Diaminodiphenylmethane Sensitization in north-eastern Italy from 1996 to 2012.

BACKGROUND: 4,4'-Diaminodiphenylmethane (DDM) is an aromatic amine used as a hardener, insulator and anticorrosive. Exposure implies risk of being sensitized and developing contact dermatitis. OBJECTIVE: The aim of this study was to determine the occurrence of contact sensitization to DDM among patients with contact dermatitis and the role of occupational exposure. PATIENTS AND METHODS: From 1996 to 2012, 24 056 consecutive patients with suspected allergic contact dermatitis were patch tested in north-eastern Italy. Individual characteristics were collected through a standardized questionnaire in eight departments of dermatology and occupational medicine. RESULTS: The overall prevalence of DDM sensitization was 2.5% (n = 599) with a decreasing trend in considered years. Trieste area had the higher prevalence of sensitization (3.2%). Mechanics and chemical industry workers had a significant higher risk of being sensitized to DDM. CONCLUSION: DDM sensitization is decreasing in years and is associated with some occupational exposures.

Healthcare workers and skin sensitization: north-eastern Italian database.

BACKGROUND: Working in healthcare is regarded as a risk factor for occupational skin disease. Workers are exposed to disinfectants, soaps, detergents and latex and need to wash their hands frequently and thoroughly. AIMS: To investigate the association between healthcare work and patch test reactions to various potential sensitizers in a population of contact dermatitis patients in various dermatology and occupational medicine units in north-eastern Italy. METHODS: Patients with suspected allergic dermatitis underwent patch testing. Odds ratios (ORs) and 95% confidence intervals (CIs), adjusted by age and sex, were calculated for healthcare workers (HCWs), using white-collar workers as control group. RESULTS: HCWs represented 14% of the sample of 19088 patients (68% women, 32% men). Among HCWs, both sexes had a higher risk of developing hand/forearm dermatitis (females: OR 2.1, 95% CI 1.8-2.5; males: OR 1.6, 95% CI 1.3-2.1). HCWs had an increased risk of sensitization to formaldehyde (OR 1.65; 95% CI 1.2-2.3) and to p-phenylenediamine (OR 1.6; CI 1.1-2.3). CONCLUSIONS: Our study suggests a significant association between healthcare work, hand/forearm dermatitis and sensitization to formaldehyde and p-phenylenediamine.

[Approach to the assessment of occupational stress at a hospital]. / Approccio alla valutazione dello stress lavoro-correlato in un'Azienda Sanitaria.

In the health sector, the theme of work-related stress is a major issue, representing a significant risk factor on health-care providers which can also affect the quality of health services provided. It is therefore important to adopt a multidimensional evaluation system of work-related stress in order to integrate the results of the analysis of objective and subjective stress indicators. The adoption of a multidimensional validated tool as the one proposed by Inail, allows an integrated analysis of sentinel indicators, objective factors of context and content jointly to direct analysis of the subjective perception of workers through the analysis of the Management Standards developed by Health and Safety Executive. The comparison between three Healthcare Districts, three Mental Health Centers and Administrative Offices of an Healthcare Organization (652 workers involved) revealed the most critical areas which need urgent improvement intervention.

[Work-related injuries in Monfalcone shipyard (2000-2010)]. / Il fenomeno infortunistico nei lavoratori della cantieristica navale del cantiere di Monfalcone (Gorizia) dal 2000 al 2010.

Shipbuilding industry exhibits higher injury rates at the workplace than those reported in other industrial sectors. Work-related injuries (n = 6714) occurred from 2000 to 2010 at the shipyard of Monfalcone (Gorizia-Italy) were considered. Injury frequency incidence (IF = number of accidents/number of workers x 1000) and injury severity rate were estimated. Among permanent (directly employed) shipyard workers, the IF ranged from 294.6 in 2000 to 113.7 in 2010. Injury severity rates showed the same decreasing trend. The IF for contract workers was unchanged over the calendar period (110.5 in 2000 to 110.9 in 2010) with no significant change in the injury severity rate. These findings suggest an improvement of the working condition for permanent shipyard workers as a result of prevention policies (education and surveillance) and the automation of production processes. Further preventative interventions are suggested to minimize work-related injuries and to promote health and safety in the shipbuilding industry.

[The evaluation of occupational contact dermatitis using the information network: the Triveneto experience]. / La valutazione delle sensibilizzazioni professionali utilizzando i risultati multicentrici dei patch test: l'esperienza del Triveneto.

Contact allergy surveillance networks provide information that permits a better evaluation of the role of different haptens in allergic contact dermatitis work related. The Triveneto region network is active since 1996 and comprises 12 center of dermatology and occupational medicine: all centers use a standardized protocol to perform patch test and a questionnaire to obtain information on skin diseases, atopy, occupations. All data are collected from Padua and Trieste and used to evaluate sensitization trends and occupation relevance of haptens. The Triveneto region network participates to the European Network on Contact Dermatitis. Data analysis permit to confirm the increase in sensitization in some occupational groups: construction workers has higher risk to be sensitized to chromium, hairdressers to be sensitized to p-phenilendiamine, mechanics to be sensitized to nickel, epoxy resin and mercaptobenzothiazol. Trend analysis of sensitization permit to evaluate in large scale the benefits of preventive measure and the needs for future.

[Cutaneous allergy in construction workers]. / Allergie cutanee in un gruppo di lavoratori edili.

Nine hundred building trade workers and 4372 office workers (from a database of 16267 patients) with suspected allergic dermatitis, underwent patch tests. The associations between patch test results and occupations were assessed by multivariate logistic regression analysis. As expected, building trade work was significantly associated with chromium sensitization (OR 1.55; 95% IC 1.22-1.97), a well known occupational hapten in this occupational group. An increased risk for epoxy resin sensitization (OR 3.80; 95% IC 2.11-6.86) and thiuram mix sensitization (OR 1.69; 95% IC 1.07-2.65) was also found in the construction workers. Epoxy resin is a strong skin sensitizer widely used in building trade, while thiuram mix is often present as an additive in the rubber gloves used by construction workers. These findings suggest that effective measures to prevent allergic contact dermatitis are needed in the construction workers.

[Sex specific differences in physiologic response to stress evaluated by means of salivary cortisol]. / Differenze sesso-specifiche della risposta fisiologica allo stress misurato con il cortisolo salivare.

The psychophysiological mechanism behind the development of stress-related diseases includes a long-term both increase and decrease in circulating cortisol levels, leading to an allostatic disregulation of the hypothalamic-pituitary-adrenal (HPA) axis. This research explores the relationship between perceived stress (assessed by means of the Job Strain Model) and neuroendocrine response quantified by means of repeated measures of salivary cortisol in 46 call-centre operators. Job strain influenced the total amount of cortisol response to waking, but not the cortisol excretion in the remainder of the day. The cortisol response to waking showed gender-specific differences, women excreting greater cortisol than men [AUC(t): coeff (IC 95%) = 16.2 (5.3-27.1); AUC(i): coeff (IC 95%) = 8.3 (2.4-14.2); MnInc: coeff (IC 95%) = 5.2 (1.6-8.9)]. In long run the gender-specific differences of the dis-regulation of the hypothalamic -pituitary-adrenal (HPA) axis can be related to differences on prevalence of autoimmune diseases.

[In vitro percutaneous absorption of silver nanoparticles]. / Assorbimento percutaneo di nanoparticelle di argento in un sistema in vitro.

There is a growing interest in the debate on nanoparticle safety for topical use. The benefits of nanoparticles have been shown in several scientific fields, but little is known about their potential to penetrate the skin lies. This study aims at evaluating in vitro silver nanoparticles skin penetration. Experiments were performed using the Franz diffusion cell method with intact and damaged human skin. Physiological solution was used as receiving phase and 70 microg/cm2 of silver nanoparticles dispersed in synthetic sweat were applied as donor phase to the outer surface of the skin for 24h. The receptor fluid measurements were performed by Electro Thermal Atomic Absorption Spectroscopy (ETAAS). Silver concentration of 0.2 microg/L was found in the receiving solutions of two cells, in which damaged skin membranes were set up. In the other tests, we obtained a silver concentration below the limit of detection in the receiving cells. Our experimental data show that silver nanoparticles permeation through intact and damaged skin is negligible. These findings are consistent with previously published results. Further researches are necessary to explore skin absorption of silver nanoparticles.

[In vitro percutaneous absorption of chromium powder and the effect of skin cleanser]. / Assorbimento percutaneo di polvere di cromo ed effetti della detersione: risultati di una indagine in vitro.

Occupational chromium dermatitis occurs frequently among cement and metal workers, workers dealing with leather tanning and employees in the ceramic industry. The present study, using an in-vitro system, evaluated percutaneous absorption of chromium powder and the effect of rapid skin decontamination with a common detergent. Experiments were performed using the Franz diffusion cell method with human skin. Physiological solution was used as receiving phase and a suspension of chromium powder in synthetic sweat was used as donor phase. The tests were performed without or with decontamination using the cleanser 30 minutes after the start of exposure. The amount of chromium permeated through the skin was analysed by Inductively Coupled Plasma Atomic Emission Spectroscopy and Electro Thermal Atomic Absorption Spectroscopy. Speciation analysis and measurements of chromium skin content were also performed. We calculated a permeation flux of 0.843 +/- 0.25 ng cm(-2) h(-1) and a lag time of 1.1 +/- 0.7 h. The cleaning procedure significantly increased chromium skin content, whereas skin passage was not increased. These results showed that chromium powder can pass through the skin and that skin decontamination did not decrease skin absorption. Therefore, it is necessary to prevent skin contamination when using toxic agents.

[Occupational contact dermatitis in metal workers and gender effect]. / Dermatiti professionali nei metalmeccanici ed effetto di genere.

Contact dermatitis is more frequent among women for anatomical reasons and for extraprofessional exposure to irritants and detergents during homeworks. In addition sensitisation to contact haptens is different in sexes. The aim of our work was to evaluate the association between patch test skin sensitizations and professional exposure to metals analyzing data for gender. Of the 15.217 patients patch tested for dermatitis, 678 were metalworkers. The statistical analysis revealed a significant association between dermatitis and sensitisation to nickel in professional exposed women (OR = 1.68; LC50% 1.11-6.50) while metal sensitisation (Cr.Ni and Co) was not relevant in men: for them a significant association between dermatitis and sensitisation was found to quaternium (OR = 3.91; LC95% 1.18-12.9), to mercaptobenzothiazole (OR = 2.69; LC50% 1.11-6.50) and to ethylendiamine dichloride (OR = 2.53; LC95% 1-6.41). The authors stress the need to evaluate patch test sensitisation considering gender effects.

Latex allergy: a follow up study of 1040 healthcare workers.

BACKGROUND: Natural rubber latex allergy can cause skin and respiratory symptoms The aim of this study was to evaluate the prevalence and incidence of latex related symptoms and sensitisation among a large group of healthcare workers in Trieste hospitals, followed for three years before and after the introduction of powder-free gloves with low latex release. METHODS: In the years 1997-99 the authors evaluated 1040 healthcare workers exposed to latex allergen for latex related symptoms and sensitisation by means of a questionnaire, a medical examination, skin prick tests, and IgE specific antibody assay. The second evaluation was carried out in the years 2000-02, subsequent to the changeover to a powder-free environment. RESULTS: Glove related symptoms were seen in 21.8% of the nurses (227), mostly consisting of mild dermatitis: 38 (3.6%) complaining of contact urticaria and 24 (2.3%) of asthma and/or rhinitis. These symptoms were significantly related to skin prick tests positive to latex (OR = 9.70; 95% CI 5.5 to 17) and to personal atopy (OR = 2.29; 95% CI 1.6 to 3.2). Follow up was completed in 960 subjects (92.3%): 19 new subjects (2.4%) complained of itching erythema when using gloves, but none was prick positive to latex. Symptoms significantly improved and in most cases disappeared (p<0.0001). CONCLUSIONS: Simple measures such as the avoidance of unnecessary glove use, the use of non-powdered latex gloves by all workers, and use of non-latex gloves by sensitised subjects can stop the progression of latex symptoms and can avoid new cases of sensitisation.