Alberto Scarselli

INAIL Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro, Roma, Latium, Italy

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Publications (48)65.18 Total impact

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    ABSTRACT: Background: Crystalline silica is a human carcinogen and its use is widespread among construction, mining, foundries, and other manufacturing industries. Purpose: To evaluate occupational exposure to crystalline silica in Italy. Methods: Data were collected from exposure registries and descriptive statistics were calculated for exposure-related variables. The number of potentially exposed workers was estimated in a subset of industrial sectors. Linear mixed model analysis was performed to determine factors affecting the exposure level. Results: We found 1387 cases of crystalline silica exposure between 1996 and 2012. Exposure was most common in construction work (AM = 0·057 mg/m(3), N = 505), and among miners and quarry workers (AM = 0·048 mg/m(3), N = 238). We estimated that 41 643 workers were at risk of exposure in the selected industrial sectors during the same period. Conclusions: This study identified high-risk sectors for occupational exposure to crystalline silica, which can help guide targeted dust control interventions and health promotion campaigns in the workplace.
    International journal of occupational and environmental health 10/2014; 20(4):301-7. · 1.10 Impact Factor
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    ABSTRACT: Occupational cancer is an important public health concern in Italy and in many industrialized countries. The difficulties in monitoring and the complexity in retrieving occupational cancer cases have required the enrolment of a national epidemiologic sureveillance system at national scale with active search methods. A structured system for the registration of occupational cancer cases is normed by the Decree No. 81/2008, that accounts for the previous legislative procedures and experiences. Research activities and prevention of occupational cancer should be integrated with insurance policies to the purpose of an efficient protection of workers health.
    Giornale italiano di medicina del lavoro ed ergonomia 10/2014; 36(4):360-4.
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    ABSTRACT: Occupational cancer is an important public health concern in Italy and in many industrialized countries. The difficulties in monitoring and the complexity in retrieving occupational cancer cases have required the enrolment of a national epidemiologic sureveillance system at national scale with active search methods. A structured system for the registration of occupational cancer cases is normed by the Decree No. 81/2008, that accounts for the previous legislative procedures and experiences. Research activities and prevention of occupational cancer should be integrated with insurance policies to the purpose of an efficient protection of workers health.
    Giornale italiano di medicina del lavoro ed ergonomia 10/2014; 36(4):360-4.
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    ABSTRACT: The costs of productivity loss due to occupational cancer mortality are rarely investigated. An estimate of occupational cancer deaths in Italy in 2006 and an approximation of the resultant costs from medical and non-medical expenditures together with figures of remuneration lost are provided. Occupational cancer deaths, obtained from the application of the attributable fraction (AF) to mortality data (source: Italian National Institute of Statistics), were used to calculate the Potential Years of Life Lost (PYLLs), the Potential Years of Working Life Lost (PYWLLs) and the costs of the loss of productive life. The health care costs for any cancer was applied to the estimated number of occupational cancer cases to obtain the total cost. Around 8,000-8,500 deaths/year from occupational cancer are estimated to occur in Italy, corresponding to 170,000 PYLLs and more than 16,000 PYWLLs, leading to around 360,000,000 euros in indirect economic loss. Health care costs of occupational cancer are estimated at 456,000,000 euros. Occupational cancer is of major concern in terms of mortality and economic productivity loss. Preventive efforts in evaluating ongoing risks and current exposures are strongly recommended to health policy-makers. Am. J. Ind. Med. 2013 Wiley Periodicals, Inc.
    American Journal of Industrial Medicine 06/2013; · 1.59 Impact Factor
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    ABSTRACT: BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs) are generally present in the workplace environment as complex mixtures and often difficult to identify a priori. OBJECTIVES: The aim of this study is to evaluate the level and coverage of occupational exposure to PAHs in Italy. METHODS: Data were collected from exposure registries of companies with mandatory reporting to the National Workers' Compensation Authority. Statistical analyses were carried out on the retrieved information and the number of workers potentially exposed was estimated for some industrial sectors. RESULTS: Overall 12,849 measurements of exposure levels to individual PAHs were selected from the database of registries in the period 1996-2010. Most exposures occurred in the manufacture of chemicals (N = 5,383, 51%), and the occupational group most frequently measured was chemical-processing-plant operator (N = 3,930, 31%). Measurements were associated to various PAHs, including benzo[a]pyrene, benzo[a]anthracene, benzo[b]fluoranthene, benzo[k]fluoranthene, dibenz[a,h]anthracene, and benzo[j]fluoranthene. Overall, 39,230 workers were estimated as potentially at risk of exposure to PAHs in the selected industrial sectors. CONCLUSIONS: This study summarized data recorded in the Italian occupational exposure database and identified specific exposure patterns to PAHs. The systematic recording of occupational exposures is a source of data that allows the recognition, control, and prevention of high-risk situations for workers' health. Am. J. Ind. Med. © 2013 Wiley Periodicals, Inc.
    American Journal of Industrial Medicine 02/2013; · 1.59 Impact Factor
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    ABSTRACT: to show how malignant mesothelioma (MM) surveillance not only identifies settings of exposure representing past industrial history, but it may also detect conditions of current exposure relevant for the prevention, if the wide spectrum of asbestos uses is considered. active search of MM cases and exposure assessment at individual level through a questionnaire; identification of exposure circumstances relevant for prevention. Italy, all the Regions where a Regional Operating Centre (COR) is established to identify all MM cases diagnosed in the population and analyze their occupational, residential, household and environmental histories. Period of diagnosis: 1993-2008. descriptive analysis of MM cases and of asbestos exposures. ReNaM includes 15,845 cases of MM diagnosed between 1993 and 2008.The male/female ratio is 2.5.Mean age at diagnosis is 69 years. Pleural MMs represent 93% of all cases. Exposures have been investigated in 12,065 cases (76%). The median latency time is 46 years. In addition to clusters of MM cases in activities well known to entail asbestos use, different current exposure circumstances requiring intervention have been evidenced. on the basis of this experience, epidemiological surveillance of all occupational cancers should be implemented to foster synergies with the compensation system and the Local Health Authorities' occupational safety and health services, as required by the Italian Legislative Decree N. 81/2008.
    Epidemiologia e prevenzione 01/2013; 37(1):35-42. · 1.46 Impact Factor
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    ABSTRACT: Hexavalent chromium (Cr(VI)) compounds have been classified as carcinogenic to humans. This study evaluates the extent and magnitude of occupational exposures to Cr(VI) in Italy. Data were collected from exposure registries of companies compulsorily notified by the National Workers' Compensation Authority. Each measurement was characterized by economic activity sector, work force size, worker personal data, job description, year of measurement, and level of exposure. Descriptive statistical analysis was carried out on the retrieved information. The number of workers potentially exposed was estimated for some industrial sectors. A mixed-effects model was adopted to evaluate the association between exposure variables and exposure concentrations. Over 8400 measurements of Cr(VI) exposures were selected from the database of registries for 1996-2009. Most exposures occurred in the manufacture of fabricated metal products (>50%), and the occupational group most frequently measured was metal finishing-, plating- and coating-machine operators (>52%). Measurements were associated with various Cr(VI) compounds, including chromium trioxide, potassium dichromate, sodium dichromate, strontium chromate, and zinc chromate. Cr(VI) exposure has decreased in more recent years, and the fixed-effects (Cr(VI) compound, activity sector, size and location of the facility, job category, and year of measurement of the final statistical model explained more than 70% of the variance in the observed exposure data. This study summarized data recorded in the Italian occupational exposure database and identified specific exposure patterns to Cr(VI). The mean level of exposure to Cr(VI) was 30.41 μg/m³, and 50,118 workers were estimated at exposure risk in the selected industrial sectors. Systematic recording of occupational exposures is a source of data that allows recognition of high risk situations and improvements in exposure assessment for epidemiologic studies.
    Journal of Occupational and Environmental Hygiene 06/2012; 9(6):398-407. · 1.21 Impact Factor
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    ABSTRACT: Malignant mesothelioma is an aggressive and lethal tumour strongly associated with exposure to asbestos (mainly occupational). In Italy a large proportion of workers are protected from occupational diseases by public insurance and an epidemiological surveillance system for incident mesothelioma cases. We set up an individual linkage between the Italian national mesothelioma register (ReNaM) and the Italian workers' compensation authority (INAIL) archives. Logistic regression models were used to identify and test explanatory variables. We extracted 3270 mesothelioma cases with occupational origins from the ReNaM, matching them with 1625 subjects in INAIL (49.7%); 91.2% (1,482) of the claims received compensation. The risk of not seeking compensation is significantly higher for women and the elderly. Claims have increased significantly in recent years and there is a clear geographical gradient (northern and more developed regions having higher claims rates). The highest rates of compensation claims were after work known to involve asbestos. Our data illustrate the importance of documentation and dissemination of all asbestos exposure modalities. Strategies focused on structural and systematic interaction between epidemiological surveillance and insurance systems are needed.
    BMC Public Health 04/2012; 12:314. · 2.32 Impact Factor
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    ABSTRACT: During the 1990's, the traditional unimodal treatments (surgery, radiotherapy, chemotherapy, immunotherapy) for malignant pleural mesothelioma started to be combined in bimodal or multimodal strategies. However, recent population-based analyses of the survival of patients with malignant pleural mesothelioma indicate that even these treatments have not led to significant improvements in prognosis, which remains very poor. The present study assessed the survival of patients given combined treatments and multimodal therapies in a specialized hospital department. The study population comprised 530 patients diagnosed with malignant pleural mesothelioma from 1982 to 2006: 343 of them were residents in the province of Brescia (Lombardy, Northern Italy) and 187 were residents outside the province, with a follow-up to 31 December 2009. Kaplan-Meier survival analyses and Cox proportional risks model were used to test sex, age at diagnosis, histological type and treatments, as prognostic factors. The estimated median survival for the whole group of patients was 317 days (257 for residents and 398 for non-residents), and respectively 310 and 340 days in the groups diagnosed in the periods 1982-2000 and 2001-2006. Multivariate analysis confirmed that the prognosis was better for younger patients and cases of epithelioid type malignant pleural mesothelioma, whereas for patients receiving any single treatment the prognosis was not significantly better than for those given palliative care alone. However, patients receiving combined treatments or the multimodality approach had significantly longer median survival and the relative risk of death was respectively 0.57 and 0.61 compared to untreated patients (or those only given symptomatic therapy). This is the first study in Italy to assess the effectiveness of different treatment approaches in a significant number of patients treated in one hospital. Further studies are needed to confirm the improvement in prognosis - even if modest--on larger numbers of patients and taking into account the different stages of the disease.
    Tumori. 03/2012; 98(2):215-9.
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    ABSTRACT: Occupational exposure to silica dust occurs in many workplaces and is well known to cause silicosis. However, the link between silica exposure, silicosis and other diseases is still disputed. To evaluate cause-specific mortality in a cohort of Italian silicotics. The cohort included 2034 male compensated for silicosis between 1943 and 1986, alive on 1 January 1987 and resident in the Latium region (Italy). Mortality follow-up was from 1987 to 2006. Vital status and death causes were ascertained from the regional mortality archive. Standardized mortality ratios (SMRs) were computed assuming a Poisson distribution of observed deaths. Significant excess mortality was observed from all causes (SMR: 1.17, 95% CI: 1.11-1.24), cancer of trachea, bronchus and lung (SMR: 1.39, 95% CI: 1.17-1.64), cancer of larynx (SMR: 2.18, 95% CI: 1.32-3.60) and tuberculosis (SMR: 5.85, 95% CI: 3.03-11.30). Higher risks were observed for masons (lung cancer, SMR: 2.46, 95% CI: 1.65-3.66) and miners (larynx cancer, SMR: 5.31, 95% CI: 1.88-15.03). In a Poisson regression analysis, the relative risk of death from lung cancer and silicosis increased with silicosis severity and decreased in more recent compensation periods. The excess mortality from respiratory tract cancers and other diseases detected among Italian workers compensated for silicosis confirms previous epidemiological findings.
    Occupational Medicine 06/2011; 61(6):422-9. · 1.45 Impact Factor
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    ABSTRACT: Due to the large scale use of asbestos (more than 3.5 million tons produced or imported until its definitive banning in 1992), a specific national surveillance system of mesothelioma incident cases is active in Italy, with direct and individual anamnestic etiological investigation. In the period between 1993 and 2004, a case-list of 8,868 pleural MM was recorded by the Italian National Register (ReNaM) and the modalities of exposure to asbestos fibres have been investigated for 6,603 of them. Standardized incidence rates are 3.49 (per 100,000 inhabitants) for men and 1.25 for women, with a wide regional variability. Occupational asbestos exposure was in 69.3% of interviewed subjects (N = 4,577 cases), while 4.4% was due to cohabitation with someone (generally, the husband) occupationally exposed, 4.7% by environmental exposure from living near a contamination source and 1.6% during a leisure activity. In the male group, 81.5% of interviewed subjects exhibit an occupational exposure. In the exposed workers, the median year of first exposure was 1957, and mean latency was 43.7 years. The analysis of exposures by industrial sector focuses on a decreasing trend for those traditionally signaled as "at risk" (asbestos-cement industry, shipbuilding and repair and railway carriages maintenance) and an increasing trend for the building construction sector. The systematic mesothelioma surveillance system is relevant for the prevention of the disease and for supporting an efficient compensation system. The existing experience on all-too-predictable asbestos effects should be transferred to developing countries where asbestos use is spreading.
    International Journal of Cancer 06/2011; 130(9):2146-54. · 6.20 Impact Factor
  • Alberto Scarselli, Alessandra Binazzi, Davide Di Marzio
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    ABSTRACT: Benzene is classified as human carcinogen and the association with lymphohaematopoietic cancer has been observed in many occupational epidemiological studies. The aim of this study is to summarize data about occupational exposure levels to benzene in Italy. Airborne concentrations of benzene were selected from the Italian database on occupational exposure to carcinogens in the period 1996-2007. Descriptive statistics were calculated for exposure-related variables. The number of workers potentially exposed was estimated for the industrial sectors better characterized in the database. An analysis through linear mixed model was performed to determine factors affecting the exposure level. The total number of benzene exposure measurements was 15,776, with an overall arithmetic mean of 0.09 ppm and a geometric mean of 0.02 ppm. Economic sectors with a higher number of measurements (N) were the manufacturing of chemicals (N = 10,480) and the petrochemical industry (N = 2,652). The number of workers potentially exposed in the selected sectors was 37,137, and the most predictive independent variables of the exposure level were measurement year and job category. Occupational benzene exposure is still widespread in many different industries, and proactive measures are needed to reduce its impact on the workers' health. The potential of occupational exposure databases as a source of data for exposure assessment is confirmed.
    International Archives of Occupational and Environmental Health 02/2011; 84(6):617-25. · 2.10 Impact Factor
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    ABSTRACT: The association between cancer incidence and the residence near polluting facilities in an industrial area nearby Taranto has been investigated. Age, sex and occupational exposure were controlled as confounding variables in a case-control study (658 cases, 2092 controls). High risks were evidenced close to the steel mill (OR: 3.54), coke plant (OR: 4.80), mineral deposit (OR: 3.33) and shipbuilding (OR: 4.29) for pleural neoplasm, and to the steel mill (OR: 1.65) and shipbuilding (OR: 1.79) for lung cancer. After adjustment for occupational exposure, increasing trends of risk were observed both for lung and bladder cancers. Cancer risks were evidenced near industrial sites and the introduction of "occupational exposure" as a confounder modified significantly the risks with respect to distance from the source of pollution, particularly for pleural, lung and bladder cancers.
    Annali dell'Istituto superiore di sanita 01/2011; 47(2):192-9. · 0.77 Impact Factor
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    ABSTRACT: Bladder cancer is one of the most common occupational tumours. The objective of this study is to evaluate the number of workers potentially at risk in Italy. Economic activities entailing bladder cancer risk were selected on the basis of the excesses resulting from studies reporting risk estimates. Firms and the number of workers potentially at risk were retrieved from the National Institute for Occupational Safety and Prevention (ISPESL) database of enterprises. Excluding low level exposures, the number of workers (blue-collars) likely exposed to bladder cancer risk in the industry and services is 366 175 ± 11 096 (248 573 ± 7 533 men, and 117 603 ± 3564 women). The North-Western area of Italy shows the majority of workers potentially at risk (86 625 ± 2625 men, and 27 225 ± 725 women). Quantify the number of exposed workers is the first step for performing analyses on occupational cancer risks. National database of enterprises may be useful in identifying potential risk situations for worker's health.
    Annali dell'Istituto superiore di sanita 01/2011; 47(2):200-6. · 0.77 Impact Factor
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    ABSTRACT: The epidemiology of extrapleural malignant mesothelioma is rarely discussed and the risk of misdiagnosis and the very low incidence complicate the picture. This study presents data on extrapleural malignant mesothelioma from the Italian National Mesothelioma Register (ReNaM). ReNaM works on a regional basis, searching for cases and interviewing subjects to investigate asbestos exposure. Classification and code criteria for certainty of diagnosis and exposure modalities are set by national guidelines. Between 1993 and 2004, 681 cases were collected. Incidence measures and exposure data refer to the ReNaM database. Age-standardised rates were estimated by the direct method using the Italian resident population in 2001. Correlations between the incidence of pleural and non-pleural malignant mesothelioma for the 103 Italian provinces were analysed. Standardised incidence rates (Italy, 2004, per million inhabitants) were 2.1 and 1.2 cases for the peritoneal site (in men and women, respectively), 0.2 cases for the tunica vaginalis testis, and 0.1 in the pericardial site, varying widely in different parts of the country. Mean age at diagnosis for all extrapleural malignant mesothelioma cases was 64.4 years and the men/women ratio was 1.57:1. Median latency was over 40 years for all extrapleural sites combined. The correlation between pleural and peritoneal mesothelioma was 0.71 (Pearson's r coefficient, p<0.001). Modalities of exposure to asbestos fibres were investigated for 392 cases. The rarity of the disease, the low specificity of diagnosis and difficulties in identifying the modalities of asbestos exposure call for caution in discussing aetiological factors other than asbestos.
    Occupational and environmental medicine 11/2010; 67(11):760-5. · 3.23 Impact Factor
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    ABSTRACT: To analyze data stored in the National Register of Occupational Cancers, set up by law at the Italian Institute for Occupational Safety and Prevention. Statistical analyses were performed on economic activity, cancer site, and carcinogenic agent. Mesothelioma cases were excluded because they were exhaustively recorded and managed in a proper register. The number of cancers diagnosed between 1995 and 2008 was 936 (92% men). Lung cancer was the most frequently reported neoplasm (58% of cases). The metal industry had the highest reporting percentage (15%), and silica was the most common causative agent (20%). Despite some limits and incompleteness pertaining to data flow, the results of this study are in accordance with epidemiological findings on occupational cancer risks. The collection of information on occupational cancers is of primary importance to plan targeted prevention programs.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 02/2010; 52(3):346-53. · 1.88 Impact Factor
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    ABSTRACT: The aim of this study is to analyze the information on workers and exposures to biological agents in Italy, collected by the National Institute for Occupational Safety and Prevention in the period 1994-2008 on the basis of a regulation. Employers are asked to identify the biological agents and to report data on employees exposed to biological hazards. Biological agents included in the system belong to risk group 3 and 4 of the European Union classification, and are grouped by family and transmission type. Data analyzed in this study regard 90 firms (28% in "Laboratory analysis clinics" economic activity) and 2,194 workers exposed to biological agents in the period 1994-2008. The most frequent biological agent reported is Salmonella typhi, while the one which counted more exposures is Mycobacterium tuberculosis. Nonetheless the incompleteness of Italian legislative framework about "exposure registers" to biological agents in the workplace, the identification of large groups of workers "at risk" can contribute to undertake epidemiological studies aimed at the prevention of occupational infection diseases.
    Industrial Health 01/2010; 48(3):365-9. · 1.05 Impact Factor
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    ABSTRACT: Legislation in Italy concerning health, safety and prevention at the workplace recently established a new data communication standard The findings are reported of a specific survey on 18 Local Health Units (ASL) over the entire Italian territory, aimed at identifying the critical points in data management and analyze the available information. The occupational health physician for each company must collect and transmit information on the number of workers submitted to health surveillance protocols to the Local Health Unit. Information must be divided by risk factor and gender Local health Units then transmit the data to the Regions and finally to the Italian National Institute for Occupational Safety and Prevention (ISPESL). A sample of 22.977 companies was studied, providing information on about 410,009 workers undergoing health surveillance protocols. Carrying or moving heavy loads, exposure to noise, VDU and chemical substances were the most frequent risk factors. The difference between genders was significant in risk allocation, with exposures to VDU and biological agents prevalently among females. Conclusions: The information thus collected suffered from a lack of data organization and completeness in the sample under study, but nevertheless provides preliminary evidence of a map of occupational risks on a national basis, confirming the potential for the new law (D.Lgs 81/2008) to investigate health safety and prevention at the workplace.
    La Medicina del lavoro 01/2010; 101(4):252-61. · 0.48 Impact Factor
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    ABSTRACT: The aim of this study is to assess the number of workers potentially at risk of bladder cancer in Italy. A detailed list of codes of economic activities entailing bladder cancer risk was developed on the basis of the excess risk resulting from two different pooled analysis (separately for men and women) in Europe. Firms and the number of blue-collars potentially at risk were selected from the ISPESL (National Institute for Occupational Safety and Prevention) database of enterprises. The number of blue-collars likely exposed to bladder cancer risk in Italy is about 443,849 (67.88% men). This evaluation, based on administrative sources rather than on direct measures of exposure, is likely to overestimate potential exposure to carcinogenic agents. ISPESL database of enterprises, which permits the identification and territorial localization of each local unit, is helpful to characterize the current situations at risk for the health of workers.
    Industrial Health 12/2009; 47(6):673-6. · 1.05 Impact Factor
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    ABSTRACT: The aim of this study is to analyze occupational cancer claims compensated in the industrial sector in Italy between 1994 and 2006. A descriptive analysis of compensated occupational cancers based on the Italian Workers' Compensation Authority (INAIL) data was performed. Summary statistics were compiled by sex and age of worker, cancer type, workplace agent and economic sector. The temporal trend in the period 1994-2006 was investigated for the most frequently compensated cancers (mesothelioma and lung cancer from asbestos; nasal cavities cancer from wood and leather dust). Between 1994 and 2006, 6,243 cancer claims were compensated by INAIL due to occupational exposure in the industrial sector. Most (5,288, or 85%) of these compensated claims occurred in the period 2000-2006, when the annual mean of the most compensated cancers increased approximately four times compared to the period 1994-1999. There is an increasing trend in compensation for work-related cancers in Italy in recent years, even if occupational cancers are still widely underreported.
    American Journal of Industrial Medicine 09/2009; 52(11):859-67. · 1.59 Impact Factor