Work related stress and blood glucose levels.

AIM: The aim of the study is to evaluate work-related subjective stress in a group of workers on a major Italian company in the field of healthcare through the administration of a valid "questionnaire-tool indicator" (HSE Indicator Tool), and to analyze any correlation between stress levels taken from questionnaire scores and blood glucose values. MATERIAL AND METHODS: We studied a final sample consisting of 241 subjects with different tasks. The HSE questionnaire - made up of 35 items (divided into 7 organizational dimensions) with 5 possible answers - has been distributed to all the subjects in occasion of the health surveillance examinations provided by law. The questionnaire was then analyzed using its specific software to process the results related to the 7 dimensions. These results were compared using the Pearson correlation and multiple linear regression with the blood glucose values obtained from each subject. RESULTS: From the analysis of the data the following areas resulted critical, in other words linked to an intermediate (yellow area) or high (red area) condition of stress: sustain from managers, sustain from colleagues, quality of relationships and professional changes. A significant positive correlation (p <0.05) between the mean values of all critical areas and the concentrations of glucose values have been highlighted with the correlation index of Pearson. Multiple linear regression confirmed these findings, showing that the critical dimensions resulting from the questionnaire were the significant variables that can increase the levels of blood glucose. CONCLUSION: The preliminary results indicate that perceived work stress can be statistically associated with increased levels of blood glucose.

Liver damage in automotive and industrial workers of the glass.

OBJECTIVE: High doses of organic solvents can cause hepatic disease. We investigated whether exposure to low doses of solvents in automotive and industrial workers may lead to changes in liver tests. METHODS: We studied the liver parameters (glutamic oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), gamma-glutamyl-traspeptidasi (γ-GT), alkaline phosphatase (PHA), total (TB) and direct bilirubin (DB) of 24 workers exposed to organic solvents and of 30 unexposed controls. RESULTS: A significant increase of GOT, GPT and γ-GT was found in exposed workers compared to unexposed controls workers. The ratio GPT/GOT was significantly higher among the exposed compared to controls. CONCLUSIONS: The results confirmed the hypothesis that exposure to low doses of solvents may determine a liver damage.

[Carpal tunnel syndrome and steel industry]. / Tunnel carpale e industria metalmeccanica.

OBJECTIVES: The carpal tunnel syndrome (CTS) is a common working pathology. The CTS diagnosis is not so easy because neurophysiological investigations are necessary. The purpose of this study is to evaluate the working risks and the presence of CTS signs using a focused anamnestic and clinical procedure. MATERIALS AND METHODS: We evaluated the working risks of CTS in a population of 65 male workers of a steel industry (average age 25.1 and seniority 2.82), performing 5 different tasks. The Borg Scale was used to evaluate the subjective muscle effort. Diurnal paresthesia (V1FG), nocturnal paresthesia (V1FN), hypersensitivity (V1IS), hypostenia (V1IT) were considered. RESULTS: We identified three main working risks repetitiveness of single actions, static and prolonged posture of the truck, muscle effort. 21.5% of the workers showed at least one of the three symptoms;13.8% showed one or more symptoms; the clinical objectivity was observed in 18.5%. A relation between V1FG, V1FN, clinical objective linked to the workers age of the task 1 (p =0.035) is showed. CONCLUSIONS: To prevent CTS, the use of the Borg Scale associated with identification of the risks and with the anamenstic-clinical investigation is useful to discriminate people at risk of CTS.

Professional exposure to anaesthetic gases in health workers: estimate of some hepatic and renal tests.

OBJECTIVES: The aim of this study is to estimate whether the occupational exposure to low dose of anaesthetic gases could cause alterations of haematochemical hepatic and renal parameters in the health workers of a city hospital. MATERIALS AND METHODS: After excluding the main confounding factors, 154 exposed subjects and 98 not exposed controls were included in the study. The exposed subjects were divided in more exposed (group 1: n.54) and less exposed (group 2: n.100). Each worker included in this study underwent the CBC test (Complete Blood Count test). The differences between means were compared using the Student T test for unpaired data and considered significant when the p value was < 0.05. RESULTS: The mean values of serum albumin, alpha 1, alpha 2, beta and gamma globulins were significantly decreased in health workers of both groups compared to controls. The mean values of serum creatinine and gamma-GT were significantly higher in health workers of group 2 compared to controls. CONCLUSIONS: The obtained results suggest that occupational exposure to low dose of anaesthetic gases could influence haematochemical hepatic and renal parameters in exposed health workers.

Cadmium blood/urine levels and blood pressure in workers occupationally exposed to urban stressor.

BACKGROUND: Cadmium (Cd) is a metal, which induces hypertension in animals. This may not be relevant to the human population because the number of studies is inconsistent. OBJECTIVE: Our aim is to identify an association between levels of blood/urinary cadmium and blood pressure in a group of employees of the municipal police assigned to outdoor activities. MATERIALS AND METHODS: 349 subjects of both sexes were enrolled and sorted on the basis of gender, job function and smoking habit. Blood and urinary cadmium levels and blood pressure readings were collected for each subject. The data were subjected to statistical evaluation. Pearson correlation coefficient between the variables and a linear regression curve was drawn. After eliminating the confounding factors, the multiple linear regression analysis assessed statistical differences. Associations were considered significant at p < 0.05. RESULTS AND CONCLUSIONS: The Pearson correlation showed a positive association between urinary cadmium levels and blood pressure especially for groups of women and non-smokers. The simple and multiple linear regression and t-tests confirmed these associations and underlined the influence cadmium has on diastolic blood pressure, higher than systolic blood pressure. No association was found between blood cadmium and blood pressure. In conclusion, we can say that there is a statistically significant association between urinary cadmium and diastolic blood pressure, supporting the hypothesis that cadmium has a long-term effect on diastolic blood pressure (BP).

[Phlebopathies and occupation]. / Flebopatie e lavoro.

Chronic venous disorder is a public health problem that affects the western industrialized countries. The aim of this study is to evaluate the etiology and prevalence of venous disease of the lower limb in workers, and to identify some risk factors using a detailed and systematic analysis of the literature from 1964 to 2011. There is an important relationship between standing position at work and venous disease. The prolonged orthostatic position of the body implies: venostasis, high pressure and risks of blood clots and thrombosis; in standing workers there is an overproduction of reactive oxygen species (ROS) with oxidation of the components of cell membranes, endothelial damage and increase in vascular permeability. Other risk factors were investigated: sitting during work time, weight lifting-moving and exposure to heat sources, the data suggest that this risk factors are less important than orthostatic body position. Age, sex and familiarity are relevant as the extra-occupational risk factors. For a more accurate study of the role of the prolonged orthostatic position on the development of venous disease in the lover limb all authors should define exactly the population, the role and the length of standing time at work. They should also set a universal language to define the correct standing position (ie. within 1 m2 or steps) and time (ie. one hour or 50%-70% of work time). Attention should be given to prevention, to use early therapeutic measures in view of mortality as a consequence of venous disease, of the high social costs related to the loss of working days, of medical care and of residual disability.

[Meta analysis blood and urinary values in urban pollution exposed workers]. / Meta-analisi di indicatori di effetto in lavoratori esposti ad inquinamento urbano.

INTRODUCTION: Aim of this study is evaluating alteration of neuro-immune-endocrine parameters in exposed workers and estimating whether urban pollution can modify them. METHODS: Literature research. Different categories of exposed workers were included in the study (7287) and compared with controls (8054). To calculate results Effect Size (ES) and confidence interval were used. RESULTS: A correlation between urban pollution exposition and some neurogenic mediators and metabolites alterations was demonstrated; blood values can be alterated by toxicity of benzene and by xenobiotic metabolites' mechanism; follicle stimulating hormone is significantly increased in exposed versus controls. CONCLUSIONS: High heterogeneity and literature limitations, together with results of this meta analysis, induce to believe that is necessary to deepen the research about urban pollution effects on these parameters.

Exposure to antineoplastic drugs in health care and blood chemistry parameters.

OBJECTIVES: The purpose of the research is to evaluate whether the exposure to antineoplastic drugs of health workers may cause alteration of blood chemistry parameters. MATERIALS AND METHODS: Research was conducted on 5800 health workers employed in a hospital in a big Italian city. The final sample is composed of 57 people in charge of cytotoxic drugs compared with 57 subjects not exposed; each worker underwent a general clinical examination and determination of the following values: complete blood count (CBC), white blood cell count (WBC), total protein, BUN, total bilirubin, creatinine, GOT, GPT, alkaline phosphatase, gamma GT. Statistical analysis of data was based on calculation of the mean, standard deviation and the distribution into classes according to the nature of each variable. Differences were considered significant when p was <= 0.05. RESULTS: The mean and the distribution of values of total bilirubin were significantly higher in the workers exposed to antineoplastic drugs than in workers non-exposed; the mean and the distribution of values of monocytes were significantly lower in subjects exposed compared to controls. CONCLUSIONS: According to the results antiblastic drugs, at the doses used in the departments we studied, can induce an increase in the values of total bilirubin for liver toxicity and a reduction in the monocyte line due to myelosuppression.

[Phlebopathies and workers]. / Flebopatie e lavoratori.

The few studies in literature about the relationship between venous diseases and work show that the posture assumed while working could promote the occurrence of venous disease in lower limbs. We compared male workers belonging to different occupational categories, matched for age, BMI and traditional risk factors for venous diseases, in order to assess the prevalence of venous disease and occupational and not-occupational postural risk factors. We found that maintaining a standing position for more than 50% of the shift appears the most important occupational risk factor in provoking the observed higher prevalence of venous disease in the workers studied. It can be assumed the venous diseases are often determined by occupational factors which could be main or concomitant causes. The identification of preventive measures to apply in workplaces, such as better organization of work, targeted examinations and therapeutic indications as the prescription of elastic stockings, is very important.

GLUT4 overexpression in db/db mice dose-dependently ameliorates diabetes but is not a lifelong cure.

We previously reported that overexpression of GLUT4 in lean, nondiabetic C57BL/KsJ-lepr(db/+) (db/+) mice resulted in improved glucose tolerance associated with increased basal and insulin-stimulated glucose transport in isolated skeletal muscle. We used the diabetic (db/db) litter mates of these mice to examine the effects of GLUT4 overexpression on in vivo glucose utilization and on in vitro glucose transport and GLUT4 translocation in diabetic mice. We examined in vivo glucose disposal by oral glucose challenge and hyperinsulinemic-hyperglycemic clamps. We also evaluated the in vitro relationship between glucose transport activity and cell surface GLUT4 levels as assessed by photolabeling with the membrane-impermeant reagent 2-N-(4-(1-azi-2,2,2-trifluoroethyl)benzoyl)-1,3-bis(D-mannose-4-yloxy)-2-propylamine in extensor digitorum longus (EDL) muscles. All parameters were examined as functions of animal age and the level of GLUT4 overexpression. In young mice (age 10-12 weeks), both lower (two- to threefold) and higher (four- to fivefold) levels of GLUT4 overexpression were associated with improved glucose tolerance compared to age-matched nontransgenic (NTG) mice. However, glucose tolerance deteriorated with age in db/db mice, although less rapidly in transgenic mice expressing the higher level of GLUT4. Glucose infusion rates during hyperinsulinemic-hyperglycemic clamps were increased with GLUT4 overexpression, compared with NTG mice in both lower and higher levels of GLUT4 overexpression, even in the older mice. Surprisingly, isolated EDL muscles from diabetic db/db mice did not exhibit alterations in either basal or insulin-stimulated glucose transport activity or cell surface GLUT4 compared to nondiabetic db/+ mice. Furthermore, both GLUT4 overexpression levels and animal age are associated with increased basal and insulin-stimulated glucose transport activities and cell surface GLUT4. However, the observed increased glucose transport activity in older db/db mice was not accompanied by an equivalent increase in cell surface GLUT4 compared to younger animals. Thus, although in vivo glucose tolerance is improved with GLUT4 overexpression in young animals, it deteriorates with age; in contrast, insulin responsiveness as assessed by the clamp technique remains improved with GLUT4 overexpression, as does in vitro insulin action. In summary, despite an impairment in whole-body glucose tolerance, skeletal muscle of the old transgenic GLUT4 db/db mice is still insulin responsive in vitro and in vivo.

Modulation of insulin secretion and glycemia by selective inhibition of cyclic AMP phosphodiesterase III.

The effects of selective inhibition of cyclic AMP phosphodiesterase type III on insulin and glucose levels during an oral glucose challenge were evaluated in obese, diabetic ob/ob mice and in lean, non-diabetic littermates using the selective inhibitor, milrinone. Oral administration of milrinone increased plasma insulin levels both in ob/ob and in lean mice. Glucose tolerance was improved in lean, but not in ob/ob mice, where glucose levels were increased by milrinone treatment. In isolated hepatocytes from normal rats incubation with 200 microM milrinone caused a 30% increase in glucose release with a corresponding depletion of glycogen stores. Stimulation of isolated rat adipocytes with 200 microM milrinone increased glycerol release 7-fold. We conclude that selective inhibitors of cyclic AMP phosphodiesterase III are effective insulin secretagogues, but their therapeutic utility may be limited by their concurrent stimulation of lipolysis and hepatic glucose output.

Comparison of the glucose dependency of glucagon-like peptide-1 (7-37) and glyburide in vitro and in vivo.

The purpose of the present study was to compare the glucose dependency of the insulin secretagogue activity of the sulfonylurea, glyburide, versus that of glucagon-like peptide-1(7-37) [GLP-1(7-37)] in vitro and in vivo. In freshly isolated rat islets, maximally effective concentrations of glyburide (10 micromol/L) and GLP-1(7-37) (10 nmol/L) were equally effective in stimulating insulin secretion in the presence of 15 mmol/L glucose (2.4-fold increase relative to 15 nmol/L glucose alone). At 5 nmol/L glucose, both agents increased insulin secretion, but the effect for glyburide was threefold greater than for GLP-1(7-37) (122% and 41% increase in insulin secretion, respectively). In conscious catheterized rats infused with glucose at a variable rate to clamp plasma glucose concentration at 11 mmol/L, glyburide (1 mg/kg orally) and GLP -1(7-37) (infused intravenously [IV] at 5 pmol/min/kg) produced similar increase in insulin levels (1.8-fold relative to the respective vehicle controls) that were sustained through 60 minutes of measurement. These doses of GLP-1(7-37) and glyburide were then administered to fasted and fed rats (basal plasma glucose concentration, 5.8 and 7.3 mmol/L, respectively). Relative to the vehicle control group, GLP-1(7-37) infusion produced a transitory increase (30%) in plasma insulin concentration and a modest sustained decrease (10% to 20%) in glucose in both fasted and fed rats, whereas glyburide induced a sustained 2.4- and 1.7-fold increase in plasma insulin concentration in fasted and fed rats, respectively, and a 50% decrease in plasma glucose in both fasted and fed rats. Results of these studies demonstrate the higher glucose threshold for the insulin secretagogue activity of GLP-1(7-37) relative to glyburide in vitro and in vivo.

Glucose-dependent action of glucagon-like peptide-1 (7-37) in vivo during short- or long-term administration.

In vitro, truncated glucagon-like peptides [GLP-1(7-36)-amide and GLP-1(7-37)] increase insulin secretion in a glucose-dependent manner, and desensitization to the action of GLP-1(7-37) has been demonstrated acutely with high concentrations. The purpose of these studies was to evaluate the glucose dependency and threshold of GLP-1(7-37) action in normal rats and in a rat model of type II diabetes and to assess the effects of long-term administration in vivo. All studies were conducted in conscious catheterized rats. An intravenous (IV) infusion of GLP-1(7-37) at 0.5, 5, or 50 pmol/min/kg during the second hour of a 2-hour 11-mmol/L hyperglycemic clamp in Sprague-Dawley rats produced a dose-related enhancement of the glucose-induced increase in plasma insulin concentration. A 1-hour infusion of a submaximal dose of GLP-1(7-37) (5 pmol/min/kg IV) in fasted and fed Sprague-Dawley rats produced small transient increases in plasma insulin (incremental increases above basal, 72 +/- 27 and 96 +/- 28 pmol/L, respectively) and decreases in plasma glucose (to levels > or = 5.2 mmol/L). Infusion of GLP-1(7-37) (5 pmol/min/kg IV) during a hyperglycemic clamp at two sequentially increasing concentrations of glucose, 11 and 17 mmol/L, produced incremental increases in insulin of 600 and 1,200 pmol/L, respectively, relative to levels in clamped control rats. Similarly, infusion of GLP-1(7-37) (5 pmol/min/kg IV) in hyperinsulinemic, hyperglycemic Zucker diabetic fatty (ZDF) rats produced a transitory increase in plasma insulin concentration and normalized the plasma glucose concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Distribution of beta 3-adrenoceptor mRNA in human tissues.

The beta 3-adrenoceptor is a G protein-coupled receptor which mediates metabolic functions of the endogenous catecholamines epinephrine and norepinephrine. Questions exist regarding distribution of the beta 3-adrenoceptor in human tissue. In order to examine the distribution of beta 3-adrenoceptor mRNA in human tissues, we used sensitive and specific RNase protection assays without previous PCR amplification in an extensive list of human tissues. We confirm the presence of beta 3-adrenoceptor mRNA in human white fat from several locations, gall bladder, and small intestine, as well as extend the distribution of beta 3-adrenoceptor mRNA to previously uncharacterized human tissues such as stomach and prostate. The presence of beta 3-adrenoceptor mRNA in human white adipose tissue has important implications regarding possible use of beta 3-adrenoceptor selective agonists as anti-obesity agents, and the demonstration of beta 3-adrenoceptor mRNA in a number of gastrointestinal tissues and prostate raises the question of the role of the beta 3-adrenoceptor in motility and secretory processes.

Enhanced peripheral glucose utilization in transgenic mice expressing the human GLUT4 gene.

Human GLUT4 protein expression in muscle and adipose tissues of transgenic mice decreases plasma insulin and glucose levels and improves glucose tolerance compared with nontransgenic controls (Liu, M.-L., Gibbs, E. M., McCoid, S. C., Milici, A. J., Stukenbrok, H. A., McPherson, R. K., Treadway, J. L., and Pessin, J. E. (1993) Proc. Natl. Acad. Sci. U.S.A. 90, 11346-11350). We examined the basis of improved glycemic control in hGLUT4 transgenic mice by determining glucose homeostasis and metabolic profiles in vivo. Glucose turnover experiments indicated a 1.4-fold greater systemic glucose clearance in hGLUT4 mice relative to controls (p < 0.05), whereas hepatic glucose production was similar despite 26% lower (p < 0.05) glucose levels. Glucose infusion rate during an euglycemic-hyperinsulinemic clamp was 2-fold greater (p < 0.05) in hGLUT4 mice versus controls, and skeletal muscle and heart glycogen content were increased 3-5-fold (p < 0.05). The increased peripheral glucose clearance in hGLUT4 mice was associated with increased (25-32%) basal and insulin-stimulated glucose transport rate in soleus muscle (p < 0.01), and increased muscle plasma membrane-associated GLUT4 protein. Fed hGLUT4 mice displayed 20-30% lower plasma glucose and insulin levels (p < 0.05) and 43% elevated glucagon levels (p < 0.001) compared with controls. Triglycerides, free fatty acids, and beta-hydroxy-butyrate were elevated 43-63% (p < 0.05) in hGLUT4 mice due to hypoinsulinemia-induced lipolysis. Free fatty acids and beta-hydroxybutyrate levels in hGLUT4 mice increased further upon fasting, and skeletal muscle glycogen levels decreased markedly compared with controls. The data demonstrate that high level expression of hGLUT4 increases systemic glucose clearance and muscle glucose utilization in vivo and also results in marked compensatory lipolysis and muscle glycogenolysis during a fast.