[Dose and effect biomarkers in the diagnosis of asbestos-related diseases and health surveillance of exposed workers]. / Gli indicatori biologici di dose ed effetto nella diagnostica delle patologie asbesto-correlate e nella sorveglianza sanitaria degli ex-esposti.

The aim of the study was to assess the reliability of the indicators of dose and effect in the health monitoring of asbestos exposed workers. In 49 cases out of 158 studied workers (31%) asbestos-related diseases were diagnosed following ATS criteria (2004). Using nonparametric statistical methods (permutation tests) 6 variables were analyzed with respect to asbestos-related diseases and working sectors, demonstrating a difference in the concentration of amphiboles (p < 0.01), greater in patients with asbestosis and workers involved in asbestos removal from railway carriages. There was not a correlation between mesothelin and amphiboles, chrysotile and total fibers concentrations (Spearman test).

[Prevention of occupational dermatitis in an international perspective]. / La prevenzione delle dermatiti occupazionali in una prospettiva internazionale.

Occupational dermatitis (OD) have always been a significant part of the occupational disease with huge social and economic costs. Traditionally, the standard program of OD prevention takes place in the three phases of protection, cleansing and use of emollient creams and other products able to improve the cutaneous trophism (skincare) at the end of the shiftwork. However, in countries like Germany where protection measures and skincare were widespread, there was not a simultaneous decrease in the OD. In recent years pilot programs for the prevention of OD have been implemented with positive results. In particular the integrated approach that includes three steps of primary, secondary and tertiary prevention (Osnabrueck model) is of great interest. Primary prevention is represented by introduction of technical regulations, pre-employment counselling and specific initiatives to promote health (healthy skin campaign). In the case of initial/minor OD, secondary prevention is accomplished through the dermatological treatment of the patient and 1-2 days outpatient education initiatives/skin protection training. In severe cases of individual OD, tertiary prevention involves the hospitalization of the patient in a dermatology department. In 2009 the European network EPOS (European Initiative for the Prevention of Occupational Skin Diseases) of preventive dermatology has been organized basing on the integrated approach of primary, secondary and tertiary prevention.

[Chemical risk assessment in the leather goods producers: a comparison of the results obtained by measurements air concentration and algorithm ARChiMEDE]. / Valutazione del rischio chimico nel settore pellettiero: confronto dei risultati ottenuti con sistemi di campionamento attivo e algoritmo ARChi.MEDE.

The Italian legislation on chemical agents has undergone significant changes. The aim of the study was to compare the results obatained from an environmental investigation and the use of the ARChi.MEDE model The results of the survey were treated with the UNI EN 689/1997 that showed an acceptable result, while according to the use A.R.Chi.M.E.D.E. a significant risk was obtained. Actually the mathematical model assess workers exposure without considering in the calculation the specific preventive measures (personal protective equipment, training, uptake of pollutants at the source) as contemplated by law. So the mathematical model showed the need of preventive measures in the studied work place.

[Working hypothesis of simplified techniques for the first mapping of occupational hazards in handicraft. First part: ergonomics hazards]. / Ipotesi di tecniche semplificate per la prima mappatura dei rischi professionali nel settore artigiano. Prima parte: rischi legati all'ergonomia.

During the last Congress of the International Ergonomics Association (IEA), Beijing - China August 2009, in collaboration with World Health Organization an international group for developing a "toolkit for MSD prevention" was founded. Possible users of toolkits are: members of a health and safety committee; health and safety representatives; line supervisors; foremen; workers; government representatives; health workers implementing basic occupational health services; occupational health and safety specialists. According with ISO standard 11228 series and their ISO Application document for the Key enters and Quick Assessment (green/red conditions), our group developed a first mapping methodology of occupational hazards in handicraft, working with the support of the information technology (Excel). This methodology, utilizing specific key enters and quick evaluation, allows a simple risk estimation. So it is possible to decide for which occupational hazards will be necessary an exhaustive assessment and to which professional consultant it is better to direct them to (worker's doctor, engineer, chemical, etc.).

[Working hypothesis of simplified techniques for the first mapping of occupational hazards in handicrafts. Part two: physical and chemical risks]. / Ipotesi di tecniche semplificate per la prima mappatura dei rischi professionali nel settore artigiano. Seconda parte: rischi fisici e chimici.

Craft features a strong link with tradition which preserves and perpetuates techniques created and consolidated over time, in a particular historical, cultural and geographical situation. Italy is home to excellent craftsmanship: fashion, furniture, giftware, design. The framework law for the craft n. 433/1985 defines the craft business carried on by the craftsman for a predominant objective of producing goods, including semi-finished or services. The D.L.gs 81/2008 defines the manner in which the employer must conduct risk assessment in the workplace and process the risk assessment document. The aim of the study is to provide employers with a simple methodology that allows the drafting of the first mapping of hazards/dangers identificating risk sources in the working process. The developed methodology is expressed as a model of information gathering, which brings to a first overview of all major risk indicators that may arise in the craftsmanship.

Measurement of asbestos fibre concentrations in fluid of repeated bro-choalveolar lavages of exposed workers.

OBJECTIVES: The aim of this study was to assess the reliability of asbestos fibre concentration in bronchoalveolar lavage fluid (BALF) by carrying out the mineralogical analysis of BALF at different times in the same patient and comparing the results. METHODS: Twenty two patients underwent diagnostic fibreoptic bronchoscopy twice: the first was to assess the past asbestos exposure and the second for different clinical reasons. Mineralogical analysis of BALF was carried out. RESULTS: In 16 patients (72.7%), a reduction of concentration in BALF of all asbestos fibres was observed. The concentrations of both chrysotile and amphiboles in the first bronchoalveolar lavage (BAL) were related to their concentrations in the second BAL and the observed differences were not statistically significant. A significant decrease in asbestos body concentration between the first and the second BAL was found (Wilcoxon test, P < 0.01). CONCLUSIONS: The reliability of the fibre concentration in BALF as a marker of past asbestos exposure seems quite good. In most cases, it allows us to distinguish workers in different classes of exposure and gives useful information on the pattern of exposure. Uncertainties related in general to lung residues and in particular to mineralogical analysis of BALF (mainly due to the high coefficient of variation (CV) at low fibre concentrations and the results of the statistical analysis on total fibres) suggest that this biomarker is more likely suitable for a qualitative/categorical approach to exposure assessment than a quantitative one.

[Work related mesothelioma: analysis of cases discovered at the Section for Occupational Medicine and Toxicology of Siena University during the years 2000-2007]. / Mesotelioma di origine professionale: studio dei casi osservati presso la sezione di Medicina del Lavoro e Tossicologia Occupazionale dell'Università di Siena negli anni 2000-2007.

This study focuses on the spread of mesothelioma in Siena. The population consisted of 30 patients. The diagnosis was made through histopathological and immunoistochemical or cytological and immunoistochemical analysis. The association between malignant masothelioma and exposure to asbestos was deduced by the occupational history. The mesothelioma was noted both in traditional industries and other jobs such as the chain of manifacture, plumbers, electricians, carpenters, installers of asbestos insulation and construction workers. Thus it is possible to find other malignant and nonmalignant asbestos-related diseases more frequently than mesothelioma. There is an evident risk in rebuilding, so the development of new cases due to these exposures is expected.

In vitro predictions of skin absorption of caffeine, testosterone, and benzoic acid: a multi-centre comparison study.

To obtain better insight into the robustness of in vitro percutaneous absorption methodology, the intra- and inter-laboratory variation in this type of study was investigated in 10 European laboratories. To this purpose, the in vitro absorption of three compounds through human skin (9 laboratories) and rat skin (1 laboratory) was determined. The test materials were benzoic acid, caffeine, and testosterone, representing a range of different physico-chemical properties. All laboratories performed their studies according to a detailed protocol in which all experimental details were described and each laboratory performed at least three independent experiments for each test chemical. All laboratories assigned the absorption of benzoic acid through human skin, the highest ranking of the three compounds (overall mean flux of 16.54+/-11.87 microg/cm(2)/h). The absorption of caffeine and testosterone through human skin was similar, having overall mean maximum absorption rates of 2.24+/-1.43 microg/cm(2)/h and 1.63+/-1.94 microg/cm(2)/h, respectively. In 7 out of 9 laboratories, the maximum absorption rates of caffeine were ranked higher than testosterone. No differences were observed between the mean absorption through human skin and the one rat study for benzoic acid and testosterone. For caffeine the maximum absorption rate and the total penetration through rat skin were clearly higher than the mean value for human skin. When evaluating all data, it appeared that no consistent relation existed between the diffusion cell type and the absorption of the test compounds. Skin thickness only slightly influenced the absorption of benzoic acid and caffeine. In contrast, the maximum absorption rate of testosterone was clearly higher in the laboratories using thin, dermatomed skin membranes. Testosterone is the most lipophilic compound and showed also a higher presence in the skin membrane after 24 h than the two other compounds. The results of this study indicate that the in vitro methodology for assessing skin absorption is relatively robust. A major effort was made to standardize the study performance, but, unlike in a formal validation study, not all variables were controlled. The variation observed may be largely attributed to human variability in dermal absorption and the skin source. For the most lipophilic compound, testosterone, skin thickness proved to be a critical variable.

[Assessment of occupational skin exposure: proposal of a check-list]. / Valutazione dell'esposizione cutanea professionale: proposta di una check-list.

The dermal risk assessment requires simplified methodologies to understand the role played by the skin. The conceptual models proposed to this aim are founded on theoretical assumptions and experimental data, but their use in occupational settings shows many difficulties. For this end we have drawn up a check-list that includes six sessions and allows to obtain a preliminary dermal exposure evaluation subdivided on hazard bands.

[Evaluation of sources of mercury absorption through studying urinary mercury levels in the general population]. / Valutazione delle fonti di assorbimento di mercurio tramite lo studio dei livelli di mercurio urinario della popolazione generale.

OBJECTIVES: The number of instances where mercury exposure is possible outside the workplace are numerous, with the main source being amalgam dental fillings and diet. It is also possible to envisage environmental exposure in subjects resident in areas where there is existing environmental contamination. This is probably what happened in Tuscany where past mining activity in the Monte Amiata area may have been the cause. This study estimated the concentration of urinary mercury (HgU) in non-occupationally exposed subjects from southern Tuscany, with the aim of evaluating the sources of mercury absorption in the general population. METHODS: A questionnaire aimed at collecting specific information on factors which might influence the uptake of mercury was used. 164 subjects were studied: 82 subjects (41 males, 41 females) came from the Monte Amiata area and the other 82 (41 males, 41 females) from the Province of Siena. In this way it was possible to evaluate the elements associated with everyday life which may have influenced the presence of the metal in the urine. Since the distribution of the variables cannot be assumed multivariate normal as usual, a recently-proposed method based on a permutation procedure was adopted that allows the analysis of the variables as well as the single marginal analyses, without assuming any model for the distribution of variables. RESULTS AND CONCLUSIONS: The results showed significantly lower levels of HgU in the subjects from the Monte Amiata area. Highly significant differences were demonstrated in the population which was sub-divided according to number and surfaces of amalgam fillings, use of contact lenses and type of water drunk (p < 0.001). Correlations between the levels of HgU and the investigated variables were not observed. It was confirmed that mercury uptake is simultaneously influenced by many factors. Probably the presence of higher levels of mercury in the environment in the Monte Amiata area is a factor of minor importance compared to others, especially the number of amalgam fillings, in determining mercury absorption in the general population.

[In vitro study of transcutaneous inorganic mercury absorption from solid soil]. / Studio in vitro dell'assorbimento transcutaneo del mercurio inorganico dal terreno solido.

OBJECTIVES: Skin is such an important route of absorption of mercury compounds that the ACGIH has assigned them a skin notation. Soil has been recognised as a potential source of exposure to chemical contaminants. It therefore seems advisable to establish maximum daily exposure levels for mercury in soil. In the past, areas adjacent to certain industries and smelters were heavily contaminated by mercury. For example, on Monte Amiata in Tuscany, which was an important mercury mining and production centre in the past, several areas have been polluted. To understand the dermal uptake of chemicals bound to soil and dust, information on the pure substance is helpful but does not seem sufficient. Other factors must be accounted for, that can easily be reproduced and controlled in in vitro experiments. METHODS: Using an in vitro diffusion cell system and human skin, we studied percutaneous penetration of mercury chloride (HgCl2) at different concentrations, with particular emphasis on skin absorption from soil. The test apparatus consisted of a flow-through diffusion cell system. Dermotomed human cadaver skin was used as the membrane, while the receiving liquid was a saline solution with 6% PEG-20 oleyl-ether and gentamycin sulphate. Mercury chloride was applied at two different concentrations using a buffered solution and soil as vehicles. RESULTS AND CONCLUSIONS: Increments of percentage of absorption at the different hours were found to be significantly lower in the cells where the higher concentration of mercury chloride was applied. In the receiving fluid of cells where soil was used as vehicle, the concentration of mercury was always below the detection limit. Skin contamination with soil containing inorganic mercury does not seem to be a dermal risk.

[RISKOFDERM: European research project for assessment of occupational skin exposure to chemicals]. / RISKOFDERM: un progetto europeo per la valutazione dell'esposizione per via cutanea a tossici industriali.

OBJECTIVES: RISKOFDERM is a research project whose aim is to develop instruments to assess and manage occupational dermal exposure to chemical substances. METHODS: The research, funded by the European Commission, involves 15 Institutes from 10 member countries; it is a continuation of the Dermal Exposure Network experience and consists of four interrelated parts. The first phase (Qualitative survey) assumed that dermal exposure can be extrapolated from one compound to another when it is task-based: therefore six Dermal Exposure Operation units (DEOu) were defined that lead back to the variety of occupational dermal exposure conditions and an extensive Questionnaire was developed for on-site surveys to perform standard observations in selected working situations (scenarios). RESULTS: The Italian group, participating in the research, obtained a set of observations relating to two "scenarios" in different working sectors: asphalt, ceramic and pottery workers, spectacle decorators and paint production: the aim was to verify the validity of the methodology in assessing the risk of percutaneous absorption, time, frequency and extension of skin exposure. CONCLUSIONS: From the observations made it was shown that the perception of risk was poor; it is necessary to rationalise work organization, and train and inform the employees on the correct use of personal protection devices.

Dermal exposure assessment of polycyclic aromatic hydrocarbons: in vitro percutaneous penetration from coal dust.

To understand the dermal uptake of chemicals bound to soil and dust, information on the neat substance is helpful but does not seem sufficient. Because of its content of polycyclic aromatic hydrocarbons (PAHs) coal is suspected to be carcinogenic. However, experimental carcinogenity studies on coal dust never succeeded in demonstrating a higher incidence of cancer in treated animals. The aim of the study was to assess dermal penetration through human skin of PAHs from coal dust. A sample of coal dust was grinded and sieved, using the particle size of < 30 microm. An in vitro static diffusion cell system validated by in vitrolin vivo comparison has been used to study dermal penetration through human skin of PAHs from coal dust compared with their percutaneous absorption as pure compounds. No percutaneous penetration of PAHs was observed in the cells where coal dust was applied, while dermal penetration was demonstrated for PAHs applied in an acetone solution. Results agree with the literature that PAHs are poorly absorbed through the skin from solids. Dermal risk assessment of PAHs should take into account not only the degree and the extent of skin contamination, but also their bioavailability, which is heavily influenced by the physico-chemical characteristics of the matrix.

Percutaneous penetration studies for risk assessment.

During the last few years the general interest in the percutaneous absorption of chemicals has increased. It is generally accepted that there is very few reliable quantitative and qualitative data on dermal exposure to chemicals in the general population and in occupationally exposed workers. In order to predict the systemic risk of dermally absorbed chemicals and to enable agencies to set safety standards, data is needed on the rates of percutaneous penetration of important chemicals. Standardization of in vitro tests and comparison of their results with the in vivo data could produce internationally accepted penetration rates and/or absorption percentages very useful for regulatory toxicology. The work of the Percutaneous Penetration Subgroup of EC Dermal Exposure Network has been focussed on the standardization and validation of in vitro experiments, necessary to obtain internationally accepted penetration rates for regulatory purposes. The members of the Subgroup analyzed the guidelines on percutaneous penetration in vitro studies presented by various organizations and suggested a standardization of in vitro models for percutaneous penetration taking into account their individual experiences, literature data and guidelines already in existence. During the meetings of Percutaneous Penetration Subgroup they presented a number of short papers of up to date information on the key issues. The objective was to focus the existing knowledge and the gaps in the knowledge in the field of percutaneous penetration. This paper is an outcome of the meetings of the Percutaneous Penetration Subgroup and reports the presentations on the key issues identified throughout the 3-year duration of the Dermal Exposure Network (1997-1999).

Dermal exposure assessment of polycyclic aromatic hydrocarbons: in vitro percutaneous penetration from lubricating oil.

OBJECTIVES: Percutaneous penetration of polycyclic aromatic hydrocarbons (PAHs) is affected by various factors connected to exposure conditions. The nature of the matrix, such as that of oil, can strongly affect their percutaneous penetration. Risk assessment should consider these effects. We examined the effect of matrix on percutaneous penetration of PAHs, particularly that of lubricating oil. METHODS: The test apparatus consisted of an in vitro static diffusion cell system using full-thickness monkey (Cercopithecus aetiops) skin as the membrane and saline solution with gentamycin sulfate and 4% bovine serum albumin as receptor fluid. Chemical analysis of PAHs in the samples obtained from cells was carried out by inverse-phase HPCL, and the results were read by spectrofluorimetry. RESULTS: Comparing the penetration of 13 PAHs from a lubricating oil and from acetone solution with artificial sweat resulted in a significantly slower passage from the oil matrix for acenaphthene, anthracene, phenanthrene, fluoranthene, naphthalene, pyrene, fluorene (Mann-Whitney U test, P < 0.05). No significant differences in the passage were found for chrysene because, in the test with oil, its concentration was very often below the detection limit. For benzo[a]anthracene, benzo[b]fluoranthene, benzo[k]fluoranthene, and benzo[a]pyrene it was possible to demonstrate a passage through the skin only when compounds were applied in acetone solution with artificial sweat. CONCLUSIONS: The results of the study suggest the necessity of dermal penetration data relevant for risk assessment, obtained under experimental conditions similar to the real exposure conditions.