[Consensus Document. Update on latex exposure and use of gloves in Italian health care settings]. / Documento di Consenso. Aggiornamenti in tema di esposizione a latice e impiego di guanti in ambito sanitario.

This consensus document was prepared by an Italian working group including occupational health professionals involved for many years in the management of glove- and latex-related problems in health care settings. The aim of this document was to address the most significant technical, epidemiological, clinical, environmental and prevention problems related to the use of gloves and latex. The group's recommendations are based on scientific evidence and practical experience but they cannot be considered as final. These topics need to be periodically revised. The following points should be taken into account: glove quality seems to have improved considerably but the information on glove features provided by the manufacturers is often still inaccurate or incomplete; the regulations in force provide that the manufacturers perform tests to supply evidence for the quality of the products but they do not indicate which analytical method should be used and they do not require that the results be reported in the technical data sheets. Thus the manufacturers have only to declare that their products are "in accordance with the rules"; therefore, purchasers should require the manufacturing companies to supply detailed information and verify their reliability. Moreover, the rules should be adapted to higher quality standards; occupational physicians must be involved for the correct choice and purchase of protective gloves; the use of gloves (in particular latex gloves) and latex devices in health care settings should be based on specific criteria: procedures must be available stating which kind of gloves are suitable for specific tasks. When exposure to latex cannot be avoided it is necessary to choose products that have good biocompatibility (e.g., powder free-gloves with low allergen content); once and for all latex powdered gloves should no longer be commercially available! labels for latex devices (including gloves) should report the extractable latex allergen content. Limit values for extractable latex allergens should be established; the use of synthetic rubber gloves should be encouraged since some materials (e.g., neoprene and nitrile rubber) appear to have physical properties and protective efficacy similar to latex, plus good biocompatibility; more studies should be promoted to verify the protective efficacy of new synthetic materials; health care workers should be informed about the advisability and usefulness of using materials other than latex; health care services should not cause additional risks but rather highlight the advantages for workers and patients if the use of latex gloves and devices is minimized.

[Old and new types of sanitary gloves: what has improved?]. / Vecchie e nuove tipologie di guanti in commercio e possibili implicazioni clinico-preventive: materiali e patologie, qualcosa è migliorato?

BACKGROUND: During the eighties a large increase in latex gloves production was observed because of the high demand of gloves in health care settings. In this period a low compliance to minimal quality standard was detected and the poor glove quality was associated with an increase of both irritant and allergic glove-related diseases. Since the second half of nineties health care workers and manufacturers paid more attention to these problems and a trend to a gradual, even if slow, quality improvement was observed. Most frequently powder-free gloves and synthetic gloves were offered on the market. OBJECTIVES: The aim of this study was to highlight what has improved about materials and types of sanitary gloves during the last ten years. METHODS: The information are based on a review of the scientific literature and practical experiences. RESULTS AND CONCLUSIONS: Today a large selection of gloves made of different materials are available and they should be addressed to specific tasks. The review of the scientific literature and the analysis of many technical sheets provided by the manufacturers pointed out a trend to a better latex gloves quality (less chemical additives and generally a lower total protein content); sometimes data about a lower extractable latex allergens content are also available. Unfortunately detailed information on glove composition are not usually provided by the manufacturers; purchasers should require the manufacturing company to give comprehensive information and verify their reliability. Moreover the regulation in force should be adapted to higher quality standards. Powder-free and synthetic gloves consumption has improved but the use of synthetic rubber gloves should be further enhanced since some materials (e.g. neoprene and nitrile rubber) have a good biocompatibility and seem to have physical properties and protective efficacy similar to latex. Moreover allergic reactions to synthetic gloves (some chemical additives) are only occasional.

[Implementation of a health education programme in a sample of hairdressing trainees]. / Applicazione di un programma di educazione sanitaria in un campione di apprendisti acconciatori.

BACKGROUND: Skin and respiratory diseases and upper limb cumulative trauma disorders are common in practising hairdressers but unfortunately also in hairdressing trainees. Recent data showed that prevention by education in this working area is of fundamental importance. OBJECTIVES: The purpose of this study was to assess the knowledge that hairdressing trainees have of the risks present in their workplaces and to apply and verify, the efficacy of a specific educational programm METHODS: The programme was aimed at hairdressing trainees, aged from 15 to 21 years, attending 3 technical schools. The school training was part-time (1 day per week) and was completed in 3 years. Educational meetings were organized during the first year (154 students participated) and two years later at the end of the school training (only 83 students completed the training). The programme included a booklet and 3 self-administered questionnaires: one for the assessment of risks knowledge, work-related symptoms and preventive measures adopted, one for the assessment of long-term learning and one, after two years,for the assessment of changes in daily hairdressing practice, symptoms and preventive measures. RESULTS: At the beginning of the school training all the trainees were working as apprentices, only 76% reported using gloves (powdered latex gloves in 90% of cases) none used respiratory protective devices, 22.7% were atopic. 39% reported work-related skin lesions, 19.5% work-related rhinitis, 5.8% work-related conjunctivitis, 0.6% asthma, 9.1% work-related low back pain and 2.6% shoulder and/or elbow pain. At the end of school training most of the trainees were performing advanced procedures such as hair-drying and cutting instead of shampooing, dyeing and perming; almost all reported using gloves during technical activities and the use of non-latex gloves and skin care products increased; the percentage of work-related skin symptoms was significantly lower but the percentage of work-related musculoskeletal disorders was significantly higher. CONCLUSIONS: At the end of school training hairdressing trainees have a better knowledge of work-related risks and the importance of their prevention. Some changes in hairdressing practice (e.g use of gloves, barrier creams, skin care products) and procedures were evident and were associated with a decrease in work-related dermatitis; in this field the efficacy of specific educational programmes is significant. Nevertheless the increase in musculoskeletal disorders, probably related to the increase in performing advanced procedures (e.g. hair drying or cutting) often characterized by unsafe postures and few rest breaks, could be reduced only if employers too are involved and informed on practical aspects of prevention since, for these risk factors, changes in workplace and work organization are required.

[Report of courses on "Occupational dermatology" and "Occupational skin and respiratory allergies" organized by the Nordic Institute for Advanced Training in Occupational Health (NIVA)]. / Resoconto dei corsi di "Dermatologia occupazionale" e "Allergie cutanee e respiratorie occupazionali" organizzati dal Nordic Institute for Advanced Training in Occupational Health.

The Nordic Institute of Advanced Training in Occupational Health (NIVA), has been organising courses for around 10 years, aimed to the constant up-date of Occupational Medicine. The courses "Occupational dermatology" and "Occupational skin and respiratory allergies", held in 2001 and 2002, analysed some occupational medicine aspects such as allergic contact dermatitis in metal workers, latex disease, allergies in odontoiatric workers, correct patch test performing. The courses has underlined the importance of the cooperation between occupational physician and dermatologist or other specialists, and the project of a standard questionnaire monitoring the exposure to allergic substances. This article is a summary of an extended publication available on the following URLs: http://www.unibs.it/medlav http://www.gimle.fsm.it.

[Skin disorders and job fitness assessment]. / Dermatopatie e giudizio di idoneità lavorativa specifica.

BACKGROUND: Assessment of fitness for employment represents the final phase of the risk evaluation and health surveillance carried out during pre-employment and periodical medical examination. Dermatoses are frequent diseases both in the general population and workers, therefore job fitness assessment for workers with skin problems will frequently fall within the occupational health area. The physician must verify whether or not the dermatosis is an occupational disease and must adopt preventive measures to avoid any worsening or relapse of the clinical situation due to occupational factors. OBJECTIVES: This article gives suggestions for correct management of occupational and non-occupational skin diseases in the workplace, with practical examples of job fitness assessment. METHODS: We first examined the role of the occupational physician in the evaluation of occupational risk factors that can induce work-related dermatoses or aggravate other dermatoses. We then discussed the factors that must be considered during assessment of fitness for employment when dermatoses are present. Finally, we examined practical examples of occupational or non-occupational dermatoses that can cause functional limitations, factors that can influence job fitness evaluation, and the possible role of allergological tests. RESULTS AND CONCLUSIONS: Several dermatoses can be aggravated or caused by occupational factors (e.g. atopic dermatitis, allergic contact dermatitis, irritant contact dermatitis, keratinization disorders, lichen planus, physical urticaria). Close cooperation between the dermatologist and the occupational physician is very important in order to make an etiological diagnosis that is necessary for the job fitness assessment. It is difficult to define definitive criteria for the assessment of fitness for employment; in this article only some suggestions are made and they can vary according to the different situations.

[Protein content of latex gloves used in hospitals]. / Proteine estraibili del latice in guanti di impiego ospedaliero.

In this study the total protein content and the latex allergenic protein content in different types of medical gloves commonly used in our hospital were evaluated. The correlation between these two parameters and the correctness of the data provided by the glove manufacturers have been also verified. The main purpose of this study was to acquire information useful for preventing latex allergy in our hospital personnel. 29 different types of medical gloves were examined. The total protein contents were evaluated with Lowry modified method and the allergenic latex protein contents were evaluated with RAST-inhibition assay, both on glove samples and glove extracts. The correlation between inhibition percentages found in glove samples and in glove extracts and the correlation between total protein content and inhibition percentages determined in samples of the same gloves was verified. The highest concentrations of total proteins and allergenic latex proteins were found in examination powdered latex gloves and in surgical powdered latex gloves. A good correlation was observed between the total protein content and the inhibition percentages determined in samples of the same gloves, and between inhibition percentages found in glove samples and glove extracts. A significant amount of latex proteins was found in some brands of nitryl gloves. 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. We believe that the total protein content is relevant from a preventive point of view for a proper gloves selection in the workplaces. Therefore, manufacturing companies should provide package inserts including at least the total protein contents and possibly allergenic latex protein levels, with specific measurement methods. Since the highest total protein and allergenic latex protein contents were found in latex powdered gloves, powder-free gloves must be of first choice. 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. For latex allergic subjects it is necessary to pay attention in choosing nitryl gloves, especially as an alternative to natural rubber gloves since some brands may contain significant amounts of allergenic latex proteins.

[Occupational skin allergies in 1993-1998]. / Allergopatie professionali cutanee 1993-1998.

There are few data on the frequency of occupational allergic dermatitis in the context of occupational diseases and there is a need for coordinated large-scale studies to compare the experiences of different Occupational Health Departments involved in the surveillance of allergic occupational diseases. Therefore 6 Occupational Health Departments of Northern Italy (Bergamo, Brescia, Cremona, Desio, Lecco and Milano-CEMOC) decided to bring together all the cases of occupational allergic dermatitis diagnosed between 1993 and 1998. In this report the main characteristics of these 961 allergic dermatitis (888 allergic contact dermatitis, 63 urticaria and 10 airborne contact dermatitis), the possible correlations with gender, age, length of employment, atopy and the occupations at high risk of acquiring allergic dermatitis have been described.

Occupational dermatitis in a highly industrialized Italian region: the experience of four occupational health departments.

There is a need for several research centers to carry out coordinated large-scale evaluation of the spread of occupational irritant and allergic dermatitis. The Occupational Health Departments of Bergamo, Brescia, Lecco and Cremona therefore decided to join their experiences and bring together all the cases of occupational irritant and allergic dermatitis diagnosed by these Departments between 1993 and 1998. In this period, 1169 cases of occupational dermatitis were diagnosed, subdivided into 768 cases of allergic contact dermatitis (ACD), 337 of irritant contact dermatitis (ICD), 54 of urticaria and 10 of airborne contact dermatitis, and there has not been a trend towards increase of occupational dermatitis over the years. Our population included 724 males and 445 females and average latency after the beginning of exposure to occupational allergens was 8.01 years for ACD, 6.4 for ICD, 3.22 for urticaria and 5.57 for airborne contact dermatitis. The frequency of atopy was 33.9%, in females and 19.5% in males. The frequency of atopy was particularly high (89%) in subjects with urticaria. Among subjects with allergic dermatitis, 362 had had only one sensitization while 406 had had two or more sensitizations. The working areas where we found the highest number of ACD were metal working industry, building, health care workers and hairdressers and the frequency of ICD was high in metal workers and health care workers. Most of the cases of urticaria were diagnosed in health care workers (68.5%) and the main causing agent was latex. These are only preliminary data but occupations at risk and the substances expected to be the most frequent etiological agents do not differ significantly from those reported in the literature. It is hoped that as a result of this project there will be in the future: standardization of diagnostic procedures, uniform assessment of allergological risk in working environments not yet fully investigated, standardization of preventative measures and proper evaluation of their effectiveness.

[Postoperative radiotherapy in the treatment of breast tumors. Evaluation of a 5-year case series]. / La radioterapia post-chirurgica nel trattamento dei tumori della mammella. Valutazione di una casistica di 5 anni.

Between January 1981 and December 1985, 364 female patients underwent surgical treatment for breast cancer in Mestre General Hospital. The pathological stage of the disease was stage I in 60 patients, stage II in 215 patients, stage III A in 30 patients, stage III B in 44 patients and stage IV in 15 patients. The patients with T1-T2 N0 lesions located in the outer quadrants received no additional treatment after surgery, while the others received adjuvant therapy. The patients with stage-IV disease (M+) were treated with chemo and/or hormonotherapy. All patients were followed for an average of 33 months up to December 1986 (range 1-71 months). Local-regional relapses developed in 17 patients, 15 on the chest wall and 2 in the drainage lymph nodes (only 7 within the previously-treated area). A 5-year actuarial survival rate was observed of about 78%, and 66% of relapse-free survival, in the whole group of patients (100% and 92% in stage I; 92.5% and 76% in stage II; 51% and 33% in stage III A; 32% and 19% in stage III B; 31% in stage IV, respectively). As far as our series of patients is concerned, the massive involvement of axillary lymph nodes seems to be the most adverse prognostic factor in survival rates. Even though the short follow-up does not allow definitive conclusions to be drawn, the authors believe such loco-regional treatments as surgery and radiation therapy to be extremely important in the local control of breast cancers, as well as in the patients' survival in the long run.

Three-field isocentric technique for breast irradiation using individualized shielding blocks.

The three-field technique is the most common method used for breast and regional node treatment after conservative surgery. Several variants of this technique, which are characterized by complex geometrical problems, have been described. A possible simplification of this technique and the use of individualized shielding blocks both for anterior and for tangential fields is proposed, thus allowing for the simultaneous shielding of the half beam and the critical areas. Advantages of isocentrical techniques are thereby maintained, but the number of mechanical movements required is minimized and collimators and couch rotations are not needed. Patient set-up time is also greatly shortened. The accuracy of this technique has been verified using both photographic methods and thermoluminescent dosimetry.