[The skin cancer in the construction industry]. / La neoplasia cutanea nel settore edile.

UNLABELLED: The risk factors for the development of cutaneous neoplasms are well-known (skin type, ultraviolet rays, familiar occurrence, etc.) and the exposure to ultraviolet light is probably the most important one. Construction workers, due to the characteristics of the work performed (outdoor work), are exposed to UV rays for most of their workday, often in association with the exposure to chemicals (PAHs, solvents) with a role in promoting skin carcinogenesis. The construction industry is therefore a true "test" for the prevention of skin cancer. MATERIALS AND METHODS: description of skin cancer in the construction workers subject to medical surveillance at the "Territorial Joint Committee of Bergamo" (8 basal cell cancers, 1 squamous cell carcinomas and 4 melanomas). PURPOSE: review of the medical literature data, evaluation of the exposure to multiple risk factors, prevention proposals in a professional field where the "culture of tanning" is still widespread.

[A peculiar lead poisoning: a concern of team achievement]. / Un caso di intossicazione anomala da piombo: l'importanza di un'intervento multidisciplinare.

We describe a case of lead poisoning in a worker after hand and forearm trauma with fracture of radius and multiple fractures of metacarpal bones and hand phalanges and tissue infiltration of lead oxide (PbO) paste. Orthopedic surgery was immediately performed. After 20 days the patient had abdominal colic pain episodes and severe stipsis and blood lead level (BLL) was 60 mcg/mL with urinary lead level (ULL) of 238 mcg/24 h. After mobilization test with calcium disodium edetate were observed a high increase of BLL (180 mcg/dL) and UBL (17,000 mcg/24h). An initial anemia was observed and became severe (Hb 7.6 g/dL). A NMR exam and echography showed forearm subcutaneous lead paste infiltration and the patient underwent to a second surgical debridement with local low temperature (5 degrees C) irrigation of saline and CaNa2EDTA made the removal of the hardened lead paste. The day after, oral succimer (DMSA) chelation treatment was started with recovery of lead poison.

[Exposure to vegetal esters based metal cutting fluids: health effects]. / Esposizione ad oli lubrorefrigeranti vegetali: effetti sulla salute.

The aim of our research is to study respiratory and dermatologic diseases (irritative and allergic) in a cohort of workers exposed to vegetal esters based metal cutting fluids of the latest generation. A cohort of 81 workers (mean age 34.5 years, seniority 17.4 years), with mean exposure to vegetal esters based metal cutting fluids of 2.8 years, has been subjected to clinical evaluations. The investigation did not reveal any disease or disorder of the respiratory system, any folluculitis or any allergic contact dermatitis caused by sensitization to vegetal esters based metal cutting fluids. On the contrary we documented 5 cases of irritant contact dermatitis, even if favored by an improper use of protection devices. According to early results, the introduction of vegetal esters based metal cutting fluids seems to reduce the risk to the worker's health. A longitudinal surveillance is still needed to confirm that even in the medium and long-term sensitizations will not occur.

[The Bergamo experience of health surveillance in the bakery sector]. / L'esperienza bergamasca di Sorveglianza Sanitaria nel settore della panificazione.

The purpose of this study is to analyse the various risk factors present in the artisan and semi industrial bread making technological cycle as well as verify the kind of illnesses and ailments encountered amongst the workforce. The objective being to identify a preventive action programme together with the necessary Health support measures. Our case study, drew upon a sample of 428 workers (252 bread makers and 176 sales staff). Each of them was asked to complete a questionnaire about the production process, the kind of exposure to wheat flour particles, smoking habits, present or past common allergy pathologies, the symptoms connected to the work, both in the allergic and osteomuscular field. Those positive respondents were subjected to various medical tests so as to ascertain a definitive diagnosis of their ailments. As was easy to predict, the most common pathology (ailment), found amongst bread makers, related to the respiratory system--16.7% of the population. In particular, 7.5% was affected by eye rhinitis, 2.8% by allergic bronchial asthma, 3.2% indicated a mix between rhinitis and bronchial asthma and 3.2% by BPCO. Skin ailments affected 2% of workers and WMSDs more than 2.8%.

[Carpal tunnel syndrome in handicraft planning]. / La sindrome del tunnel carpale nella panificazione artigianale.

The purpose of this study is to assess the prevalence of carpal tunnel syndrome (CTS) in a group of bakers and to evaluate the presence of a biomechanical risk for upper limbs in the technological cycle. Health assessment (history, clinical examination, upper limbs electromyography) and risk evaluation through Check List OCRA (Occupational Repetitive Actions - Colombini / Occhipinti) have confirmed the initial hypothesis, placing this profession between those at risk for carpal tunnel syndrome.

[Model of chemical risk assessment (D.L 25/2002), applied in 19 chemical industries of the Province of Bergamo]. / Modello di valutazione del rischio da agenti chimici (D. Lgs. 25/2002) applicato in 19 Aziende Chimiche della Provincia di Bergamo.

The aim of this work is to describe a model for the evaluation of chemical risk, according to the legislative decree 25/2002, planned by U.O.O.M.L. "Ospedali Riuniti di Bergamo", in collaboration with "Gruppo Industriali Chimici dell'Unione Industriali-Provincia di Bergamo" and applied in 19 Chemical Industries of the Province of Bergamo. The objective of the model is the rationalization of the procedures to ponder the levels of exposure and to value different typologies of risk using and manipulating chemical substances with the purpose to optimize the relationship among the attention for safety, workers health and the employment of resources.

[Health surveillance in construction]. / La sorveglianza sanitaria in edilizia.

In the Italian and international literature there are very few studies about work diseases and their prevention in the construction's compartment. The analysis of the most recent articles about this theme, however, suggests the presence of an high professional risk in the compartment and indicates as the most relevant risk factors noise, dusts, fibres, manual lifting, prolonged fixed postures, cumulative trauma disorders, vibrations, chemical substances and climatic conditions. The role that extra-lavorative risk factors can play on health is also relevant; those risks are due to the workers' peculiar life-style: hyper caloric diet, smoke and use of alcohol. Interventions of medical hygienic prevention, formation and information are therefore necessary. Lombardy Region, which from many years is careful to the problems about the prevention in building yards, has created a Working party who has elaborated the "Guide Lines for the sanitary surveillance in the building industry". The indications reported in the Guide Lines could represent, even for the occupational-doctors of the building contractors of the New Hospital, a good base for the working out of the workers' health care activity, in the respect of the dues of the law in force.

[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.

Contact urticaria from latex in healthcare workers.

BACKGROUND: Latex allergy is an important medical problem for an increasing number of patients. It has been documented as causing immediate hypersensitivity reactions ranging from mild urticaria to life-threatening anaphylaxis after cutaneous, mucosal or visceral exposure. Recent studies in northern Europe and the USA suggest that between 2.8 and 16.9% of healthcare workers are affected by latex hypersensitivity type I reactions. OBJECTIVES: To test the prevalence of contact urticaria from latex gloves in a group of healthcare workers, to examine the factors associated with latex allergy and to evaluate some diagnostic methods used in latex allergy. METHODS: A total of 929 employees of the surgical units who used latex gloves on a regular basis, at least once a day, were invited to participate in this study including administration of a questionnaire, a prick test with a commercial extract of latex, a prick test with latex glove eluate, a use test, RAST and an immunoblotting system; moreover, a prick test with a group of common inhalant allergens and a prick-by-prick test with fresh fruit (banana, kiwi, avocado, chestnut) were employed. RESULTS: Of the 929 staff sent questionnaires, 313 (33.5%) replied; of those who responded, 118 gave a history of hand problems such as itch, erythema, wheals when wearing gloves, dryness and irritation most marked on the backs of the hands. Among these 118 workers, 16 refused skin testing and examination of blood, so 102 subjects were studied for latex allergy; 21/118 (17.8%) healthcare workers were found to be latex allergic. Eighty-one staff members gave a history of hand problems worsened by wearing gloves but were not latex allergic on testing. Those healthcare workers who completed the questionnaire and answered negatively (195/313) were not tested for latex allergy. Prick tests with the commercial solution were positive in 11 of the 21 subjects studied; prick tests with the eluate of glove, RAST and the use test were positive in all workers; 10 of the 21 sera showed positive immunoblot results. Atopy and a preexisting irritant contact eczema of the hands were present in a high percentage of the workers. CONCLUSION: In this study of healthcare personnel, we found that allergic contact urticaria from latex was present in 21 workers of the 313 (6.7%) who responded to the questionnaire and of the 102 (20.5%) who were tested for latex allergy. Atopy and irritant contact eczema of the hands were frequent in these subjects. Skin prick testing with latex glove eluate and the use test seem to be more sensitive than in vitro testing, particularly immunoblotting, and are biologically more relevant; skin testing with glove eluate must be preferred to testing with a commercial extract.

Occupational exposure to metallic cobalt in the Province of Bergamo. Results of a 1991 survey.

The results of a survey on workers potentially exposed to cobalt in the Bergamo Province are reported. Its aim is to assess the number of workers at risk of developing respiratory disease due to the inhalation of metallic cobalt. Interest was shown after an examination of 11 cases of 'hard metal disease', which we diagnosed, in workers who came from different production areas and had different degrees of exposure. A first group of 45 factories with potential cobalt exposure was identified by consulting the archives of the Local Sanitary Units (USSL) and of the Chamber of Commerce, and by use of the telephone directory and requesting information from the producers and users of Widia tools. A second group of 2039 factories was selected from those industrial activities where we had previously ascertained the presence of grinding operations using hard metal tools with diamond wheels. This study is related to all the factories in the first group and 10% of the factories in the second group. More than 304 inspections were carried out. In this context 403 exposed workers were identified. Workplace air measurements (250 samples) and biological monitoring (> 600 samples) to determine the exposure levels to cobalt were performed. The results show an unexpected diffuse occupational exposure in different production areas where the airborne cobalt is frequently underestimated and higher than the TLV.

Cobalt excretion in urine: results of a study on workers producing diamond grinding tools and on a control group.

A study was carried out on cobalt (Co) excretion in the urine of 12 workers exposed to known cobalt concentrations in the stone cutting diamond wheel production and in six volunteers: four of these were exposed in the same work environment for a whole workshift and the other two were exposed to cobalt in a cabin under experimental conditions. The kinetics of the urinary excretion was multiphase: (i) a first stage of rapid elimination (T 1/2' = 43.9 h); (ii) a second phase of slower elimination (T 1/2'' = 10 days); (iii) a longer period of retention, of the order of years, in subjects with higher exposure. In the control group (4 subjects), the excretion proved to be much faster in the first stage (T 1/2' = 20 h). The different behaviour of the two groups could be related to the different body burden, of cobalt and/or to the possibility of different kinetics induced by continuous exposure to the metal. Moreover, 3 weeks after the removal of the workers from exposure the urinary cobalt concentrations were not within the normal limits of CoU for the general population, (even for workers exposed to cobalt levels of the same order as the TLV). The increase of CoU concentrations in the first 3 h after the end of exposure, stresses the problem of when urine samples for biological monitoring of the workers should be collected. The present study confirms the utility of CoU in discriminating between exposed and non-exposed subjects as well as in assessing high and low level exposure.

Hard metal disease: eight workers with interstitial lung fibrosis due to cobalt exposure.

Eight hard metal workers exposed to cobalt containing dust (four producers of stone-cutting cobalt-diamond wheels and four grinders of hard metal tools) and affected by interstitial lung fibrosis have been examined. A close relationship between cobalt exposure and clinical findings was observed in six patients who were still working. The clinical picture ranged from minor symptoms to manifestations resembling those of hypersensitivity pneumonitis, with fever, weight-loss, non-productive cough and dyspnea. A restrictive impairment of the ventilatory function was prevalent. The chest roentgenogram of one patient showed a diffuse reticular nodular pattern, while the others presented a mild reticular accentuation of the interstitium. In five patients, bioptic specimens of the lung parenchyma showed interstitial collagenic fibrosis with inflammatory cells infiltrating the alveolar septa. An increased number of lymphocytes and polymorphs was reported in the bronchoalveolar lavage (BAL) fluid from seven patients. Giant multinucleated cells were present in the BAL of four subjects while an inversion of the helper-suppressor ratio was evident in those patients who were still exposed to cobalt when BAL was performed. In this study, the causal role of metallic cobalt inhalation in the etiology of the lung disease is examined and discussed.