In vitro study of interactions between silicon-containing nanoparticles and human peripheral blood leukocytes.

The effects of silicon dioxide-based nanoparticles on the viability and proliferative activity of human peripheral blood cultured lymphocytes were studied. All nanoparticles in a concentration of 100 µg/ml produced a significant cytotoxic effect, its intensity depending on particles' structure: SiO2 nanoparticles were least toxic, while Ce3(+)-intercaled montmorillonite nanoparticles were most toxic. The cells died mainly by apoptosis and postapoptotic necrosis. Incubation with nanoparticles in a concentration of 100 µg/ml for 72 h caused death of all phytohemagglutinin-activated lymphocytes, while in concentrations of 1 and 10 µg/ml the nanoparticles had no effect of proliferative activity of cells. The results suggest that the effects of nanoparticles on cells are determined by the nanoparticle concentration and size, as well as by their structure.

Maternal allergy as a potential source of variability of exhaled nitric oxide in children non-sensitized to common domestic allergens.

The goal of the study is to evaluate the importance of maternal atopy as a potential biological source of variability of exhaled FeNO values in healthy children who were non-asthmatic and non-sensitized to common domestic allergens. The study sample consisted of 61 seven-year old children. Fractional exhaled nitric oxide (FeNO) has been measured by NObreath (Bedfont portable device). Children with reported maternal atopy had significantly higher mean FeNO values (geometric mean =10.7 ppb; 95%CI: 6.7-17.1 ppb) than those who denied it (geometric mean =5.2 ppb 95%CI: 3.9-6.9 ppb) (p=0.010). Neither the correlation between FeNO values and gender, respiratory and eczema symptoms, nor ETS exposure in the prenatal and postnatal period or body mass of children were significant. We also found no significant association of FeNO values with the amount of common domestic allergens measured in the households. The results of the ROC analysis suggested 11 ppb as the cut-off point for FeNO to distinguish groups of healthy children with and without maternal atopy. In conclusion, our study provided some evidence suggesting that maternal atopy may affect FeNO level in children independently of asthma and sensitization status to common domestic allergens. The data should be considered in the interpretation of FeNO levels in clinical practice and setting up FeNO screening criteria for identification of eosinophilic airway inflammation.

Wheezing and asthma may be enhanced by broad spectrum antibiotics used in early childhood. Concept and results of a pharmacoepidemiology study.

UNLABELLED: One of the mechanisms supposed to explain the increasing prevalence of asthma, among children in particular, is the use of antibiotics because they may modify natural microbial exposure and development of the immune system in early childhood. The aim of this study is to investigate the association between the use of various classes of antibiotics (penicillin, cephalosporin and macrolide derivatives) in early childhood and the medical diagnosis of asthma or wheezing reported by mothers over the follow-up after adjustment for potential confounders and respiratory infections. In a population-based sample of 5-year-olds, a part of the ongoing birth cohort study, the standardized interviews on health outcomes, potential confounders (child's gender, maternal atopy, parity, prenatal and postnatal environmental tobacco smoke) and the use of antibiotics were gathered from mothers of 310 children. While the overall use of antibiotics during the early childhood was insignificantly associated with asthma (adjusted OR = 1.65, 95%CI: 0.93 - 2.93), the risk estimates were significant both for macrolide antibiotics (adjusted OR=2.14, 95%CI: 1.16-3.95) and cephalosporins (OR=1.98, 95%CI: 1.14-3.37). The significant excess in IRR (incident risk ratio) of wheezing episodes was related only to the use of macrolide antibiotics (adjusted IRR=1.91, 95%CI: 1.12-3.27). The use of other classes of antibiotics was found not to be associated with the medical diagnosis of asthma or wheezing episodes recorded in the study period. CONCLUSION: as early childhood use of broad spectrum antibiotics is associated with an increased risk of developing asthma in 5-year-olds, it may be hypothesized that the antibiotic- related suppression of allergic inflammatory responses in the course of treatment may later lead to greater than before atopic immune response in Th2 children or an impairment of Th1 immune responses in early childhood.

Impact of excessive gestational weight gain in non-smoking mothers on body fatness in infancy and early childhood. Prospective prebirth cohort study in Cracow.

Gestational weight gain (GWG) is important for health policy as it may be associated with overweight epidemics in childhood and adolescence. The purpose of the study was to perform the risk assessment of joint effects of the excessive GWG and the pregravid maternal BMI on overweight in infancy and childhood. The observations were collected in the ongoing prospective birth cohort study of 482 non-smoking mothers and their newborns in Cracow inner city area. At 5 years of age the subsample of 312 infants were reexamined in order to assess their nutritional status. Body fatness was assessed by means of the weight/length ratio (WLR) in neonates and weight/height ratio (WHR) in 5-year-olds since they showed the strongest correlation with subcutaneous fat mass of young children. In the statistical analysis the binary regression models were applied to identify predictors of overweight. The excessive GWG (>18 kg) increased more than twofold the adjusted relative risk (RR) of neonatal fatness (R=2.7; 95% CI 2.0-3.7) and was also a significant independent risk factor for postnatal body fatness at 5 years of age (RR=2.0; 95% CI: 1.3-3.3). The results confirmed earlier findings that pregravid overweight increased not only the relative risk of neonatal fatness (RR=2.9; 95% CI: 2.2-3.9) but also overweight in early childhood (RR=2.7; 95% CI: 1.7-4.4). The conclusion is that excessive GWG may be a risk factor for overweight in early childhood and should be a focus of public health policy.

Nanostructured biocides for means of rehabilitation.

In this work, the description of technology of intercalation of montmorillonite by ions of biometals is submitted. Laboratory techniques of definition of a mass fraction of silver and copper in montmorillonite are resulted The manufacturing regulations of obtaining of nanodispersed powders of intercalated montmorillonite are submitted. Bases of technology of obtaining and manufacturing of cosmetic means on a basis of nanomaterials; technologies of antibacterial processing of textile materials, obtaining of antimicrobic properties by medical polymers are described in the report. Bases of technology of obtaining of biocidal and fungicidal coatings (paints, varnishes) on a basis of nanomaterials are described. The estimation of biocidal and properties of nanomaterials on a basis of intercalated montmorillonite by an integral disk-diffusion method is resulted. High efficiency of application of nanosystems on a basis of intercalated montmorillonite for obtaining of antimicrobic properties in paint and varnish materials is shown.

Effect of indoor air quality in the postnatal period on lung function in pre-adolescent children: a retrospective cohort study in Poland.

The purpose of this study was to determine the association between level of lung function in pre-adolescence and indoor air quality in the postnatal period. The retrospective cohort study was carried out in a sample of 1036 pre-adolescent children (9 years of age) attending schools in two residential areas of Krakow, Poland. Measurement of health outcomes considered lung function together with height and weight. Indoor air quality was based on environmental tobacco smoke and type of household heating. In addition, the number of winter months that occurred during the first 6 months of life was included as a key independent variable. Multivariate linear regression of lung function measured by forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC), and postnatal exposure to indoor pollution in the heating season (PEIP score) was adjusted for potential confounders such as maternal smoking during pregnancy and parental education as a proxy of social class. In the total study sample, the adjusted beta coefficient for FEV1 per unit of the PEIP score was -0.06 (P=0.02), while that for FVC was -0.05 (P=0.04). The analysis carried out in the more polluted area found that children living in households heated with gas or coal had a PEIP score that was strongly inversely related to lung function (adjusted beta coefficient for FEV1=-0.13; P=0.03; for FVC=-0.15, P=0.01), whereas regression coefficients were not significant in the group of children living in households with central heating. This study suggests that a lower level of lung function in pre-adolescent children can be related to postnatal exposure to indoor emissions in the winter.

On the need to teach evidence-based preventive medicine to health professionals.

In the last decade evidence-based medicine (EBM) has become popular between clinicians and epidemiologists as a tool to facilitate the translation of scientific research into clinical practice. In public health, this approach is important for health protection, different levels of disease prevention, and health promotion practice. EBM concept applicable to public health follows the same principles, but some additional aspects have to be considered. For example, in preventive medicine, there is the strong need to compare the relative effectiveness of various interventions in prolonging survival or preventing the occurrence or complications of a disease, as it is crucial for setting preventive priorities. Usually, systematic reviews and meta-analyses quantify the effects of treatments on selected endpoints (health outcomes). However, in setting preventive priorities the reverse perspective is important. The judgement about preventive action cannot be done without an adequate consideration of ethical and social context. In view of emerging evidence-based medicine to health professionals became of paramount importance. In the paper, this course of action has been discussed as an aftermath of the EB training workshop organized in Pavia (Italy) by the International Center for Studies and Research in Biomedicine.

Cohort study on low physical activity level and recurrent acute respiratory infections in schoolchildren.

The purpose of the study was to explain childhood respiratory infections in terms of life-style factors like being overweight or physically inactive. In the course of the cohort study we gathered data on respiratory health of 1028 preadolescent children in Krakow. Recurrent acute respiratory infections (RARI) in children have been defined as frequent spells (10 or more infections) over the two-year follow-up. In scoring the physical activity level, the data on regularly exercising sport and the number of hours spent daily TV watching or doing homework have been used. Excessive weight was based on the BMI index. In the total sample, the RR estimates of RARI adjusted to BMI and other potential confounders were consistently higher in children with low physical exercise (RR = 2.96; 95% CI: 1.78-4.93) or with moderate exercise (RR = 1.87; 95% CI: 1.33-2.65). Than among the highly active group. In the subgroups of allergic and non-allergic or overweight and not-overweight children the adjusted RR estimates were consistent with those found in the total sample. We concluded that physical exercise in preadolescent children may lessen the risk of acute respiratory infections and that the low physical activity is an independent predictor of increased risk of RARI besides excessive weight and other potential risk factors.

Transient or persistent asthma-like symptoms and lung growth over 2-year follow-up in pre-adolescent children.

BACKGROUND: The main purpose of this study was to assess the effect of transient and continued asthma-like symptoms on lung function growth in preadolescent children. METHODS: The follow-up respiratory health survey has been conducted on the sample of 1,129 children aged 9 years over 2 years follow-up. The basic health end-points were the occurrence of asthma-like symptoms and slower lung function growth (SLFG), which was defined as the lung function gain over 2 years within the lowest quintile of the distribution of a given spirometric test. RESULTS: Adjusted odds ratios (OR) for SLFG [forced vital capacity (FVC)] were significantly higher only in the children having continued symptoms [OR = 3.39: 95% confidence interval (CI) = 1.39-8.27]. There was a consistent trend of adjusted ORs for SLFG [forced expiratory volume (FEV,) with the category of symptoms, where OR was 2.00 (95% Cl = 1.17-3.42) in children with transient symptoms: while 4.10 (95% Cl = 1.71-9.86) in children who had persistent symptoms. The corresponding ORs for SLFG [maximal mid-expiratory flow (FEF25_75c)] were 2.27 (95% Cl = 1.37-3.76); and 5.43 (95% Cl = 2.38-12.40). DISCUSSION: The association between asthma-like symptoms and lung function gain in preadolescent children confirmed the clinical significance of the symptoms in question. The observed slower lung function gain in preadolescence may have implications for the development of chronic lung disease later in adulthood.

Reversibility of asthma-like symptoms and lung function growth over two-year follow-up in preadolescent children.

BACKGROUND: The interesting feature of childhood asthma is the great reversibility of symptoms. The main purpose of this study was to assess the effect of persistent and reversed asthma-like symptoms on lung function growth in preadolescent children. MATERIAL AND METHODS: The follow-up respiratory health survey has been conducted in the sample of 1129 children aged 9 yrs over two years follow-up. The basic health end-points was the occurrence of asthma-like symptoms and the slower lung function growth (SLFG). RESULTS: Adjusted OR for SLFG(FVC) was significantly higher only in the children having the continued symptoms(OR = 3.40; 95% CI: 1.32-8.77). There was a consistent trend of adjusted ORs for SLFG(FEV1) with the category of symptoms, where OR was 1.46 (95% CI: 1.02-2.10) in children with recent new symptoms; 2.06; (95% CI: 0.93-4.58) in those with symptoms remitted, while 3.46; (95% CI: 1.43-8.40) in children who had persistent symptoms. The corresponding ORs for SLFG(FEF25-75%) were 2.03; (95% CI: 0.97-4.28), 2.63; (95% CI: 1.38-4.99), and 5.84; (95% CI: 2.53-13.50). CONCLUSIONS: The consistent association between reversibility of asthma-like symptoms and lung function gain in preadolescent children confirmed the clinical significance of the symptoms in question. The observed slower lung function gain in preadolescence may have implications for the development of chronic lung disease later in adulthood.

Predisposition to acute respiratory infections among overweight preadolescent children: an epidemiologic study in Poland.

This cross-sectional field health survey has as its subjects 1129 preadolescent children resident in Krakow. Trained health visitors interviewed the mothers at the children's schools or at the parents' homes in order to gather standardized information regarding the families' social background and the families' and children's respiratory health and episodes of respiratory infections. Predisposition to respiratory infections in children has been defined as frequent spells (3 or more) of acute respiratory infections experienced by a given child over the 12 months preceding the interview. Clinical examination of children consisted of anthropometric measurements and spirometric testing. Anthropometric measurements (weight and height) were used for calculation of the body mass index (kg/m2). A child whose BMI was 20 or higher was defined as overweight (90th percentile). Susceptibility to acute respiratory infections was related significantly to body mass index. The children with BMI > or = 20 experienced twice as high a risk for acute respiratory infections than children with low BMI (OR = 2.02, 95% CI: 1.13-3.59). Out of other potential factors possibly involved in the occurrence of respiratory infections only the presence of chronic respiratory symptoms (OR = 2.43, 95% CI: 1.64-3.59), allergy (OR = 1.89, 95% CI: 1.34-2.66), and Environmental Tobacco Smoke (OR = 1.54; 95% CI: 1.05-2.25) increased the susceptibility of children to acute respiratory infections. Central heating in the household was shown to have a protective effect (OR = 0.65, 95% CI: 0.43-1.00) when compared with children from households where coal or gas was used for home heating.

PIP: Factors predisposing to recurrent acute respiratory infection were investigated in a cross-sectional field study of 1129 schoolchildren 9 years of age from Krakow, Poland. Predisposition to respiratory infections was defined as 3 or more spells in the 12 months preceding the 1995 study. Susceptibility to acute respiratory infections was significantly associated with body mass index. Overweight children (body mass index of 20 or higher) had twice the risk of infection than children with a lower body mass index (odds ratio (OR), 2.02; 95% confidence interval (CI), 1.13-3.59). Other significant risk factors were the presence of chronic respiratory symptoms (OR, 2.43; 95% CI, 1.64-3.59), allergy (OR, 1.89; 95% CI, 1.34-2.66), and environmental tobacco smoke (OR, 1.54; 95% CI, 1.05-2.25). Central heating in the household exerted a protective effect compared to households where coal or gas was used (OR, 0.65; 95% CI, 0.43-1.00). The strong effect of obesity on acute respiratory infection risk was independent from other host and environmental factors. Findings of a strong correlation in these children of body weight with the lung function tests FVC and FEV further support the view that the predictive spirometric formulas for preadolescents should consider weight as an important independent predictor of lung function.

Environmental pollution in central and eastern European countries: a basis for cancer epidemiology.

The main objective of this paper is to discuss the environmental issues in the countries of central and eastern Europe (CCEE) and to show their significance for cancer epidemiology. Of known cancer risk factors that may be related to environmental exposure in the CCEE, tobacco smoking is probably the most important. The worsening trends in cancer mortality noted in middle-aged men in the CCEE can be attributed to smoking. Other lifestyle factors that interact with environmental hazards include high alcohol consumption and unhealthy nutrition. Among other factors, the most common environmental exposure in the CCEE that has potential adverse effects on health in terms of cancer incidence is related to high levels of ambient and indoor pollutants exceeding the air quality guidelines of the World Health Organization. Millions of people, usually in urban areas, are estimated to be exposed to such levels of pollution. Outdoor air pollution is a substantial environmental problem in many areas of the CCEE, where heavy industries are concentrated without adequate technology for emission control. Chemically contaminated drinking water provides a major route of exposure for many potential environmental health hazards. The pollution of water resources, including groundwaters, by industrial and agricultural wastes is a widespread problem in both the CCEE and the former USSR. An estimated 13% of treatment plants in the Russian Federation lack the necessary equipment to treat drinking water, particularly for disinfection, to meet the required standards. Many countries in the region have problems in rural areas, where the networks are small or consumers depend on private wells, and treatment of drinking water is either poor or nonexistent. Consequently, because the standards are difficult to meet, drinking-water accumulates high levels of arsenic and nitrates. The main concern is nitrate, arsenic, fluoride, and pesticides. In countries like Bulgaria, Hungary, Romania, and Slovakia, locations are known where nitrate concentration in drinking water are high enough to cause methemoglobinemia. Lack of appropriate data hamper valid estimates of the extent of unhealthy working conditions or of poor housing conditions. Unsafe industrial installations are potential environmental health hazards, the possible scale of which is difficult to estimate reasonably.

Individual susceptibility to inhaled pollutants--identification, mechanisms and public health policy implications.

In every community, there are individuals whose chances of illness or accident are greater than those of others. In susceptible persons, adverse health effects occur at a lower exposure than in the majority of population. The reason for this, though often weak, can usually be ascertained. The paper focuses primarily on host factors that may increase an individual's susceptibility to air pollutants present in the general environment. These factors include genetic background, age, gender, nutritional status, physiological status, presence of coexisting lung disease, and lifestyle. They relate to various mechanisms of individual susceptibility to air pollutants from the environment into the body, to alterations in detoxification and immunological reactions, and to variations in the responsiveness of lung tissues. Several epidemiological techniques to detect biological events relevant to host susceptibility and disease progression are mentioned. They are mainly based on genetic traits, host characteristics, pulmonary function tests, biochemical and immune changes. Measuring the variations in risk among susceptible individuals is necessary to assess correctly respiratory health risk due to inhaled pollutants at the population level, and subsequently to develop rational public health policy to reduce the incidence of those diseases in a given population. Before being able to formulate this policy, however, one must know how to detect those individuals who are susceptible to air pollutants.

Effects of Deomestic Gas Cooking and Passive Smoking on Chronic Respiratory Symptoms and Asthma in Elderly Women.

The purpose of the study was to assess the effect of indoor air pollution resulting from the use of gas stoves for cooking on women more than 65 years old, who may be more susceptible than younger women to the harmful effects of pollutants. A total of 1,544 women living in Cracow took part in a survey. The data were collected to standardized interviews dealing with respiratory symptoms (coughing, phlegm production, dyspnea on exertion), chronic chest diseases diagnosed by a doctor, active and passive smoking, educational level, type of cooking fuel used, and average time spent daily in cooking. Lung function was tested with a spirometer. Comparison of the prevalence of respiratory symptoms by daily duration of cooking of smokers with that of never-smokers showed more symptoms in smokers even in the low-exposure category. In multivariate analysis, the effects of duration of cooking with gas on asthma for the highest exposure category in terms of odds ratios (ORs) were 2.8 for the never-smokers and 2.4 for the smokers; however, passive smoking had no significant effect. As regards dyspnea on exertion, both gas cooking and passive smoking had significant effects in never-smokers (OR for gas cooking 7.2, for passive smoking 2.2). The OR for dyspnea due to cooking with gas in smokers was 3.1. Mean FVC and FEV&inf1; levels were not decreased among passive smokers or those who were subject to high levels of gas-cooking exposure.

Ventilatory lung function level as a predictor of survival among the elderly.

During a population survey in 1986/1987 among community-dwelling elderly in Cracow, aged 65 yrs and over, measurements of ventilatory lung function were carried out on 698 males and 1,211 females. The main objective of the study was to assess the importance of forced expiratory volume in one second (FEV1) as a predictor of survival experienced in this population group over a 6 year follow-up, in comparison with that of sociodemographic variables, smoking habit, chronic respiratory symptoms, hypertension, obesity and self-assessment of health. Statistical analysis of the relationship between mortality and chosen predictors has been performed with Cox proportional hazards statistical model. It was found that in addition to age, the FEV1 level was the most relevant and independent of age survival predictor among the elderly. In males, a reduction of FEV1 by 100 ml after allowing for age, showed a significantly higher risk of dying by 4%, (relative risk (RR) = 1.04; 95% confidence interval (CI) 1.01-1.06), and in females by 5% (RR = 1.05; 95% CI 1.05-1.09). Male current or ex-smokers displayed a higher mortality risk due to reduction of FEV1 (RR = 1.05; 95% CI 1.01-1.09) compared to lifetime nonsmokers (RR = 1.04; 95% CI 1.00-1.07); the corresponding RR values in women were 1.12 (95% CI 1.02-1.23) and 1.04 (95% CI 1.00-1.08), respectively. However, the differences found between the smokers and nonsmokers were not significant in either gender group. Other potential predictors considered, such as education, chronic respiratory symptoms, hypertension, self-assessment of health, or obesity, appeared to have been irrelevant in the multivariate analysis.

Biological markers of host susceptibility to air pollutants in epidemiologic studies on chronic airways obstruction.

Measuring the variations in risk among individuals or populations of environmentally induced chronic airways obstruction is necessary to develop rational policy to reduce the incidence of those diseases in a given population. Before being able to formulate this policy, however, one must know how to detect those individuals who are susceptible to ari pollutants since they are at increased risk of disease. In the paper the authors discussed several monitoring techniques to detect markers of early biological events relevant to host susceptibility and disease progression. The biological markers are based on genetic traits, pulmonary function tests, biochemical and immune changes. The authors discuss merits and demerits of particular approaches in identifying persons prone to chronic airways obstruction. They stress the point that more research is needed on biochemical and immunological markers of lung injury to assess their usefulness in identifying individuals at higher risk.

Better perspectives on use of biological markers in monitoring of lung cancer risk in occupational settings.

Although conventional approaches in cancer epidemiology and prevention have provided a wealth of information, they are seriously limited in their ability to detect and evaluate carcinogenic hazards. However, traditional methods combined with newly developed laboratory procedures provide biological markers of molecular or biochemical events linked to carcinogen exposure and open a new approach to the study of human cancer risk assessment. The goal of the new approach is to identify as precisely as possible specific carcinogenic hazards in the environment, to assess their biologically effective dose and biological effect, and to provide a means of appraising host factors that modify susceptibility. A particular promising new tool of cancer risk assessment is the highly sensitive immunoassay for carcinogen-DNA adducts. These assays may provide a tissue dosimeter of carcinogen exposure. In this paper research studies were mentioned that aimed at assessing the levels of benzo[a]pyrene-DNA adducts and protein adducts, utilizing white blood cells, or tissue specimens obtained from tissue biopsy or autopsy. Another promising method in discovering BAP exposure are levels of carcinogen-metabolizing enzymes. The potential significance in surveillance and monitoring of aryl-hydrocarbon hydroxylase (AHH) has been discussed.

Needs and requirements for undergraduate and graduate training in environmental and occupational epidemiology.

Training in modern medicine aims at teaching not only the structure and function of the human organism in health and in disease, but also it aims at revealing the factors responsible for human health. The second field of teaching is based mainly on epidemiology. In undergraduate teaching, the epidemiological training should be introduced as early as possible in the curriculum and possibly divided into two parts, theoretical and practical. With the increasing awareness that the maintenance of health in populations is an ecological problem, there is also a growing need for professional epidemiologists who could assist in recognizing health risks, assessing and developing prevention strategies and in arranging of health services in a responsible way. The objectives of graduate teaching in epidemiology are different from those of undergraduate teaching. The graduate teaching should cover not only professional epidemiologists but also should be addressed to health services administrators, clinicians and graduates from other specialists and paramedical and auxiliary personnel. The needs and requirements for teaching epidemiology in undergraduate and postgraduate levels have been discussed against the background of currently available courses in Europe and local perception of environmental and occupational problems in European countries.

Total exposure assessment in occupational epidemiology for risk management.

Exposure assessment is an integral and essential component of occupational epidemiology necessary for risk assessment, risk management as well as for diagnostic and intervention efforts. It is a multidisciplinary approach that usually requires the combined expertise of environmental and industrial hygienists, toxicologists, epidemiologists, physicians, social scientists and statisticians. Exposure-assessment methodology employs various direct and indirect techniques, including environmental measurements, personal monitoring, biological markers, questionnaires, and mathematical modelling. Exposure assessments for occupational environment must be considered in the framework of potential contributions from other media and adding the incremental exposure from other media when necessary. Furthermore, to achieve effective risk assessment, all media and routes of exposure must be assessed for the relative magnitude of their contributions before an assessment of one medium is conducted. In the paper the concept of total human exposure assessment is introduced and measurement approaches have been discussed focusing attention on environmental research surveys.

On improvement of communication between producers and users of epidemiological and statistical information on health of workers and their occupation.

In order to assess the health status of workers at the national or regional level there are necessary expensive studies on the morbidity of various occupational groups. The papers turns the attention to ambulatory care data that may be used successfully to measure directly through ambulatory medical encounters the health status of working population and its subgroups. To overcome a major weaknesses in primary health statistics a special form for survey of occupational morbidity in primary health center has been worked out. The form is very simply to fill in and most of the informations to be needed are in precoded form and it helps greatly in processing the items of information necessary for calculation of morbidity rates generated from health primary activities. This ambulatory care record should be filled in by a selected general practitioner at each visit in district ambulatories, chosen randomly from all ambulatories in the whole country or in the whole region, i.e., in Lombardy. In the statistical analysis the data collected through the survey continuously can be related to the population characteristics, such as sex, age distribution and minor or major occupational groups. The authors believe that this simple approach may be used sensible for monitoring the health status of the population in relation to occupational hazards and for the planning and management of primary health services.