No Correlation between Blood Benzene Levels and Luteinizing Hormone Plasma Values in Outdoor Workers.

OBJECTIVE: The purpose of the study is to evaluate whether low-dose exposure to benzene, an environmental pollutant to which male and female traffic policemen are daily exposed to could cause alterations in plasma luteinizing hormone (LH) levels. METHODS: From an initial sample of 1594 workers, we only selected 95 workers of whom study we knew the values of late-shift benzene and LH hormone. All subjects underwent biological monitoring (final blood benzene evaluation) and luteinizing hormone dosing. Excluding subjects with the main confounding factors, the final sample included 76 workers. The normal distribution of the variables was evaluated using the Kolmogorov - Smirnov test, followed by the logarithmic transformation of the LH and benzene values. The comparison among means was performed by using the t-test for the independent samples. The ANOVA test was performed for variables with more than 2 modes (ages and seniority) and Pearson correlation index between variables in the total sample and after subdivision as to sex, job, sports activity and smoking. The results were considered significant when p values were less than 0.05. RESULTS/CONCLUSION: The study did not show a correlation between benzene levels and LH plasma levels in outdoor workers.

A campaign aimed at increasing seasonal influenza vaccination coverage among post graduate medical residents in an Italian teaching hospital.

We analysed the impact of several strategies aimed at increasing influenza immunisation rates among Medical Residents (MRs) of an Italian teaching Hospital. During the 2015-16 and 2016-17 influenza seasons we carried out several interventions: ambulatory doubling where vaccination was offered, ambulatory opening hour extension, email invitations, informative materials, forum theatre and vaccination campaign conference. In addition, during the 2016-17 the OSV was carried out: MRs who go to specific wards where they perform influenza immunisation counselling and eventually vaccinate the personnel. 99/1041 (9.5%) and 184/1013 (18.2%) MRs received the vaccine in 2015-16 and in 2016-17 respectively (p < 0.0001). Significant difference was found among three specialisation areas (medicine, surgery, "services"; p < 0.001) and among years of residency (p < 0.001). The highest coverage was found among Infectious Diseases, Paediatrics, Haematology and Hygiene MRs (80%, 67%, 52% and 52% respectively) in 2016-2017 season. The highest coverage increase was found among MRs in Pneumology and Geriatrics (566% and 268%, respectively). The coverage rate has increased even though important differences among specialties persist. The study shows a significant increase in immunisation rate among MRs after the implementation of these strategies.

[Biological risk in agriculture and construction workplaces: a survey on perception, knowledge and prevention measures.] / Il rischio biologico nei lavoratori dei settori agricoltura ed edilizia: percezione, conoscenze e misure di prevenzione.

OBJECTIVES: Despite the potential presence in many workplaces, biological risk is little known and largely underestimated, except in healthcare environments. Objectives: To evaluate perception, knowledge and behaviors adopted for protection and prevention of biological risk, related also to the occupational activity, among construction and agricultural workers. METHODS: Workers were recruited at farms and construction companies of Molise Region, Central Italy, which were visited within the surveillance activities planned by local institutions. A questionnaire was administered to workers to collect sociodemographic and occupational data, and concerning risk perception and knowledge, and awareness of available prevention measures, also related to the work activity. RESULTS: total of 143 workers (73.4% males, 42.9±10.7 years old) were interviewed, and 56.6% were construction workers. Only 24% of workers believed that infectious diseases could be frequent and health threatening in carrying out the work activities; half of them declared to be exposed to biological hazards, but 70% were unworried. An underestimation of the severity of some pathologies, such as listeriosis, leptospirosis and viral hepatitis emerged, and only 70% of workers believed that tetanus is highly or very highly dangerous for health. Furthermore, 33% of workers said to have scarce or insufficient knowledge of biological risk, and 97.2%, 80.4% and 45.5% were aware that a vaccine is available for tetanus, hepatitis B and A, respectively. All workers undergone the tetanus vaccination and 39.2% the anti-hepatitis B. CONCLUSIONS: Despite the high probability of exposure to biological agents, the results of the survey revealed a lack of perception and knowledge of the risk, as well as a poor awareness of available preventive measures among construction and agricultural workers. These data point out the need to activate information and training programs on exposure to biological agents and on both emerging and re-emerging infectious diseases potentially related to work activities, and to provide prevention procedures specific for these workplaces.

Biological risk among agriculture and construction workers in Molise Region, Central Italy. / Studio pilota sul rischio biologico nei settori agricoltura ed edilizia in Molise.

BACKGROUND: Biological risk is a significant issue in workplaces due to continuous modification of work organization and condition. OBJECTIVES: In this pilot study, perception and knowledge of biological risk, as well as adoption of prevention measures were evaluated among construction and agriculture workers. METHODS: A structured questionnaire was administered to workers to collect socio-demographic and employment information, in addition to data on risk perception and knowledge, and adoption of preventive measures, including those related to work activities. RESULTS: Fifty-three workers aged 45.3±9.8 years participated in the study, 81% were male, and 70% were construction workers. Approximately 80% of participants declared that infectious diseases are neither frequent nor health-threatening in their occupational activity. The majority of workers considered some diseases, such as hepatitis A and B, leptospirosis and listeriosis, as posing a low risk to their health. Forty-seven % claimed to be unexposed to biohazards at their workplace, and 72% were not worried about them. Ninety-six % of the workers knew about vaccination for tetanus, but only 74% and 36% knew about the availability of vaccination for Hepatitis A and B, respectively. During lifetime, 94% of the workers received at least one vaccination. All workers had undergone tetanus vaccination, but only few received vaccine for influenza, hepatitis B and tuberculosis. CONCLUSIONS: This pilot study in occupational settings revealed a poor perception of biological risk and a limited awareness of the severity of infectious diseases. Major knowledge gaps existed about the available preventive measures. It is essential to promote safety culture at the workplace also with regard to biological hazards. This requires improving information and education, conducting appropriate studies, and prompting health and safety professional actors to focus on occupational infectious disease problems.

[A health promotion campaign to improve flu vaccination adherence among medical residents in an Italian Teaching Hospital]. / Una campagna di promozione della salute per migliorare l'adesione alla vaccinazione antinfluenzale nei medici in formazione specialistica in un ospedale universitario italiano.

INTRODUCTION: In Italy annual flu vaccination for health care workers is recommended but coverage is usually unsatisfying. The compliance is even worse among medical residents (MRs) both in literature, both in our experience: in the flu season 2014/ 15 only 0.6% of MRs enrolled at the Università Cattolica del Sacro Cuore (UCSC) were vaccinated. For this reason, during the influenza season 2015/16, the Institute of Public Health of the UCSC, in collaboration with the Health Management of the "Agostino Gemelli" Teaching Hospital (FPG) and with the directive board of the Medical Specialization Schools (SSM) present at the University has tested several strategies to improve awareness and adherence to flu vaccination campaign by its staff. This study aims to analyze the impact of the strategies used during the 2015/16 campaign on flu vaccination coverage among MRs of an important Italian Teaching Hospital. METHODS: The study was conducted among MRs enrolled at the UCSC - FPG in 2015/16. The data was collected by the Occupational Medicine which, during the influenza seasons, immunize MRs against influenza free of charge. For each variable - vaccination, area of specialization (surgical, medical, clinical services), typology of SSM - was measured the absolute and percentage frequency. In order to compare the flu vaccination coverage between seasons 2014/15 and 2015/16 and between areas of specialization in 2015/16 chi-square test was used (statistical significance level of 0.05). The data were analyzed using STATA Software. RESULTS: Were included in the analysis 42 SSM with a total of 1041 MRs. During the vaccination campaign 2015/16, flu vaccine was administered to 99 MRs (9.5%), 8.9% more than in the previous season (p<0.001). There is also a significant difference in vaccine coverage between surgical, medical and clinical services areas in 2015/16 (p <0.001). The highest vaccination coverage was recorded among MRs of Hematology and Urology (54.5%). However, no one MRs had undergone flu vaccination in about 40% of SSM. CONCLUSIONS: Seasonal flu vaccination among HCWs is important to protect patients as well as them self and their family members. Considering that MRs represent the next generation of HCWs, they should be sensitized about the importance of preventing the spread of influenza in hospital population, becoming an active part of the necessary cultural change. This study highlights a first and promising, although insufficient, increase in flu vaccination coverage among MRs enrolled at the UCSC - FPG after introducing simple strategies to promote vaccination itself and, more generally, positive and proactive behaviors. The study summarizes the results in the short term, but it is well known that cultural changes require time and constancy. Therefore, it will be useful to monitor the improvement over time and extend the assessment to all health care professionals.

Correlation between urinary cadmium and thyroid hormones in outdoor workers exposed to urban stressors.

OBJECTIVES: The aim of this study is to evaluate whether exposure to low concentrations of cadmium (Cd) can have effects on the thyroid hormone level of outdoor workers exposed to urban pollutants. METHODS: The study was conducted on a final sample of 277 individuals (184 males and 93 females). The environmental monitoring of Cd was evaluated through the use of portable dosimeters, while the biological monitoring was achieved through the assessment of urinary Cd and thyroid hormones. The total sample was divided according to sex and task. The Pearson's correlation coefficient among the variables was calculated after subdivision on the basis of sex and task. The multiple linear regression was performed to take into account the major confounding factors. RESULTS: Statistical tests showed a negative correlation between urinary Cd levels and free triiodothyronine and free thyroxine and a positive correlation between urinary Cd and thyroid-stimulating hormone levels. CONCLUSIONS: Our early results seem to point out that occupational exposure to low concentrations of Cd present in urban air affects the thyroid hormone levels in exposed workers.

[Health management of Italian workers abroad]. / La gestione dei lavoratori italiani all'estero.

In the last 20 years traveling workers abroad have increased markedly. This resulted in the need for standardized preventive tools available to protect workers-travelers in geographic areas with related additional risk factors. Health surveillance of these workers require a company organization that involves the components of the process prior: the occupational physician, safety service, administrative areas, travel clinic. The application phases of medical surveillance must be differentiated into two main phases: 1. pre-travel, in which successive stages also encoded by the SIMLII guidelines; 2. the return journey, where the paths are different for asymptomatic and symptomatic workers. The evaluation of fitness to perform the job abroad is based on general criteria that allow to correlate the health of the worker with respect to the destination area. The application methods actually available allow modulations of the health surveillance for companies of different dimension.

Luteinizing hormone (LH) levels in male workers exposed to urban stressors.

The aim of the study is to evaluate if occupational exposure to urban stressors could cause alterations in luteinizing hormone (LH) plasma levels in male traffic policemen vs. administrative staff of Municipal Police.After excluding the subjects with the main confounding factors, male traffic police and administrative staff of Municipal Police were matched by age, working life, body mass index (BMI), alcohol drinking habit, cigarette smoking habit and habitual consumption of Italian coffee.In 166 male traffic police mean LH values were significantly higher compared to 166 male administrative employees. The distribution of LH values in traffic police and in administrative employees was statistically significant.Our results suggest that recent exposure to urban stressors (chemical, physical and psycho-social) can alter the plasma concentration of LH. In agreement with our previous research, levels of plasma LH may be used as early biological markers, valuable for the group, used in occupational set before the appearance of the disease.

Plasma 17-alpha-OH-progesterone in male workers exposed to traffic pollutants.

The aim of the study is to evaluate if the occupational exposure to urban pollutants could cause alterations on 17-alfa-hydroxy-progesterone plasma levels and related diseases in male traffic policemen. 17-alpha-OH-P is synthesized in Leydig cells and in adrenals; it influences spermiogenesis, acrosoma reaction, testosterone biosynthesis, blocking of gonadotropin secretion; it regulates learning, memory and sleep. After excluding principal confounding factors, i.e., rotating or night shifts, exposure to solvents, paints and pesticides during time-off and smoking, traffic policemen were matched with controls by age, working life and drinking habit. Finally, 112 traffic policemen and 112 controls were included in the study. In traffic policemen 17-alpha-OH-P mean values were significantly higher vs. controls. The distribution of 17-alpha-OH-P values in both groups was significant. An increased frequency of fertility disorders referred to the questionnaire items were found in traffic policemen vs. controls, but the difference was not significant. The occupational exposure to low doses of chemical urban stressor, interacting with and adding to the psychosocial ones, could alter plasma 17-alpha-OH-P concentrations in traffic policemen vs. controls. 17-alpha-OH-P could be used as an early biological marker, even before the onset of the reproductive and mental health diseases.

Plasma dopamine in workers exposed to urban stressor.

The aim of this study is to evaluate if the occupational exposure to urban stressor could cause alterations in dopamine (DA) plasma levels and related diseases in traffic police officers compared to a control group. After excluding subjects with principal confounding factors, 306 traffic police officers (139 female and 167 male) and 301 controls (134 female and 167 male) were included in the study. In traffic police officers, mean DA values were significantly higher compared with controls (P = 0.006 and P = 0.000 in male and female, respectively). The distribution of DA values in traffic police officers and controls was significant (P = 0.000 and P = 0.000 in male and female, respectively). The number of male traffic police officers with a positive response to the questionnaire's items concerning anxiety, depression and panic attacks was higher than controls, though not significant (7.2% traffic police officers versus 4.2% controls). This difference was also not significant in female traffic police officers compared with controls. According to our previous researches on other neuro-immune-endocrine parameters, DA could be used as an early biological marker, valuable for the group to be employed in occupational sets, even before the onset of pathology.

Exposure to traffic pollutants and effects on 17-beta-estradiol (E2) in female workers.

OBJECTIVE: The aim of the study is to evaluate whether the occupational exposure to urban pollutants including endocrine disruptors (EDs) could cause alterations in plasma 17-beta-estradiol (E2) levels and related diseases (adverse pregnancy outcome and mental health disorders) in female traffic police compared to a control group. METHODS: After excluding the subjects with the principal confounding factors, traffic police and controls were matched by age, years of police work, age of menarche, menstrual cycle day, body mass index (BMI), drinking habit, cigarette smoking habit, habitual intake of soy or liquorice in diet and habitual consumption of Italian coffee. Thirty-seven traffic police and 31 controls (seventh day; follicular phase of the ovarian cycle); 38 traffic police and 42 controls (14th day; ovulatory phase of the ovarian cycle); and 25 traffic police and 28 controls (21st day; lutheal phase of the ovarian cycle) were included in the study and then matched for the above-mentioned variables. RESULTS: In follicular and in lutheal phases, mean E2 levels were significantly lower in traffic police compared to controls. The distribution of E2 values in traffic police and controls was significant in follicular, ovulatory and lutheal phases. In ovulatory phase, mean E2 levels were lower but not significant in traffic police compared to controls. An increase was found concerning mental health disorders referred to in the questionnaire items in traffic police compared to controls, although the difference was not significant. CONCLUSIONS: Considering that the potential confounding effect of extraneous factors was controlled for by restricting the study population and by matching traffic police and controls on the above-mentioned variables, our results suggest that occupational exposure to urban pollutants, EDs included, might alter E2 plasma concentrations. E2 could be used in occupational set as an early biomarker of exposure to urban pollutants, valuable for the group, even before the onset of the related pathologies (adverse pregnancy outcome and mental health disorders).

Occupational exposure to noise and hypertension in pilots.

The role of occupational exposure to noise as a hypertension risk factor has not been established sufficiently. The aim of the study is to evaluate whether chronic exposure to different levels of noise in two groups of pilots, operating with two types of aircraft, could be a risk for hypertension, what relevance the parameters (intensity, duration and type) of exposure can have and, lastly, whether there are any links between hearing impairment and hypertension. After excluding pilots with confounding factors, a study was made of 77 male pilots of turboprop planes (group A) and 224 male pilots of jet aircraft (group B), matched by age and working life. Blood pressure (supine and standing positions) and heart rate were measured. Electrocardiogram, stress tests on a cycle ergometer, sound-level measurement and audiometric tests were also done. Pilots of group A were exposed to Leq of 93 dBA while pilots of group B were exposed to the Leq of 79 dBA. Significant results in group A compared to group B were found between heart rate, blood pressure, drop in blood pressure, parameters (intensity, duration and type) of exposure to noise and between hearing damage and hypertension. The findings suggest that chronic exposure to noise is a risk factor for blood hypertension in pilots exposed to high noise levels, and that the drop in blood pressure may be a sign of more sensitive effect of noise on blood pressure, according to other studies in literature.

Urban pollution and nickel concentration in serum.

The study's objective has been to evaluate whether urban pollution, here nickel compounds and metallic nickel (Ni) are present, could determine serum concentrations of the above mentioned metal. Out of a population of 394 Municipal Police employees, subjects with main confounding factors were eliminated. The remaining subjects were made comparable for sex, age, and length of employment. Thus, 160 subjects were included in the study: 80 traffic policemen (42 men and 38 women) with outdoor activity exposed to urban pollutants in a direct way, and 80 administrative workers (42 men and 38 women) with indoor unexposed activity. The results obtained in the studied population demonstrate that in traffic policemen the serum levels of Ni are more elevated than those in administrative workers; both in male and female workers. The authors hypothesise that the presence of Ni as fuel additive in lead free fuels and as catalyser in catalytic exhausts, which have been obligatory in Italy in new cars for the last 10 years, could be one of the causes for the increased serum levels of the above mentioned metal in traffic policemen.

Work exposure to urban pollutants and urinary homovanillic acid.

The aim of this study was to evaluate whether traffic policemen exposed to urban pollutants could be at risk of alterations on urinary homovanillic acid in 24h HVA(U) excretion levels, an end product of dopamine catabolism, compared with a control group. Traffic policemen were matched by sex, age, and working life with control group after excluding principal confounding factors; 50 traffic policemen (29 men and 21 women) with outdoor activity exposed to urban pollutants and 50 not exposed subjects (29 men and 21 women) with indoor activity were included in the study. The HVA(U) excretion levels were significantly higher in male and female traffic policemen compared to not exposed subjects (respectively P=0.003; P=0.023). The authors hypothesize an effect on the excretion of HVA(U) in traffic policemen exposed to chemical and physical stressors, according to HVA(U) modifications found by other authors in workers exposed in factories.

Occupational exposure to urban pollutants and plasma growth hormone (GH).

The aim of present study was to evaluate whether traffic policemen exposed to urban pollutants and possible psycho-social stressors are at risk of alterations on plasma growth hormone (GH) levels compared with a control group. Out of a population of 395 Municipal Police employees, the subjects with principal confounding factors were excluded from the study. The remaining traffic policemen were matched with those not exposed by sex, age, working life, and habitual consumption of alcohol; 71 traffic policemen (40 men and 31 women) with outdoor activity exposed to urban pollutants and 71 not exposed subjects (40 men and 31 women) with indoor activity were included in the study. The plasma levels of GH were significantly lower in the exposed traffic policemen compared with those not exposed (P = 0.000); similarly in male (P = 0.011) and female subjects (P = 0.000). The authors hypothesize the possibility of an effect of the specific working activity in traffic policemen on the plasma GH concentrations.