[Introduction to the work of the Congress]. / Introduzione ai Lovori del Congresso.

A research was performed to evaluate the burden of publications on Occupational Health in health care settings in the last 20 years. National and international literature shows a relevant interest, in particular for biological, biomechanical and psychosocial risks. In the three sections of this Congress these topics will be discussed in the light of the latest scientific advancements in the field and of recent laws. Moreover, the results of multicenter studies performed on these topics will be presented by three working groups.

[Integration of subjective and objective methods for stress related risks evaluation in the health care sector]. / L'integrazione di indicatori oggettivi e soggettivi per la valutazione dei fattori di rischio stress-correlati nel settore sanitario.

One of the most relevant aspects in the evaluation of occupational stress is concerned with the survey methodology. Several studies adopted subjective and objective methods of evaluation and the debate about the benefits and limitations of both approaches has continued for several years (Frese et al. 1988, Hurrell et al. 1998). To choose an appropriate, specific and focused-on-context evaluation, it is necessary to identify the sources of risk in the investigated area. Then, it is necessary to choose the methods, subjective and objective, more suitable for stress evaluation. In this study we reviewed the psychosocial risk factors that are specific to the health sector and the instruments, objective and subjective, most used in this context. We considered also the methods for the detection of episodes of violence. Finally, we presented the results of a study conducted in the health care sector, which has adopted and compared objective parameters, as potential stressors, and subjective symptoms. The study revealed statistically significant correlations between objective and subjective indicators, suggesting the importance of integrated methods of evaluation.

Training in safer and healthier patient handling techniques.

The aim of the project was to educate nursing staff on patient handling techniques to prevent low back pain. Within the framework of a multidisciplinary preventive intervention, a pre-post study design was implemented in a hospital. One hundred and forty nurses and healthcare assistants attended a two-hour lesson and a three-hour practical training session; 48 nurses attended a train-the-trainer programme that was comprised of three-hour classes, two-hour lessons on communication techniques and four hours of practical training. Improvements were tested using questionnaires and direct observations. A statistically significant improvement was noted in questionnaire scores (p<0.001) and handling techniques (p<0.001); use of equipment and low back symptoms improved remarkably. The train-the-trainer programme improved knowledge, communication skills and ability to evaluate manual handling techniques; this allowed the education programme in patient-handling techniques to be extended to all healthcare workers. This approach was effective in increasing the knowledge, practical abilities and communication skills of the workforce. It also allowed a network of internal trainer nurses to be set up, who enabled the implementation of safer and healthier working techniques in nursing staff.

From lead to manganese through mercury: mythology, science, and lessons for prevention.

BACKGROUND: Lead (Pb), mercury (Hg), and manganese (Mn) are well-known neurotoxic metals. The knowledge of toxicity was developed through an extensive amount of research, starting with lead and mercury and proceeding today with manganese. Unfortunately, the consequent implementation of preventive measures was generally delayed, causing important negative effects to the exposed populations. METHODS: A review and historical reconstruction of the research development that yielded modern understanding of lead and mercury neurotoxicity was conducted to derive useful lessons for the prevention of manganese neurotoxicity. RESULTS: Medieval alchemists named planets and metals from gods since they were already aware of the toxicity and the adverse effects caused by lead and mercury. Historical lessons learned from these two metals may help to avoid the repetition of further mistakes regarding other neurotoxic metals like manganese. The knowledge and experience on the toxicokinetics and toxicodynamics of lead and mercury is useful and valuable to identify a proper approach to "safe" exposure levels for manganese. CONCLUSIONS: Further information is still needed on the early neurotoxic and neurobehavioral effects after prolonged exposure to very low doses of lead, mercury, and manganese. Nevertheless, according to the precautionary principle, effective preventive measures should be already undertaken to prevent the onset of more severe health effects in the population. This is the most important lesson to be learned and applied from more than 30 years of occupational and environmental neurotoxicology of metals.

High prevalence of Parkinsonian disorders associated to manganese exposure in the vicinities of ferroalloy industries.

OBJECTIVE: To assess the prevalence of Parkinsonian disturbances in relationship to environmental exposure to manganese due to ferroalloy industries in the province of Brescia, Northern Italy. METHODS: Manganese concentrations were measured in settled dust collected in each of the 206 municipalities. Parkinsonian patients were identified using two sources: (1) clinical registers from local hospitals, specialized neurologists, and exemption from prescription payment; (2) L-Dopa prescriptions. Standardized prevalence rates and raw and full Bayesian-smoothed standardized morbidity ratios (SMRs) were calculated for the entire province and for each municipality. RESULTS: Manganese concentrations in settled dust were significantly higher in the surroundings and downwind from the industrial plants. A total number of 2,677 Parkinsonian cases were identified among 903,997 residents (crude prevalence, 296/100,000; 95% CI: 284.80-307.20; standardized prevalence, 407/100,000; 95% CI: 393.87-420.12). Significantly higher SMRs (Kruskal-Wallis chi(2) 1 df = 17.55, P < 0.001) were observed in 37 municipalities in the vicinities of ferromanganese plants (324 cases among 77,708 residents; standardized prevalence 492/100,000; 95% CI: 442.80-541.20), compared to the other 169 municipalities of the province (2,353 cases among 826,289 residents, standardized prevalence 321/100,000; 95% CI 308.80-333.20). Row and Bayesian SMRs were associated with the concentrations of manganese in settled dust. CONCLUSION: Study results suggest that environmental exposure to manganese is associated with an increased prevalence of Parkinsonian disturbances. Since the highest prevalence rates were observed in a closed community of the pre-Alps where the industries are located, further research should address a possible interactive role of genetic factors.

Prevention of latex allergy among health care workers and in the general population: latex protein content in devices commonly used in hospitals and general practice.

BACKGROUND: In this study the latex protein content in devices commonly used in hospitals and general practice were investigated. The main aim was to acquire information for preventing latex allergy in health care workers and in the general population. METHODS: About 22 different types of medical devices and 23 devices commonly used in general practice were examined evaluating the total allergenic potency by a modified RAST-inhibition assay and quantitative determination of single allergens (Hev b1, Hev b5 and Hev b6.02) by using commercial ELISA kit. RESULTS: A high level of inhibition was found in medical devices, such as elastic bandage (81.57%), tourniquet (74.09%), Foley urinary catheter (68.35%), Penrose drainage (67.25%) and taping (39.6%), and in common devices, such as rubber inner-sole (84.20%), toy balloon (78.62%), latex mattress (74.27%), household rubber gloves (49.10%), working gloves (38.25%), inflatable floating mattress (32.10%). Concentrations of latex extractable proteins and Hev b1, Hev b5 and Hev b6.02 antigens were high in some medical and general devices. CONCLUSIONS: Latex exposure sources were found in hospitals and the home. These findings, though only preliminary and far from conclusive, could enable sensitized persons to avoid risky exposures and prevent allergic reactions. From the point of view of prevention, the time may come when every natural rubber object could be systematically labelled as "containing latex" together with the warning that "this item may cause allergic reactions in sensitized subjects."

Prevention of injuries at work: the role of the occupational physician.

OBJECTIVES: To highlight the role of occupational physician (OP) in occupational injuries (OI) prevention and management. To suggest an approach beyond traditional focus on descriptive epidemiology, engineering interventions, administrative aspects of OI prevention. To promote a person- and enterprise-tailored approach, entailing greater attention to human factors and to practical problems of the specific workplace, with a call to a leading role played by OP. METHODS AND RESULTS: Analysis of the literature on the broader topic of OI prevention revealed thousands of publications; however, only a handful of them mention or describe the participation of OP in OI prevention. While recognizing that literature search is not the proper and only way to appreciate the current role of OP in this field, therefore, it seems necessary to call OP to a stronger effort in prevention and management of OI, through the context of a comprehensive intervention in cooperation with managers, supervisors, safety personnel and workers, focusing on specific needs of each enterprise. The following areas of OP intervention were examined: risk assessment, health surveillance, management, scientific research and health education. Within each of these topics, possible contributions, methodologies, instruments available for the OP were discussed, taking into account the relevant literature. Pathways for practical applications were illustrated, e.g., OI data generation and analyses, predictors of OI, fitness for work, case management, team work, educational issues, first aid, suggestion for OP contribution in specific research questions. CONCLUSIONS: OI continue to take a remarkable toll from individuals and society. New multidisciplinary interventions are needed to prevent OI. Focused activities at the single worksite with a central role from OP are definite options. OP is an effective interface between workforce and management and may offer, through a proactive approach, valuable practical and cultural contributions, while respecting technical and ethical guidelines of occupational health professionals.

Neurobehavioral science in hazard identification and risk assessment of neurotoxic agents--what are the requirements for further development?

OBJECTIVES: Modern neurobehavioral methods find useful application in research into the early effects of exposure to neurotoxic agents in the environment. This paper briefly describes the history and evolution of neurobehavioral toxicology, reviews some current trends in research in this specific discipline and identifies the most important needs and challenges to be addressed in future studies. METHODS: All published literature was considered, including ad hoc meeting reports. Further information was obtained directly from experts in the field. RESULTS: The number of studies (including those in occupational, environmental and pediatric exposure) using neurobehavioral evaluation is constantly increasing. Regulatory agencies are using scientific data obtained through neurobehavioral assessment, which includes other areas such as neurosensory toxicology. However, further development of this discipline is facing a number of problems and issues. Three major areas that deserve further attention have been identified: (1) specific technical issues regarding testing development, (2) epidemiological issues regarding the study design, including the need for meta-analysis/multi-center studies and for longitudinal observation, and statistical issues regarding the most adequate models for the analysis and treatment of complex neurobehavioral datasets, and (3) the need for scientific consensus on the significance of adverse effects identified with neurobehavioral methods. CONCLUSIONS: The importance of neurobehavioral toxicology in the evaluation of mechanisms of action and for preventive purposes is progressively growing. Further development is needed for the advancement of this discipline through collaboration between experts from different fields.

Application of a latent variable model for a multicenter study on early effects due to mercury exposure.

A latent variable model was applied to the results of an Italian multicenter nation-wide cross-sectional study to assess the earliest health effects due to mercury (Hg) exposure caused by occupation, dental amalgams (DENTAM) and fish eating (FISH). The studied population included subjects recruited from four different geographical areas. A total number of 122 workers from chloroalkali plants and production of thermometers and neon lamps formed the occupationally exposed group, whereas 196 subjects, recruited from the same areas and not occupationally exposed to mercury, formed the control group. Neuropsychological functions were assessed with neurobehavioral testing including vigilance, motor and cognitive function, tremor measurements, and with symptoms concerning neuropsychological and mood assessment. Neuroendocrine function was examined with the measurement of prolactin (PRL) level. Parameters of immunological and renal function were also measured. The target population was characterized by the number and surface of dental amalgams and consumption of fish. In the exposed workers the average urinary mercury (U-Hg) was 10.4+/-6.9 (geometric mean 8.3, range 0.2-35.2) microg/g creatinine, whereas in the control group it was 1.9+/-2.8 (geometric mean 1.2, range 0.1-33.2) microg/g creatinine. The preliminary results indicated that finger tapping (FT) and the Branches alternate movement task (BAMT) coordination test were associated with the occupational exposure (OCCEXP). PRL was significantly decreased among the exposed workers, and inversely related to U-Hg. Among the immunological and renal parameters, cytokine serum interleuchin-8 (sIL8) and beta(2) micro globulin (beta(2)MG) were lower in the exposed group and negatively correlated to U-Hg. Small-size fish consumption was associated to a beneficial effect on symptoms reporting. No effects were observed concerning dental amalgams. After first evaluating the relationship between mercury exposure and each indicator of effect, further assessment was performed to identify the earliest effects related to mercury exposure among those who resulted in being associated in the preliminary elaboration. Two latent variables "exposure" and "effect" were identified, integrating respectively the different forms of exposure (occupational, due to dental amalgams and fish consumption) and the indicators of effects (FT, BAMT, PRL, sIL8, beta(2)MG). Confounding factors (age, alcohol, body mass index (BMI)) were considered in the same model. This further analysis showed that an inverse association of occupational exposure to mercury with PRL and BAMT, with Hg-U mediating the effect on PRL, was predominant with respect to the other form of mercury exposure, the other indicators of effect and the confounders. In conclusion, this study supports the finding of alterations of neuroendocrine secretion and motor coordination at very low occupational exposure levels of inorganic mercury, below the current ACGIH Biological Exposure Index. These changes occur at lower levels than other subtle effects on the renal function and the immunitary system. On the contrary, dental amalgams and small-size fish consumption do not seem to be associated to any adverse health effect at these exposure levels.

Prevention of latex allergy among health care workers: evaluation of the extractable latex protein content in different types of medical gloves.

BACKGROUND: Since the 1980s, there has been increased use of latex gloves by health care workers and a concomitant increase of irritant and allergic reactions. The total protein content and the latex allergenic protein content in different types of medical gloves commonly used in our hospital were evaluated to acquire information useful for preventing latex allergy in our hospital personnel. METHODS: The total protein content and the allergic latex protein contents were evaluated with Lowry modified method and RAST inhibition assay in samples and extracts of 29 different types of medical gloves. RESULTS: The highest concentrations of total proteins and allergenic latex proteins were found in examination powdered latex gloves and in surgical powdered latex gloves; a significant amount of latex proteins was found in some brands of nitrile gloves. CONCLUSIONS: The clear association between the total protein levels and the allergenic latex protein levels suggests that the gloves with highest total protein content have the greatest allergenic potential. Therefore, it is recommended that manufacturing companies should provide package inserts including the total protein contents and possibly allergenic latex protein levels. They should declare whether they have added latex to their nitrile glove formulation. RAST-inhibition assays directly on glove samples instead of glove extract seems to be a good reliable and faster alternative for the evaluation of the allergenic potential of latex gloves.