance; a respiratory monitoring program was conducted from 1974 to 1987, with follow-up through 1991 that included annual chest radiography and measurement of lung function. Radiography findings were defined as silicosis if the chest films were ≥1/0 with small, rounded opacities. Multiple linear regression models for repeated measures (generalized estimating equations) were run to evaluate associations of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) with years of exposure and radiograph opacities. Nine cases of silicosis were identified on the basis of radiographic evidence. Silicosis risk was not associated with smoking but was related to employment before 1970 and demonstrated a dose-response gradient for years of exposure. FVC and FEV1 both showed significant (p < 0.05) associations with duration of exposure and with positive radiography findings. The results for female ceramic workers are consistent with those for male employees regarding exposure to fibrogenic dusts. [ABSTRACT FROM PUBLISHER]

The presence of asbestos in cosmetic talc has been reported in the United States since the 1970s. The present article first retraces the Italian case, then focuses on technical features as well as the relevant laws, rules, and regulations, ending with a precautionary evidence-based approach. Research was mainly aimed at retrieving official Italian Health Authority papers on the tests carried out several decades ago, to identify the presence of any asbestos in talc of products for sale. Results show that, in Italy, National Institute of Health (the technical agency of the Ministry of Health) and the Italian Pharmacopoeia (1985) used scanning electron microscopy (SEM) to ascertain the absence of asbestos fibres, following positive identification in several samples they had analysed. In 2008, Italy adopted the EU Pharmacopoeia according to which light microscopy (LM) was sufficient for analysis. Such a technical downgrading clearly went - and goes - against the standard principle of precaution to prevent harm to users' health.Unfortunately, documents on the above-mentioned SEM research that would have contextualized observations were not recovered from the Italian State Archive. Observations and results indicate that in practice levels of attention on the issue underwent a considerable (negative) decline, so much that effective planning of the necessary controls was not possible, which is unfortunately true to this day. Final comments deal with the principle of precaution and possible practical operational solutions.

More than 30 years have passed since the beginning of the epidemiological surveillance of mesothelioma (MM). The Italian National Mesothelioma Register (ReNaM), part of the research department of the National Institute for insurance against industrial injuries (INAIL), has published 7 reports with the description of the cas-es concerning the assessment of diagnoses and exposures to asbestos suffered mainly during working activities but also environmental, in the family premises and during personal activities.Today we are witnessing a reduction in the commitment by some regions which negatively affects those who develop the pathology. Reading the ReNaM reports it emerges, among others, the problem of the delay in reporting new cases which limits the collection of information directly from patients. This contribution, discussing various topics, invites to develop a debate that should allow to update and resolve the critical aspects that arise after decades of activity regarding, in particular, the asbestos exposure assessment. It is the primary interest of the authors to give continuity and improve the ReNaM which remains the most prestigious MM register among those active in other countries.

The SIML Position Paper dedicated to asbestos (PPA) is addressed (mainly) to competent practitioners (CP) for the purposes to provide a guidance about a set of items classified as markedly interesting: the actuality of asbestos exposure and the evaluation of the related risk; the diagnosis of the asbestos related diseases; the shape of the risk functions (namely about mesotheliomas); the causal relationship between exposure and disease; the medical surveillance of the workers currently and previously exposed. The scientific literature doesn't acknowledge the idea that nowadays in Italy the frequency of pleural mesotheliomas deriving from environmental asbestos from outdoor sources exposures is really a relevant item. Inside the SIML PPA the chapter concerning industrial hygiene and environmental monitoring themes shows inaccuracies and deficiencies, so resulting of scarce utility for the CPs that should be called for a more cooperative role in front of the employers. The arguments of the diagnosis of the asbestos related diseases is developed with an undue emphasis upon the differential histological diagnosis of asbestosis and, especially, of pleural mesothelioma: nosographic aspects that hardly are posed to the attention of the CP. A similar emphasis is posed towards the shape of the risk function for pleural mesothelioma, a theme absent from the current practice of the CP such as of other occupational practitioners. In conclusion, next to themes of undoubted interest for the PC, the SIML PPA dwells on the scrutiny of some topics representing critical elements of the current contrast between consultants and valuers in the context of criminal prosecutions: subjects having forensic relevance but far from the "application actuality" for the CP invoked in the PPA. A greater transparency, last but not least, was to have been posed, inside the SIML PPA, in the disclosure of the conflict of interests (COIs) of some Authors, declaring their consultancy in favour of companies.