An intensive monitoring campaign of PAHs for assessing the impact of a steel plant.

This study provided a useful approach for assessing the impact of industrial sources on surrounding, especially in a sensitive industrial area as Taranto (South of Italy). Taranto is one of the most industrialized Italian towns, where several emission sources operate simultaneously in proximity to the urban settlement. An intensive monitoring campaign of PAHs was carried out from January 28th to July 30th, 2011, in seven sites located in residential settlement around the industrial area and in the city center. The collected data were integrated with the information about wind direction and speed by means bivariate polarplot in order to characterize and localize the industrial sources. High BaP concentrations were detected especially when Benzene to Toluene ratio (B/T ratio) values excedeed 1 and all receptor sites were downwind to the steel plant. Moreover, in order to discriminate among PAH sources and quantify their contributions, a source apportionment analysis of the collected data was provided by means Principal component Analysis (PCA) and Positive Matrix Factorization (PMF) methods. Finally, the processing of PMF5.0 output by bivariate polar plot, confirmed the impact of steel plant on both industrial sites downwind the steel plant and the city center. B[a]P apportionment was quite similar for industrial and urban sites: the traffic source contributed only 11% and 24% to B[a]P measured at two sites, respectively. Therefore, the proximity of Taranto downtown to industrial pole makes negligible all other source contributions to PAH concentrations.

Environmental and biological monitoring of PAHs exposure in coke-oven workers at the Taranto plant compared to two groups from the general population of Apulia, Italy.

BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs) exposure in the coke industry poses a risk for workers' health as well as for subjects living in the plant vicinity. OBJECTIVES: To assess PAHs exposure in coke-oven workers (CW) at the Taranto plant, Apulia, and in subjects from the general population living near (NC) and far away (FC) from the plant. METHODS: Exposure was assessed by personal air sampling and urinary 1-hydroxypyrene (1-OHP) measured in 100 CW 18 NC and 15 FC. RESULTS: Median airborne benzo[a]pyrene (BaP) levels were 152, 1.5, and 3.6 ng/m3 in CW NC, and FC, respectively. In CW, median 1-OHP increased from 1.45 to 1.96 microg/g creatinine (crt) during the work shift (p > 0.05); in NC and FC, 1-OHP levels were 0.56 and 0.53 microg/g crt. No significant differences between NC and FC for both air and urinary indices were found. BaP exposure in CW exceeded the recently proposed German acceptable (70 ng/m3) and tolerable (700 ng/m3) risk-based limit values in 82 and 11% of subjects, respectively. In NC and FC, BaP exposure exceeded the European target value for ambient air (1 ng/m3) in 67 and 60% of subjects, respectively. Biomonitoring showed that 21% of CW had 1-OHP levels higher than the proposed biological limit value for the coke-oven industry (4.4 microg/g crt), while 93% of FC, and 88% of NC, had 1-OHP levels exceeding the Italian reference value (0.3 microg/g crt). Among non-smokers, a linear regression between 1-OHP and BaP (Pearson value r = 0.65, p < 0.05) allowed us to estimate levels of 1.2 and 1.9 microg/g crt for 1-OHP end-of-shift corresponding to acceptable and tolerable limit values. CONCLUSIONS: Although lower than in the past, PAHs exposure in the coke plant still poses a health risk for workers and the general population and requires further efforts to improve workplace conditions.

[Environmental and biological monitoring of exposure to PAHs in Taranto coke-oven workers and in two groups of the general population from Apulia]. / Monitoraggio ambientale e biologico dell'esposizione a IPA nei lavoratori della cokeria di Taranto e confronto con due gruppi della popolazione generale pugliese.

The exposure to PAHs was assessed by personal air sampling and urinary 1-hydroxypyrene (1-OHP) in 100 coke-oven workers (CW) of the Taranto plant and in subjects from the general population living close (NC, 18) and far away (FC, 15) from the plant. Median airborne benzo[a]pyrene (BaP) and 1-OHP levels were 152, 1.5, and 3.6 ng/m3 and 2.0, 0.5 and 0.6 microg/g creatinine in CW, NC, and FC, respectively. BaP exposure exceeded the German acceptable (70 ng/m3) and tolerable (700 ng/m3) limit risk based values in 82 and 11% of CW and the European target value for ambient air (1 ng/m3) in about 65% of NC and FC. 1-OHP levels exceed the proposed biological limit value for the coke-oven industry (4.4 microg/g crt) in 21% of CW and the Italian reference value (0.3 microg/g crt) in about 90% of NC and FC. The exposure resulted lower than in the past, but this study highlights that PAHs exposure from the coke plant still poses a health risk for workers and the general population.

[Epidemiology of tumors in the construction industry]. / Epidemiologia dei tumori in edilizia.

Many epidemiological studies, mostly with a case-control design, show an increased risk of cancer, in particular lung cancer, in construction workers. Asbestos is the occupational carcinogen considered for a long time the most important in this sector, but now it covers a residual role, at least in Italy. In this review the most recent studies are considered and the presence of other carcinogens, as crystalline silica, man-made mineral fibers, diesel exhausts, metals, solvents, UV rays, must be considered in risk evaluation also, possibly, for health and epidemiologic surveillance.

[Source apportionment of benzo(a)pyrene in Taranto and carcinogenic risk estimate in general population]. / Individuazione e caratterizzazione delle sorgenti di benzo(a)pirene nel comune di Taranto e stima del rischio cancerogeno associato all'esposizione della popolazione generale.

INTRODUCTION: In 2009 the limit value of benzo(a)pyrene (BaP) in ambient air of 1.0 ng/m3 has been exceeded in the urban district of Taranto near to the industrial area, where a several large plants are located, including an integrated cycle steel plant. OBJECTIVE: To identify emission sources and quantify relative contribution to the PAHs levels; to estimate health impact associated to PAHs exposure in general population. METHODS: Multivariate receptor models have been used. Concentration of PAHs measured in 4 location in Taranto in 2008-2009 have been analyzed. 5 different models estimated profiles of unknown sources and identified significant chemical species. To compute the lung cancer risk the WHO unit risk estimate for BaP (8.7 x 10(5) ng/m3) has been adopted. RESULTS: Models employed identify 3 to 4 emission sources. Estimated profiles have been compared with measured ones. Based on the average annual BaP level measured (1.3 ng/m3), 2 attributable cancer cases in the district Taranto population are estimated to result from a life-time exposure. CONCLUSIONS: Among different emissive sources, the analysis identifies theoretical sources whose profiles, compared with observed data, allow to identify dominant contributions to PAHs pollution and to design corrective actions to reduce environmental and health impact.

Formaldehyde exposure and irritative effects on medical examiners, pathologic anatomy post-graduate students and technicians.

BACKGROUND: Exposure to formaldehyde (FA) causes irritative effects and induces nasopharyngeal cancer; the International Agency for Research on Cancer (IARC, Lyon) classified FA as carcinogenic to humans, Group 1. Many studies have been published so far concerning the occupational exposure of industrial workers, embalmers, pathologists and anatomists to FA but very few data regarding medical examiners are available. METHODS: To assess the extent to which subjects were exposed to FA, airborne concentrations of this chemical were measured by High Performance Liquid Chromatography (HPLC). In September-October 2006 we examined the personnel, which worked in an autopsy room (medical examiners) and in three laboratories of pathologic anatomy of the University Medical School of Bari, Policlinico Hospital, Southern Italy. Irritative effects were also investigated. RESULTS: All the personal exposure data obtained exceeded the National Institute for Occupational Safety and Health Threshold Limit Value-Time Weighted Average (NIOSH TLV-TWA: 0.02 mg/m(3)) and, in a few cases, even the American Conference of Industrial Hygienists Threshold Limit Value-Ceiling level (ACGIH TLV-C: 0.37 mg/m(3)). CONCLUSION: Irritative effects in more than 50% of the workers enrolled, increasing the risk of injuries.

Synaptic contacts impaired by styrene-7,8-oxide toxicity.

Styrene-7,8-oxide (SO), a chemical compound widely used in industrial applications, is a potential hazard for humans, particularly in occupational settings. Neurobehavioral changes are consistently observed in occupationally exposed individuals and alterations of neurotransmitters associated with neuronal loss have been reported in animal models. Although the toxic effects of styrene have been extensively documented, the molecular mechanisms responsible for SO-induced neurotoxicity are still unclear. A possible dopamine-mediated effect of styrene neurotoxicity has been previously demonstrated, since styrene oxide alters dopamine neurotransmission in the brain. Thus, the present study hypothesizes that styrene neurotoxicity may involve synaptic contacts. Primary striatal neurons were exposed to styrene oxide at different concentrations (0.1-1 mM) for different time periods (8, 16, and 24 h) to evaluate the dose able to induce synaptic impairments. The expression of proteins crucial for synaptic transmission such as Synapsin, Synaptophysin, and RAC-1 were considered. The levels of Synaptophysin and RAC-1 decreased in a dose-dependent manner. Accordingly, morphological alterations, observed at the ultrastructural level, primarily involved the pre-synaptic compartment. In SO-exposed cultures, the biochemical cascade of caspases was activated affecting the cytoskeleton components as their target. Thus the impairments in synaptic contacts observed in SO-exposed cultures might reflect a primarily morphological alteration of neuronal cytoskeleton. In addition, our data support the hypothesis developed by previous authors of reactive oxygen species (ROS) initiating events of SO cytotoxicity.

[Occupational exposure to formaldehyde in autopsy room and in pathologic anatomy laboratories]. / Esposizione professionale a formaldeide in sala settoria di medicina legale e in laboratori di anatomia patologica.

The aim of the present study is to evaluate the personal exposure to formaldehyde in an autopsy room and in three pathological anatomy laboratories. Passive sampling for the whole workshift and HPLC analysis were performed. The final result showed a remarkable exposure of the workers enrolled. All the data obtained exceeded the NIOSH-TWA and several cases personal of exposure levels above the ACGIH-Ceiling value (0,37 mg/m3) were observed in the anatomy laboratory.

[Biological monitoring in workers exposed to inorganic arsenic in a disused industrial plant in the area of Manfredonia]. / Monitoraggio biologico dell'esposizione professionale ad As inorganico in lavoratori di un impianto industriale dismesso nell'area di Manfredonia.

Inorganic arsenic and its methylated metabolities were measured in 108 spot urine samples obtained from the medical surveillance programme of workers exposed to inorganic Arsenic in July 2006. 15% of the samples showed levels higher than limit value of 35 microg/L (mean value 23,9 microg/L). After the improvement of the working conditions, in August-October 2006, we collected a urinary sample from each of the 108 workers enrolled. A questionnaire was also administrated, in order to investigate the influence of occupational and non occupational factors on the urinary arsenic excretion. The median value of urinary arsenic was 15,12 microg/L; among the 108 samples, 5% showed levels higher than limit value. A significant difference was observed in relation with sea-food consumption and aging stratification. In conclusion, we have described a significant reduction of urinary arsenic excretion between the two phases of biological monitoring, likely due to a proper hygienic work-related intervention.

[Acute pneumonia caused by aspiration of hydrocarbons in a fire-eater]. / Polmonite acuta da aspirazione di idrocarburi in un "mangiafuoco".

Accidental aspiration of fuel in fire eaters can cause an acute chemical pneumonitis known as 'fire-eater's pneumonia". We report a case in a 29 year-old fire-eater. Six hours after aspiration of kerosene, he developed fever up to 39,5 degrees C, dyspnea, cough and chest pain. Chest radiograph showed infiltrates in the middle and lower parts of the lungs and left pleural effusion. He was treated with an antibiotic and antipiretic therapy and then with corticosteroids. The acute stage lasted four weeks and the patient recovered without sequelae within 3 months. Hazard related to main fuels used for fire eating is discussed.

Life expectancy in patients with hereditary haemorrhagic telangiectasia.

BACKGROUND: There are few data on life expectancy in patients with hereditary haemorrhagic telangiectasia (HHT), a disorder with life-threatening complications. METHODS: Seventy HHT patients provided data on age and age at death of their HHT-affected parent, which was compared with that of the parent's non-affected partner. RESULTS: At the time of the study, 40 HHT parents (57.1%) vs. 36 (51.4%) non-HHT parents had died (p = 0.404). Median age at death was lower in HHT vs. non-HHT parents (63.2 vs. 70.0 years, respectively). The mortality of HHT parents showed an early peak in the under 50s and a late peak at 60-79 years. HHT was the main risk factor influencing life expectancy after 30 years (p < 0.05). No differences in survival probability were found in HHT patients with respect to sex (p = 0.37), or ENG vs. ALK-1 genotype (p < 0.9). DISCUSSION: Life expectancy appears to be significantly lower in HHT patients than in their partners. Prevention of HHT complications with screening programs could increase life expectancy.

Biological monitoring and allergic sensitization in traffic police officers exposed to urban air pollution.

Urban air pollution is associated with an increased incidence of allergic respiratory diseases. The aim of this study is to assess the occupational exposure to urban pollution through biological monitoring of PAHs and CO airborne levels in 122 traffic wardens in Bari, Italy and to investigate sensitization to inhaled allergens in a subgroup of workers. After filling in a questionnaire on lifestyle habits and occupational history, a medical examination, spirometry were carried out and blood samples were taken; the measurement of exhaled CO and urinary 1-hydroxypyrene (1-HOP) was performed and data on the air quality of Bari Municipality were obtained. Specific IgE dosage and skin prick tests were done on 18 workers giving altered values of spirometry or anamnestic allergic symptoms. Urinary 1-HOP showed median levels of 0.1 microMol/Mol(creat) (range 0.02-6.68) and was not influenced by smoking habits, work tasks, area of the city and environmental levels of PM10. Exhaled CO, with median value of 1 ppm (range 0-27), was significantly higher in smokers than in non-smokers, while no other variable seemed to play a role in modifying the levels. Specific IgE production versus inhalant allergens was found in 6 cases. Positive skin prick test results were observed in 11 cases. Allergic rhinitis was diagnosed in 6 cases. At least one of the allergometric tests performed was positive in 61 percent of the subjects. In conclusion, our results suggest the importance of introducing allergic status evaluation in this class of workers, exposed to several urban air pollutants.

[Occupational Medicine Programme in the university degree on prevention techniques in living and working environments]. / La Medicina del Lavoro nel Corso di Laurea in Tecniche della Prevenzione nell'Ambiente e nei Luoghi di Lavoro.

This document has been prepared by a working group of University Professors belonging to the Italian Society of Occupational Medicine and Industrial Hygiene, with the aim of defining the role of this discipline in the university course on Prevention Techniques in Working and Living Environments. The course trains health professionals to apply risk assessment techniques, preventive measures and legislative tools for safety and health in working and living environments, food and beverages hygiene, and Public Health. The document describes the organization and the structure of the course, general and specific learning objectives, occupational medicine teaching and other organization aspects. Also, training of non-graduate technicians working for local health authorities is discussed.

[Role of biological monitoring in health and epidemiological surveillance: a proposal]. / Ruolo del monitoraggio biologico nella sorveglianza sanitaria ed epidemiologica: proposte operative per la SIMLII.

Biological markers can be used at an individual level for medical surveillance or at group level within the context of epidemiological surveillance. However, the use of biological monitoring for medical and epidemiological surveillance is heavily conditioned by the critical issue of biomarker validation. One effective means for combining biological monitoring with medical and epidemiological surveillance is the mandatory annual report on anonymous and collective data; this will be made possible after providing adequate training schemes for the occupational physicians involved and the definition of appropriate guidelines, aimed at improving the quality of occupational health services. It will then be possible to design multicentric surveys to assess the quality of occupational health services using validated indicators.

[Biologically effective dose biomarkers]. / Indicatori di dose biologicamente efficace.

Biologically effective dose markers--DNA and protein adducts--are classified among exposure biomarkers, and are currently used to assess the biologically active fraction of xenobiotics, which is capable of interacting with cellular macromolecules at the target site. Macromolecular adducts should not only be considered as exposure indicators; indeed, their biological significance can also be extended to biomarkers of effect and of susceptibility. The achievement of such a goal needs research programs aimed both at studying molecular mechanisms related to each step along the continuum of events between exposure and disease, and at establishing quantitative relationships between exposure levels and adduct formation, between adducts and early biological effects, effects and cellular structural/functional modifications, leading to the development and eventual increase in incidence of specific diseases. Moreover, different factors must be considered during data evaluation, such as interindividual variability, the background levels of biomarkers in non occupationally exposed population, the gradually decreasing doses of genotoxic agents involved in occupational exposure, and confounding factors such as diet and smoking habits. Despite the large body of literature documenting DNA and protein adduct molecular dosimetry for many carcinogen exposures, many authors highlight the need for systematic interlaboratory comparison and collaboration by measuring the same biomarkers using different techniques and/or different biomarkers related to the same exposure levels. There is also general agreement about reducing costs, so that dosimetric analyses can become economically more advantageous and accessible in all cases where they prove to be useful in preventing health risks.

[Epidemiologic surveillance in occupational carcinogenesis]. / La sorveglianza epidemiologica in tema di cancerogenesi professionale.

Research on occupational cancer epidemiology has been an important area of occupational health in Italy. While according to epidemiological estimates the proportion of all cancers attributable to occupational factor is about 4%, the number of compensated occupational cancers in Italy is remarkably lower. Re.Na.M., OCCAM and ISOD projects are example of epidemiological surveillance and can serve as basis for ad hoc studies.

[Occupational epidemiology in Italy]. / L'epidemiologia occupazionale in Italia.

The development of Occupational Epidemiology in Italy is closely correlated with the political and social awareness of the needs of preventive strategies in the workplace. In the late '60s the Trade Unions supported a model of intervention based on the involvement of the so-called "Homogeneous group of workers" in the validation of the preventive measures taken on the workplace. In spite of the shortcomings of the model, it was extremely effective resulting in enhanced perception of the priority of preventive strategies and in the formation within the National Health Service of the Occupational Health Services. In Italy over the period 1973-2002 there has been an impressive trend of research in field of occupational epidemiology (a search on Medline shows an increasing trend over the years and, in terms of international comparison, higher figures than in Germany, France and Spain). Occupational Epidemiology is now present in the activities of the local Occupational Health Services and in the teaching activities of the Medical Schools throughout the country.

[Analysis of occupational injuries using the new database developed for prevention in the workplace]. / L'analisi degli infortuni sul lavoro attraverso "i nuovi flussi" informativi per la prevenzione nei luoghi di lavoro.

In Italy occupational injuries still represent a serious medical, social, and economic issue in spite of the improvement in working conditions, and an improved attention to occupational safety from both legislators and employers. In Apulia we have evaluated the new data record by INAIL (National Institute for Insurance against Occupational Injuries) reporting the occupational injuries occurred in 2000 and compensated within the following year. The new data record represents a remarkable improvement, from the epidemiological point of view, compared to the old one. However, the statistical analysis is still not completely comparable to the international epidemiological indicators. Nevertheless, the coming data base will contain the first data codified in conformity with the new European recording system "ESAW/3" adopted by INAIL since January 1st 2002.

[Environmental pollution and short-term effects on human health in industrialized urban areas]. / Inquinamento ambientale ed effetti a breve termine sulla salute umana in aree urbane industrializzate.

Several studies investigating the adverse short-term effects of air pollution indicate that even concentrations of air pollutants close to or lower than air quality standards could negatively affect respiratory and cardiovascular health. Therefore, it seems crucial to develop knowledge about health adverse effects in industrialized urban areas. A time-series study on the association between air pollution levels and daily mortality and hospital admissions for respiratory and cardiovascular diseases is currently carried out in the town of Taranto, "area at high environmental risk" according to WHO because of the presence of several heavy industries and elevated rates for all-causes and all cancer mortality, higher than regional mortality rates, especially for lung cancer.

[Mortality among workers employed in the production of pulp and paper in Apulia]. / Studio di mortalità di lavoratori addetti alla produzione di cellulosa e carta in Puglia.

The authors studied a cohort of 2660 pulp and paper workers in Capitanata, Apulia (Italy). All workers with at least 1 year of employment on January 1 1965 or thereafter until march 30, 2000 where studied. Standardized Mortality Ratios (SMRs) were used to compare the mortality rates of the cohort with those of Apulian population. Ninetyfive percent confidence intervals (CIs) for SMRs were obtained. Cancer risks significantly associated with work where observed: all causes for males (SMR 112.09, 95% CI 104.91-119.77), brain cancer for males (SMR 206.04, 95% CI 103.04-412.01), digestive tract for males (SMR 126.78, CI 100.63-159.73). Association with other malignancies are suggested in this study for Laryngeal and Kidney. These malignancies have been associated with different exposures in the production cycle: biocides (Kidney), Formaldehyde (Kidney, Brain). Unclear is the risk factor for the excess showed in digestive tract cancer.