[Sleep disordered breathing and driving]. / Disturbi respiratori nel sonno e guida.

Obstructive Sleep Apnea (OSA) is the most common Sleep Disordered Breathing. OSA is associated with an increase risk of motor vehicle crash and effective treatment with continuous positive airway pressure (CPAP) reduces that risk to the one of the general population. In commercial drivers an excessive prevalence of OSA has been reported, and the contribution of heavy vehicle crashes to road-related deaths appears to be substantial. Thus, assessment of the risk of OSA and development of effective methods to identify and treat professional drivers with OSA is necessary. Nevertheless, until now there is no consistency in the way OSA is considered by the Driving Licence legislations within the member countries of the European Union (EU), and most ignore OSA, even for professional drivers. The inclusion of OSA in the European traffic license regulations would represent a step forward towards driving safety.

[Occupational accidents, work performance and obstructive sleep apnea syndrome (OSAS)]. / Infortuni e performances sul lavoro in lavoratori affetti da sindrome delle apnee ostruttive nel sonno (OSAS).

Although many patients with obstructive sleep apnea syndrome (OSAS) form part of the work force, the impact of OSAS on occupational accidents and on work performance is unclear. To address this issue, we investigated 100 referents workers without OSAS (50 blue-collar and 50 white-collar) and 331 workers affected by OSAS (144 blue-collar and 187 white-collar). Workers affected by OSAS had been involved in occupational accidents more often than referents (27.2% vs. 20%). The mean number of accidents/year was slightly higher in blue-collar workers with OSAS and significantly higher (p=0.013) in white-collar workers with OSAS than referents. Furthermore, workers with OSAS referred more impairments in work performance as difficulties in memory (p=0.000), vigilance (p=0.000), concentration (p=0.000), performing monotonous tasks (p=0.000), responsiveness (p=0.000), learning new tasks (0.006) and manual ability (p=0.023), with the mean number of impairments being higher (p=0.000) in workers with a more severe OSAS (referents = 0.32; mild OSAS = 1.11; severe OSAS = 1.70). These results suggest OSAS increases the risk of occupational accidents and impaired work performance. Given the impact of OSAS on fitness for duty assessment, occupational physicians should be aware of it and could play a strategic role in its diagnosis, in monitoring treatment, and in providing appropriate information.

Sick building syndrome in like symptoms in emergency prefabricated accommodation.

The present study investigated the sources of discomfort and the symptoms reported by earthquake victims residing in temporary emergency prefabricated accommodation (prefab). The investigation was carried out by means of a questionnaire. 203 prefab occupants and 13 inhabitants of houses, who were chosen as reference population, replied in winter and 233 prefab occupants and 154 inhabitants of houses replied in summer. In both seasons more people living in prefabs indentified dry air, stuffy air, stale air, dust, dampness, uncomfortable temperature and bad odours as sources of discomfort. They also complained of general symptoms (headache, irritablility, insomnia, difficulty in concentration) and irritative symptoms of the eyes, upper and lower airways and skin. Multiple regression analysis identified the type of accommodation as the variable that most influenced the onset of general, ocular, upper and lower airway symptoms. Intrinsic characteristics of the prefabs (being constructed with synthetic materials, combustion sources, poor ventilation and insulation) and psychosocial factors e. losing their home, could have contributed to the onset of symptoms.

Prevalence of irritative symptoms in a nonproblem air-conditioned office building.

OBJECTIVES: To assess the prevalence of work-related complaints and symptoms in employees in an air-conditioned office building (Building AC) in a mild climatic area (Italy). No discomfort had previously been reported. METHODS: A total of 198 employees in Building AC and 281 controls working in three naturally ventilated buildings (Building NV) answered a questionnaire investigating work-related complaints and symptoms. RESULTS: A significantly higher percentage of workers in Building AC reported a lack of comfort in the working environment as compared with the controls (30.6% versus 18.9%). The most common complaints were strong lighting, high temperature, and dry, dusty, and/or stuffy air. The prevalence of ocular, upper airway, and cutaneous symptoms was significantly higher (29.8% versus 14.9%, 25.3% versus 9.6%, and 14.1% versus 3.6%, respectively). No significant difference was observed in respiratory or general symptoms. Logistic regression analysis showed that working with video display units and photocopiers influenced ocular symptoms; upper airway and cutaneous symptoms were influenced by female gender and working in the air-conditioned building. CONCLUSIONS: In an apparently healthy air-conditioned office building, complaints and symptoms are reported more often than in a naturally ventilated edifice, but the prevalence is lower than that usually observed in sick buildings. Symptoms are influenced by individual and work-related characteristics.

Bilateral median and ulnar neuropathy at the wrist in a parquet floorer.

Many cases of work related compression neuropathy of the ulnar and median nerves at the wrist have been described. This report presents a case of bilateral distal neuropathy of the median and ulnar nerves in a parquet floorer, who laid wooden block flooring by hand and used the palms and volar surface of both hands to hit the blocks into place. He also used an electric sander and polisher. Bilateral numbness and paraesthesias in all fingers had been present for about one year. Clinical examination was normal; the neurological assessment indicated slight impairment in response to tactile, heat, and pain stimuli in all 10 fingers. Electroneurography showed increased distal motor latencies of median and ulnar nerves at both wrists, although the lower limbs were normal. The results of blood, urine, and instrumental tests excluded systemic disease or local factors that could cause compression neuropathy. After stopping work for three months, the clinical picture and electroneurographic results improved. These data support the hypothesis that the damage to the median and ulnar nerves had been caused by the patient's way of working, which provoked repeated bilateral microtrauma to his wrists. To diagnose work related multiple neuropathy can be difficult and an accurate work history is necessary. Preventive measures and diligent health care are required for this category of worker.

Increased lead absorption in children living in an area with high concentration of ceramic workshops.

Children who live in contaminated areas or whose cohabitants are occupationally exposed to lead are at a higher risk of lead absorption. The present study examined the blood lead levels of 539 nursery and primary school children living in three towns in the Umbria region (central Italy): Deruta, Corciano and Perugia. Deruta is a small town with a high number of ceramic workshops; Corciano is a mainly agricultural centre; Perugia is the largest town in Umbria. The lead concentrations of house dust, soil, air and water ducts of Deruta and Corciano were also examined. The blood lead levels were significantly increased in children in Deruta (9.7 S.D. = 3.6 micrograms/dL, p < 0.05) and Perugia (9.6 S.D. = 4.0 micrograms/dL, p < 0.05) compared to Corciano (8.3 S.D. = 1.9 micrograms/dL). In Deruta the blood lead levels were higher in children whose cohabitants worked in small ceramic factories or workshops near or in the homes (10.7 S.D. = 4.1 vs 9.0 S.D. = 3.0 micrograms/dL, p < 0.05). The mean concentration of lead in the house dust in Deruta was higher than in Corciano (2.8 S.D. = 2.5 vs 0.8 S.D. = 3.8 micrograms/m2, p < 0.01); the highest values were found in the house dust of the homes of children whose cohabitants worked in small ceramic factories either near or in the same building. There was no significant difference between the concentrations of lead in street dust or tap water of Deruta and Corciano. We conclude that the production of handworked ceramics could lead to an increased risk of lead absorption in children, particularly those who live with workers from this sector.

High prevalence of sick building syndrome in a new air-conditioned building in Italy.

This study, which was conducted in central Italy, included (a) 525 office workers employed in an air-conditioned building that had fan coil units in every room (building B) and (b) 281 subjects who worked in three naturally ventilated buildings (building A) that were operated by the same public administration. The prevalence of work-related symptoms was assessed by a questionnaire that was administered by an occupational medicine specialist. The most frequent complaints of employees in building B were dry air, strong lighting, and high temperature. Employees who worked in this building experienced a statistically higher prevalence of symptoms that were characteristic of the sick building syndrome. This is the first time that this syndrome has been reported in Italy. Excessive illumination, a low relative humidity, and fiberglass on floors and furniture might have contributed to the symptoms. Inadequate maintenance of the building's air-conditioning plant and the employees' lack of information regarding self-regulation of the fan coil units may also have contributed to the prevalence of symptoms.

Effects of low doses of lead on children's health.

An investigation has been carried out of the blood lead levels of children resident in three different municipalities of Umbria: Corciano, selected as a control area; Perugia, the largest town in Umbria (approx. 150,000 inhabitants), with intense automobile traffic; and Deruta a town in which there is a flourishing ceramic industry. The mean blood lead levels were found to be higher in children in Perugia (96 micrograms/l) and Deruta (97 micrograms/l) with respect to Corciano (83 micrograms/l); in Deruta the mean blood levels were raised in those children whose families are occupationally exposed to lead (107 micrograms/l). The concentration of lead in the air in Deruta was higher than in Corciano (0.19 vs 0.11 microgram/m3, respectively). The lead concentrations in house dust were higher in Deruta (2.8 micrograms/m2) than in Corciano (0.8 microgram/m2) and the difference was greater in the houses were the inhabitants were exposed to lead in factories (2.7 micrograms/m2) or in workshops which were adjacent to the houses (4.7 micrograms/m2). The blood lead levels of children included in this study have been compared with those obtained during a similar investigation in 1978. Over the last eight years primary school children in Corciano and Deruta have shown a marked reduction in blood lead levels (greater than 50%). This improvement should not lead to false optimism: in fact, it is impossible to establish the blood lead level at which no adverse effects are induced, especially in children. Numerous studies suggest that even sub-clinical levels of lead can cause alteration in heme synthesis, peripheral nervous system, kidney, immune system, skeleton and growth. Furthermore, with regard to the central nervous system, low blood lead levels can provoke neuropsychological deficits, which can result above all, in a decreased I.Q., and behavioural alterations.

Blood lead levels in children living in three communities, at different risks of lead pollution.

We carried out a survey on blood lead levels in children living in three different communities in Umbria, Italy: Corciano, a small community (12,500 inhabitants), free of lead-using factories and with light traffic; Perugia, a medium-sized city (146,500 inhabitants); Deruta, a small community (7500 inhabitants) whose economy is based mainly on the production of artistic pottery, mostly in small home-operated factories. The study sample was made up of 539 children (275 boys and 264 girls); 156 of them attended nursery school (aged 3-6) and 383 primary school (aged 6-11). The mean blood lead level was significantly higher in Deruta than in Corciano (9.7 vs 8.3 micrograms/dl); Deruta children whose parents were occupationally exposed to lead had significantly higher blood lead levels than children of lead-unexposed parents (10.7 vs 9.0 micrograms/dl). The mean blood lead level was higher in Perugia than in Corciano children. On the average boys had higher blood lead levels than girls in all of the groups. We conclude that blood lead levels were low in the groups of children studied. Nevertheless children of ceramic workers and children living in a medium-sized city had greater lead absorption than children living in the control area.