[Evaluation and management of pesticide risk in agriculture: the experience of the Region of Lombardy (Italy)]. / Valutazione e gestione del rischio da antiparassitari in agricoltura: l'esperienza della Regione Lombardia.

The evaluation of chemical risk in agriculture is complicated because of difficulties in obtaining measures representative of working conditions. This is the reason why experiences finalized at producing risk estimates are running. In this frame, a Regional working group has developed the project "Pesticide exposure and risk profiles in agriculture". Priority scenarios have been selected and the main variables correlated with pesticide exposure have been pointed out. A value for each variable has been defined. The sum of these values allows the definition of "Exposure Indices" (EI), which can be reduced by multiplication for a coefficient calculated based on use of personal protective devices, training and education and equipment conditions. A Risk Index is calculated as the product of EI per a toxicity index, calculated based on the risk phrases of the substances used ("Risk Profile"). Risk Profiles allow the production of risk estimates and the definition of the appropriate preventive interventions. Next phase will be addressed at the validation of the model, to be carried out through the determination of the levels of concordance between the risk class allocation obtained from the model and the one obtained from environmental and biological measures, in the same groups of workers.

[Noise pathology]. / Patologia da rumore.

After defining noise and describing the physical characteristics that determine its noxious capability, the paper discusses the etiopathogenesis, clinical features and diagnostic criteria (anamnestic, audiometric, exclusion of other causes) of noise-induced damage. In conclusion, the legislative (preventive) and medico-legal issues of noise pathology are presented.

[Research and formal demonstration of evidence of efficiency in occupational medicine]. / Ricerca e dimostrazione formale delle prove di efficacia in medicina del lavoro.

There is an increasing pressure on occupational health professionals to ensure that their practice is based on a quality standard and an evidence of appropriateness. The efficacy-effectiveness of their activity strictly depends on their intellectual and professional integrity, their technical and legal competence, but also on the quality of the relations with the company organisation they are able to establish. We asked to some occupational physician when they considered their interventions in the workplace to be efficacious. Then, accordingto our epexrience, we propose some effectiveness indicators, particular concerning health surveillance and health educttaon, that should be evaluated to verify the health professional agccvity agreement to quality standards.

Application of mathematical modelling for assessing the urinary half-times of nickel in stainless steel welders.

The study regards workers employed in manual metal are welding of stainless steel (MMA/SS). For two weeks they collected their urine during the work shift and the 16 hours following in order to evaluate the kinetics of nickel. Using one-compartment mathematical modelling we calculated the values of the toxicant's urinary half life during the two phases of exposure and postexposure and also during non working weekends. The aim of the study was to find correlations between inhaled doses and excreted quantities and to acquire practical data for use in biological monitoring. In the welders the mean urinary half life in the exposure period was 59.5 hours, in the post exposure it was 95.6 hours, while in weekend it was 95.5 hours. The study showed that exposure to fumes containing nickel could determine the accumulation of the metal in slow elimination speed compartment. As a consequence of the accumulation of nickel in compartments with different elimination speeds, the collection of single urinary portions in biological monitoring seems to give little information about the actual exposure. In our opinion this indicates collecting urine samples throughout the entire work shift and the 16 hours following exposure.

[Judgment on work capacity of a health worker with schizophrenia]. / Giudizio di idoneità lavorativa in un operatore sanitario affetto da schizofrenia.

We show the case of a worker affected with schizophrenia who was declared by the psychiatrist fit to work. The "Medico Competente" on the contrary, on the basis of his studies and in particular on his deep knowledge of the features of the office and the place where that worker works, decides that he is not fit to do that job. This judgement is confirmed by the "ASL-Collegio Medico". The case we described emphasizes in a very strong way what is written in the item 17, paragraph 1, letter a of the D.Lgs 626/94, which extends the judgement of the fitness to work given by the "Medico Competente" even to the psychic sphere of the worker.

[De Quervain's tenosynovitis and work with hand tools: a case study]. / Tenosinovite di De Quervain e lavoro con utensili. Discussione di un caso clinico.

Work-related musculoskeletal disorders of the upper limbs are a frequent complaint and their pathogenetic mechanism is often related to mechanical overload of the body region involved without traumatic events. The occupational origin of such disorders is much debated, since the clinical pictures are often not specific and may be found in subjects who do not perform hazardous work tasks. A better understanding of the relationship between clinical symptoms, diagnosis, and functional capacity would provide a deeper knowledge in decision making for return to work and rehabilitation strategies. In this paper we present a case study of a worker using scissors who developed De Quervain's syndrome in the dominant hand. A methodology for the biomechanical investigation of the work task and the possible occupational aetiology of the clinical picture are discussed according to the findings of the specific literature.

[Environmental and biological reference values of plant pesticides]. / Valori di riferimento ambientali e biologici dei fitofarmaci.

A wide range of studies concerned with the definition of environmental and biological reference values for plant pesticides is reviewed. All phases of data production are critically assessed, including sampling, sample preparation and analysis, choice of population, statistical analysis and expression of results. The importance of the studies for the definition of reference values useful in the sectors of environmental hygiene and occupational toxicology is also examined. Most of the studies were based on American populations, though work on reference values has also recently been done by Italian authors, particularly the SIVR, which has published data on 3,5,6-trichloro-2-pyridinol and ethylenethiourea in urine. Because the number of the studies is small and more detail about variables is needed, the lists of reference values, given separately for American and Italian populations, also include proposals and attempts at definition of reference values. When available, biological reference values (BRV) are given separately for adults and children, emphasising the greater intake of the infant population due to higher food intake per unit body weight and greater exposure to contaminants present in the domestic environment. BRVs for plant pesticides generally depend on factors such as smoking, wine consumption and diet, major sources of residue intake for the human population.

[VDT and work: descriptive epidemiologic research]. / VDT e lavoro: indagine epidemiologica descrittiva.

We report the statistical elaboration of some data pertinent to a population of workers professionally exposed to VDT. These first data also confirm that the length of the use of VDT doesn't influence the judgement of fitness to work.

[Judgement of fitness to work in a health worker with schizophrenia]. / Giudizio di idoneità lavorativa in un operatore sanitario affetto da schizofrenia.

We show the case of a worker affected with schizophrenia who was declared by the psychiatrist fit to work. The "Medico Competente" on the contrary decides that he is not fit to do that job and his judgement is also confirmed by the "ASL-Collegio Medico" according to the D.Lgs 626/94, item 17, which extends the judgement of the fitness to work given by the "Medico Competente" even to the psychic sphere of the worker.

[Environmental and biologic monitoring of atrazine exposure at a formulating plant]. / Monitoraggio ambientale e biologico dell'esposizione ad atrazina in ambito industriale formulativo.

Atrazine exposure was evaluated in three workers engaged in technical Atrazine dust formulating and bagging processes, by environmental and biological monitoring. We found an Atrazine concentration in breathing area of 31.2 micrograms/m3 (SD +/- 9.9); actual inhalatory absorption was 20.7 micrograms/workshift. Cutaneous amount was 6 mg per workshift and the largest fraction was found on hands. Supposing that only 3.5% of the applied was absorbed, 239.7 micrograms of Atrazine were taken up by skin per workshift. The dealkylated metabolites and parent compound excreted in urine, as a whole, accounted for 71.09% of the presumed total dose absorbed. The spectrum or the urinary Atrazine metabolites comprised bi-dealkylated (58%), deethylated (30.7%), deisopropylated (7.7%) and unmodified Atrazine (3.6%). About 31% of the amount is excreted during the workshift itself. These findings allow to evaluate the magnitude of the real doses absorbed, keeping into account the effect of protective means.

[Analysis of occupational allergies reported to the Occupational Medicine and Hygiene Service of the Pavia ASL and to the Hospital Operative Unit of Occupational Medicine in 1993-98]. / Analisi delle allergopatie professionali segnalate ai Servizi di Medicina ed Igiene del Lavoro della ASL di Pavia e alla Unità Operativa Ospedaliera di Medicina del Lavoro nel periodo 1993-98.

In this article the cases of occupational allergic diseases notified to 2 Occupational Health Units in Pavia in the period 1993-1998 are reported. A retrospective study was performed to obtain a descriptive analysis of the diseases. In the studied period 58 cases of occupational allergic diseases were notified. This datum probably underestimates the real occurrence of occupational diseases, because of the low accuracy of the notification system. Allergic skin diseases were more frequent (70.7%) than respiratory diseases.

A respiratory and allergy survey in textile workers employed in early stages of wool processing.

OBJECTIVES: To determine frequency and type of respiratory and allergic symptoms in textile workers employed in early stages of wool processing. METHODS: A cross-sectional study was carried out in four wool textile mills. 202 subjects (n. 148 males, 54 females, mean age 38.9 yrs, SD 9.5) employed in early stages (combing, n. 138, carding, n. 64) of wool processing were examined and an environmental survey was carried out to determine the level of wool dust exposure. All subjects were submitted to clinical interview, spirometry and measurement of serum specific IgE (s-IgE) against extracts of two wool lots (Australia and New Zealand) by means of RAST. In the subjects with a positive questionnaire for allergic symptoms serum specific IgE for common pneumoallergens were measured (PHADIATOP test). RESULTS: We found higher air dust concentrations during carding operations (inspirable fraction-IF-: range 1.6-20 mg/m3; respirable fraction (RF): 0.5-6.9 mg/m3) and lower concentrations during combing (IF 0.3-0.7 mg/m3, RF 0.1-0.3 mg/m3). 70 out of 202 subjects (34.7%, n. 26 employed in carding and n. 44 in combing operations) reported work-related symptoms. Cutaneous itching was reported by 30 subjects, upper airway irritation by 24, ocular irritation by 17 and dyspnoea by 5. Globally 27 subjects (13.4%) had respiratory work-related symptoms. 12 subjects reported only seasonal respiratory symptoms not related to work. Within the group of 82 symptomatic subjects, 62 (75.6%) had serum specific IgE for common pneumoallergens. In the whole group (n. 202) mean basal FEV-1 was L 3.6, SD 0.9 (103.6% of predicted values). No significant difference was found in basal FEV-1 between carding and combing workers. No s-IgE against the two wool extracts was detectable in any of the 202 examined subjects. CONCLUSIONS: Our data show that in early stages of wool processing: 1) the overall frequency of respiratory work-related symptoms is low and does not seem to be related to the stages of processing, 2) symptoms are mainly nasal and/or ocular; 3) serum s-IgE against wool extracts are not detectable. We conclude that respiratory allergy risk in wool textile mills is low.

[Organization of health and safety activities in health care centers]. / Organizzazione delle attività di prevenzione e sicurezza nelle aziende sanitarie.

The paper proposes a model for health and safety organization in health care units and hospitals which takes account of the risk assessment procedures required by law and the quality assessment of the measures thus taken. A redefinition is given of the role of Medical Director and of the functions, aims and standards on which health and safety service and the services of an authorized occupational health physicians must be based.

[Responsibility (according to the legislative act "626/1994") in the implementation of preventive measures in the preparation of antiblastic drugs]. / Le responsabilità (ai sensi del d.lgs. "626/1994") nell'attuazione delle misure preventive per la preparazione di farmaci antiblastici.

The 7th title of the legislative act "626/1994" (and the other normative indications) identifies cavcingenic agents in occupational uses, and also the protections of workers in exposure. Among these agents there are any antiblastic drugs. This is a difficult problem for a correct application of normative indications: it's no possible to replace cavcingenic agents with no cavcingenic agents, as so as it's impossible to operate on "closed cycle". The authors put the attention on the other very important normative indications: "preparations in bordered and isolated room", "minimal exposure", "severe procedures and internal normations", formal "identification of the responsibilities" in the hospital organization (also with the strictly identification of managers and foremen).

Reference values of urinary 3,5,6-trichloro-2-pyridinol in the Italian population--validation of analytical method and preliminary results (multicentric study).

The interlaboratory validation of analytical procedures for the assay of urinary 3,5,6-trichloro-2-pyridinol (TCP) in the general Italian population is reported. The determinations were performed by high-resolution gas chromatography (HRGS) with electron capture detection and HRGS with mass spectrometry (MS) in 2 laboratories. The urine samples were from 42 participants from 3 regions of Italy. The results were evaluated by interlaboratory quality control. Urinary TCP concentrations were above the detection limit (1.2 micrograms/L) in 88% of the population, with a mean detectable concentration [GM (GSD)] of 2.8 (1.9) micrograms/g creatinine (creat). (GM, geometric mean; GSD, geometric standard deviation.) The Mann-Whitney U test showed that wine consumption was a statistically significant variable (p < 0.05) for urinary concentrations of TCP. Analysis of variance of the logarithm of urinary TCP versus wine consumption and diet showed a statistically significant fit. The model used explained 30% of the total variance: wine consumption and diet accounted for 37 and 17% respectively of the explained variance.

[Role and significance of information tools in occupational asthma]. / Il ruolo e l'importanza degli strumenti informativi nell'asma professionale.

Role of education in occupational asthma. Subjects' education, i.e. information and training in the specific topic, has a substantial role in several medical fields and is considered to be the challenge to reach the primary, secondary and tertiary preventive goals. In occupational medicine workers information and training is considered particularly relevant and it has been included in a recent governative law regarding prevention and health care at the workplace. The present short review deals with the role of education in occupational asthma, which at present appears the most frequently compensated occupational lung disease.

[Diagnosis and consultation at the Hospital Unit of Occupational Medicine (UOOML)]. / Diagnosi e consulenza nelle Unità Operative Ospedaliere di Medicina del Lavoro (UOOML).

The author describes the operating course of the Occupational Medicine Operating Units (OMOU) in our region. (Lombardia) These Units, born as a second level support to the Basal Occupational Medicine Units, greatly enlarged, as time passed, the limits of their users together with the charge of preventive duties ordered to the employers by the recent laws regarding Occupational Hygiene. (DLgs 277/91-DLgs 626/94) The author also illustrates the variety of the diagnostic demands to the OMOU according to the enlargement of the legal protection of occupational diseases and to the numerous aspects of specific job fitness. He underlines the need of multiple specialistic skillfulnesses achievable by means of a complete integration of OMOU in to the hospital to which they belong. In conclusion the author illustrates the new tasks of the OMOU in the field of the therapy and rehabilitation.

3,4 Dichloroaniline-haemoglobin adducts in humans: preliminary data on agricultural workers exposed to propanil.

Propanil is one of the major herbicides used on rice-paddies and is thought to produce adverse health effects through the action of its metabolite 3,4-dichloroaniline (3,4-DCA). T he feasibility of monitoring human exposure to propanil on the basis of 3,4-DCA adducts to haemoglobin (Hb) was investigated. We developed a method based on gas chromatography negative ion chemical ionization-mass spectrometry (NICI-GC-MS) to quantify 3,4-DCA released from human Hb after alkaline hydrolysis of the protein. 3,4-DCA-Hb adducts were identified in agricultural workers exposed to propanil and were detectable even 4 months after the last herbicide application. Urine samples collected at the same time had no measurable level of 3,4-DCA. 3,4-DCA-Hb adducts might be useful for monitoring human exposure to 3,4-DCA from agricultural sources.

Urinary excretion of ethylenethiourea in five volunteers on a controlled diet (multicentric study).

Urinary excretion of ethylenethiourea (ETU) was monitored for 8 days in a group of five male non-smoker volunteers on a diet, the items of which were assayed for ETU and carbon sulphide. Urinary excretion of ETU reflected the consumption of wine, fruit and vegetables. Urinary ETU concentrations ranged from 0.6 to 6.7 micrograms/g creatinine. ETU concentrations in the food eaten by the volunteers were generally below the detection limit whereas in wine 8.8 micrograms/l ETU was detected. Evolution of carbon sulphide by food samples ranged from 0.03 to 0.17 mg/kg. Mean (+/- S.D.) daily intake of ETU in wine was 3.5 +/- 0.2% of the acceptable daily intake (ADI): 0.070 +/- 0.004 micrograms/kg body wt. During the 8 days of the study, an average of 48.3% of the ETU ingested in wine was excreted unmodified by the kidneys. Twenty-four hour urinary excretion of ETU was significantly correlated with daily intake of ETU (r = 0.768) and CS2 evolved by the daily food items (r = 0.414).

[A case of occupational pulmonary siderosis: the pathogenetic and prognostic considerations]. / Un caso di siderosi polmonare professionale: considerazioni patogenetiche e prognostiche.

Pulmonary siderosis is a disease which can be considered with the pneumoconioses of the so-called inert dust (either by deposit or by accumulation) and, from the earliest nosographic descriptions dating back to the thirties and forties, it has been substantially considered a benign form because of the scarce sclerogenic evolution and the preservation of discrete respiratory function. We present a case of pulmonary siderosis characterized on one hand by the importance and clarity of the cytopathological picture and on the other by the presence of changes, although modest, in lung function which confirm the most recent hypotheses in the literature on the potential evolution of pneumosiderotic diseases and their relatively less benign prognosis. From a preventive point of view the case draws attention to the need for greater control of environmental hygiene conditions in small factories. From an insurance and medico-legal point of view siderosis has recently been explicitly added to the occupational diseases which can be declared to the Italian state department dealing with occupational disease and disability payments (I.N.A.I.L.) (DPR of the 13.04.1994, section 47).