Development of metabolic syndrome and electrocardiographic features of left ventricular hypertrophy in middle-aged working subjects.

BACKGROUND AND AIMS: Metabolic syndrome (MS) leads to excess cardiovascular disease, including heart failure. Left ventricular hypertrophy (LVH) is common in MS patients, but it is unknown whether onsets of MS and LVH coincide. Herein, we tested the association between development of MS and of electrocardiographic LVH in a cohort of middle-aged individuals. METHODS: We included 303 working subjects (mean age 43.0 ± 6.2; 41% males), followed- up for 4.3 ± 0.8 yr. ATP-III MS components were determined. Electrocardiographic LVH features were assessed by Sokolow and Cornell voltage indexes and Romhilt-Estes (RE) score. RESULTS: At baseline, Cornell index was significantly higher in subjects with (no.=55; 18.2%) than in those without MS (12.8 ± 6.4 vs 10.9 ± 5.4 mm; p=0.023), while Sokolow index and RE score were not different. At followup, individuals who developed (no.=51) compared to those who did not develop MS showed a significant increase in Cornell voltage index (1.0 ± 0.6 vs -0.55 ± 0.3 mm; p=0.035) and RE score (0.17 ± 0.17 vs -0.08 ± 0.04; p=0.028). The change in Cornell index over time was directly correlated with the change in the number of MS components (r=0.133; p=0.02) and in homeostasis model assessment of insulin resistance (r=0.117; p=0.046). The association between MS onset and the increase in Cornell index/RE score was independent from confounders. CONCLUSIONS: In a young population of working subjects, the development of MS is associated with worsening features of LVH. Early LVH electrocardiographic screening in young subjects who develop MS should be considered and performed using Cornell voltage index.

Work stress and negative affectivity: a multi-method study.

BACKGROUND: In the literature negative affectivity (NA) is considered both a confounding variable as well as a predictive variable for work-related stress. However, a common limitation in this line of research relates to the use of self-report measures for determining NA, perceived stressors and psychophysical strain. AIMS: To test, using a multi-method study, a theoretical model that correlates NA, perceived interpersonal conflict (with co-workers and supervisors), psychophysical strain and medically certified sickness absences. METHODS: A multi-method prospective study was carried out on a sample of metalworkers. NA and interpersonal conflict were determined using self-report (Time 1), whereas psychophysical strain was determined by an occupational physician (Time 2). Data on medically certified sickness absences were collected from the company's database (Time 3). RESULTS: There were 326 participants. The results showed an association between NA and conflict with co-workers, as well as between NA and conflict with supervisors. Psychophysical strain could be predicted from NA and conflict with co-workers but not from conflict with supervisors. NA had a significant indirect effect on psychophysical strain through conflict with co-workers. Lastly, psychophysical strain predicted sickness absences from work. CONCLUSIONS: NA influenced psychophysical strain in the worker, both directly and indirectly, through perceived conflict with co-workers.

[A new scale for measuring the psycho-physical effects of work-related stress in a perspective of methods integration]. / Una nuova scala di misura degli effetti psico-fisici dello stress lavoro-correlato in una prospettiva d'integrazione di metodi.

BACKGROUND: This study fits into a perspective of integrated work-related stress assessment, in response to the need to limit the common method variance and the role played by individual variables in subjective measures. OBJECTIVES: The goal of this study was to check the metric properties of a new scale of mental and physical strain developed for the evaluation of stress symptoms by the physician and to detect the antecedents of psycho-physical symptoms, in terms of both individual and work characteristics, through an integrated approach. METHOD: The study was conducted on 409 workers involved in health surveillance activities, to whom the new scale and a subjective assessment tool were administered. RESULTS: Confirmatory factor analysis showed that the scale is a reliable tool for hetero-evaluation of psycho-physical symptoms attributable to stress at work. Moreover, specific individual characteristics, such as the presence of prior health disorders and the female gender, and organizational features, such as the pathological work/life conflict and the workload, were found to be risk factors in relation to psychological and physical strain. Age, consumption of alcoholic beverages between meals, relationships with colleagues, and the characteristics of the workplace were instead found to be important protective factors. DISCUSSION: The adoption of an integrated approach made it possible to improve and study in depth the ways of work-related stress assessment, highlighting the pivotal role of the occupational health physician making the evaluation.

[Drugs use assessment in a group of bus drivers]. / Valutazione dell'assunzione di sostanze stupefacenti in un gruppo di conducenti di autobus.

Bus driver is one of those tasks inherent transport activity, which involves special risks to safety and health of others and for which it is necessary, according to art. 41 of Decree No. 81/08, to check the consumption of psychoactive substances during the health surveillance. This assumption was investigated in a group of 461 bus drivers of a large trucking company. In medical history, one subject reported a previous history of opiate addiction and another, in the past, occasional taking of cannabis, and at the time of the visit, in no cases the objectivity has shown intoxication or abstinence signs, or signs of parenteral injection. Laboratory tests were found positive in one case of screening texts, not confirmed by subsequent laboratory analysis and a case of positive analysis for confirmation. The worker, temporarily suspended from driving and taken over by the Service for Drug Addiction of competence, was then reinstated in his job, having held that the absence of drug addiction.

[Work-related stress: comparing two assessment methods]. / Stress lavoro-correlato: due metodi di valutazione a confronto.

Aim of the study is to compare and evaluate the possible integration of two methods of work-related stress risk assessment: the "subjective/perceptive" ISPESL-HSE and the "objective/intersubjective" VIS. Four different types of companies were examined: public education, social services, forestry work, agricultural machinery industry. Both VIS and HSE showed a different level of risk among the companies, with a good overlap of the results obtained with the two different methods of investigation. They also integrate each other in eliciting a better and more articulated study of work-related stress risk.

Otoneurological study in workers exposed to styrene in the fiberglass industry.

Twenty workers exposed to styrene and acetone in small fiberglass factories were monitored for 8 h using passive dosimeters. Urine samples were collected at the end of the workshift and before the start of work on the next morning. The 8-h time-weighted average exposure values for styrene and acetone ranged from 14 to 416 mg/m3 and from 70 to 277 mg/m3, respectively. The sum of styrene metabolites, mandelic acid and phenylglyoxylic acid (MA + PGA), in the next-morning urine samples ranged from 81 to 943 mg/g creatinine. Different test sensitivity was identified in the otoneurological battery: it was low for audiometric tests and ABR, and relatively high for vestibular tests. The vestibular system seems partially sensitive to the toxic effects of styrene in the absence of clinical signs and symptoms. The actual exposure levels for styrene cannot be considered devoid of functional subclinical consequences.

[Interference of acetone in styrene metabolism in subjects exposed to both solvents]. / Interferenza dell'acetone sul metabolismo dello stirene in soggetti esposti ad entrambi i solventi.

Thirty-seven workers exposed to styrene and acetone in fiberglass industry were monitored on Monday and Thursday for 8 hours (two subsequent samplings of 4 hours each) using passive dosimeters (mod. TK200). The charcoal disks of the passive dosimeters were analysed by gas-chromatography. Urine samples were collected at the end of the workshift and before the start of the workshift the next morning (Tuesday and Friday). Mandelic acid (MA) and phenylglyoxylic acid (PGA) were measured in the urine, using a HPLC method; values were expressed in mg/g of creatinine. The 8-h TWA exposure values ranged from 10 to 522 and 13 to 1581 mg/m3 on Monday and 8 to 423 and 10 to 579 mg/m3 on Thursday for styrene and acetone, respectively. Styrene TWA exposure values significantly correlated with the sum of metabolites at the end of workday (r = 0.72 on Monday and r = 0.91 on Thursday) and also the next morning (r = 0.88 on Tuesday and r = 0.85 on Friday). A calculated styrene exposure level of 213 mg/m3 (ACGIH-TLV) was associated with an excretion of metabolites (MA+PGA) higher on Thursday (814 mg/g creat.) than on Monday (600 mg/g creat.). The same observation was made on Friday (409 mg/g creat.) as compared with Tuesday (302 mg/g creat.). In conclusion, the TLV of styrene was associated with different values of metabolites at the beginning and at the end of the work-week. Moreover our data show that the simultaneous exposure to acetone does not modify the excretion of MA.

Biological monitoring of workers exposed to styrene and acetone.

Twenty-two workers exposed to styrene and acetone in two fiberglass industries were monitored on Monday and Thursday for 8 hours using passive dosimeters. Urine samples were collected at the end of the workshift and before the start of the work on the next morning (Tuesday and Friday). The charcoal disks of the passive dosimeters were analysed by gas-chromatography. Mandelic acid (MA) and phenylglyoxylic acid (PGA) were measured using a HPLC method; values were expressed in mg/g of creatinine. The 8-h TWA exposure values for styrene and acetone ranged respectively from 22 to 522 mg/m3 and 40-1581 mg/m3 on Monday; 25-423 mg/m3 and 55-579 mg/m3 on Thursday. Styrene TWA exposure values significantly correlate with the sum of metabolites at the end of workday (r = 0.70 on Monday and r = 0.95 on Thursday) and also at the next morning (r = 0.86 on Tuesday and r = 0.85 on Friday). A styrene exposure level of 213 mg/m3 (ACGIH-TLV) was associated with an excretion of metabolites (MA+PGA) higher on Thursday (803 mg/g creat) than on Monday (570 mg/g creat). The same result was found on Friday (459 mg/g creat) compared with Tuesday (305 mg/g creat). Moreover our data show that the simultaneous exposure to acetone does not modify the excretion of MA. In conclusion the TLV of styrene is associated with different values of metabolites at the beginning and at the end of the work-week.

[The occupational risks in a company producing aluminum alloy wheels]. / Rischi lavorativi in una azienda produttrice di ruote in lega di alluminio.

An environmental hygiene study was carried out in a factory making aluminium alloy wheels via pressure moulding. Physical risk factors (noise and microclimate) and chemical risk factors (respirable dust, mineral oils, solvents, fluorides, formaldehyde, CO) were assessed. Analysis of the data showed that physical risk factors were prevalent, whereas chemical pollution was insignificant due to technical improvements made by the management in the course of several redesigns of the plants.

Helicobacter pylori and luminal gastric pH. Relationships in nonulcer dyspepsia.

The relationships between gastric pH and Helicobacter pylori infection were studied in 37 consecutive subjects affected with nonulcer dyspepsia. Each underwent esophagogastroduodenoscopy with multiple gastric biopsies for both H. pylori and histologic assessment, and 24-hr antral pH monitoring. H. pylori was harbored by 59.5% of the subjects with whole gastric spread of infection in all but one patient. Histologic gastritis was shown in 70.3% of the subjects. H. pylori was strongly associated with gastritis, both antral nonatrophic and multifocal atrophic. The ranges of 24-hr pH values were 1.3-6.9 in the H. pylori-positive and 1.2-6.8 in the H. pylori-negative group. Differences in pH values between the two groups were not significant. Moreover, the mean percent time duration of pH above 2, 4, and 6 did not significantly differ between the two groups. Therefore, this study has shown that chronic H. pylori infection is not related to luminal gastric pH.

[Pollution by nitrous dioxide during diagnostic laparoscopy interventions]. / Inquinamento da protossido d'azoto durante interventi di laparoscopia diagnostica.

Here we have outlined the data relative to an environmental survey carried out in a laparoscopy clinic at the hospital of Padua, to determine the environmental concentration of nitrous dioxide (N2O) used for intra-abdominal inflation during diagnostic laparoscopy interventions. The data obtained have revealed cases of considerable N2O environmental pollution. This above all, due to spontaneous loss of gas during the intervention and to the lack of adequate ventilation systems.

Relationship between mixed acid-alkaline gastroesophageal reflux and esophagitis.

The severity of reflux esophagitis is related to the potency of refluxed material and the duration of its contact with the esophageal mucosa. The occurrence of esophagitis in patients with gastric hyposecretion or even with achlorhydria has focused attention on nonacid gastroduodenal contents. Until analytical studies of refluxed material are available to clarify its composition, the 24-hour combined gastric and esophageal pH monitoring can be used for detecting gastroesophageal reflux and for trying to analyze the composition of the refluxate. The first problem of this investigation was to examine whether the mixed acid-alkaline reflux, defined by pH monitoring, represented reflux of duodenal content; the second to study if there was a correlation between this type of gastroesophageal reflux and esophagitis. Unequivocal grade II and III esophagitis were considered. Our data suggest that the mixed acid-alkaline gastroesophageal reflux represents reflux of duodenal contents into the stomach and successively into the esophagus. The higher incidence of endoscopic-proven esophagitis in patients with mixed acid-alkaline gastroesophageal reflux in comparison to patients with acid gastroesophageal reflux supports the concept that biliary and pancreatic secretions may be a contributory factor in esophageal injury.