Impact of wearing a surgical mask on respiratory function in view of a widespread use during COVID-19 outbreak. A case-series study.

BACKGROUND: Because of the COVID-19 outbreak, the widespread use of Respiratory Protective Devices (RPD) is recommended to prevent the spread of infection. This recommendation involves not only healthcare workers but other category of workers and the general population as well, in public places, especially where social distancing is difficult to maintain. The use of facemasks should not cause physical impairment to individuals, especially for people suffering from lung and heart diseases. OBJECTIVES: To evaluate the impact of RPDs on the respiratory function in healthy and asthmatic subjects, in order to identify the fitness for use mainly, but not only for, occupational purposes during COVID-19 outbreak. METHODS: Ten individuals were included, three of which affected by asthma and three current smokers. A Respiratory Functional Test (RFT) was performed at three times: at the beginning of the work shift 1) without wearing and 2) wearing surgical masks, and 3) after 4 hours of usual working activities wearing the masks. Arterial Blood Gas (ABG) samples were also tested before the first test and the third test. RESULTS: Observed RFTs and ABG parameters did not suffer significant variations, but for Maximal Voluntary Ventilation (P=0.002). Data on asthmatic subjects and smokers were comparable to healthy subjects. DISCUSSION: Our results suggest that wearing a surgical mask does not produce significant respiratory impairment in healthy subjects nor in subjects with asthma. Four hours of continuing mask-wearing do not cause a reduction in breathing parameters. Fitness for use in subjects with more severe conditions has to be evaluated individually. Our adapted technique for RFTs could be adopted for the individual RPDs fitness evaluation.

Mortality of Talc Miners and Millers From Val Chisone, Northern Italy: An Updated Cohort Study.

OBJECTIVE: The aim of this study was to update the analysis of mortality of a cohort of talc miners and millers in Northern Italy. METHODS: We analyzed the mortality during 1946 to 2013 of 1722 male workers in an asbestos-free talc mine (1166 miners and 556 millers) employed during 1946 to 1995. RESULTS: The overall standardized mortality ratio (SMR) was 1.24 [95% confidence interval (95% CI) 1.17 to 1.32]; no deaths were observed from pleural cancer; mortality from lung cancer was not increased. Mortality from pneumoconiosis was increased (SMR 26.62; 95% CI 20.71 to 33.69), in particular among miners, and was associated with duration of employment and time since first employment. CONCLUSIONS: We confirmed the lack of association between exposure to asbestos-free talc, lung cancer, and mesothelioma. Increased mortality from pneumoconiosis among miners is attributable to past exposure to silica.

Mortality from cancer and other causes among Italian chrysotile asbestos miners.

OBJECTIVE: To investigate the long-term mortality of a cohort of Italian asbestos miners. METHODS: The cohort included 1056 men employed in a chrysotile mine between 1930 and 1990, who were followed up during 1946-2014, for a total of 37 471 person-years of observation. Expected deaths and SMRs were computed using national and local (after 1980, when available) reference. RESULTS: A total of 294 (27.8%) subjects were alive and at the end of follow-up, 722 (68.4%) were dead and 40 (3.8%) were lost to follow-up. The SMR for overall mortality was 1.35 (95%CI 1.25 to 1.45). The SMR for pleural cancer, based on seven observed deaths, was 5.54 (95% CI 2.22 to 11.4) and related to time since first exposure, but not to duration of employment, cumulative exposure or time since last exposure. The SMR for lung cancer was 1.16 (95% CI 0.87 to 1.52; 53 observed deaths), with no excess among workers with cumulative exposure below 100 fibre/mL-years (SMR 0.82; 95% CI 0.44 to 1.40). CONCLUSIONS: The update of the follow-up of this cohort confirmed an increased mortality from pleural cancer mortality in miners exposed to chrysotile and a lack of significant increase in lung cancer mortality.

Updated mortality study of a cohort of asbestos textile workers.

Limited information is available on risk of peritoneal mesothelioma after asbestos exposure, and in general on the risk of cancer after cessation of asbestos exposure. We updated to 2013 the follow-up of a cohort of 1083 female and 894 male textile workers with heavy asbestos exposure (up to 100 fb/mL), often for short periods. A total of 1019 deaths were observed, corresponding to a standardized mortality ratio (SMR) of 1.68 (95% confidence interval [CI]: 1.57-1.78). SMRs were 29.1 (95% CI: 21.5-38.6) for peritoneal cancer, 2.96 (95% CI: 2.50-3.49) for lung cancer, 33.7 (95% CI: 25.7-43.4) for pleural cancer, and 3.03 (95% CI: 1.69-4.99) for ovarian cancer. For pleural and peritoneal cancer, there was no consistent pattern of risk in relation to time since last exposure, whereas for lung cancer there was an indication of a decline in risk after 25 years since last exposure. The findings of this unique cohort provide novel data for peritoneal cancer, indicating that - as for pleural cancer - the excess risk does not decline up to several decades after cessation of exposure.

In vitro percutaneous penetration and characterization of silver from silver-containing textiles.

The objective of this study was to determine the in vitro percutaneous penetration of silver and characterize the silver species released from textiles in different layers of full thickness human skin. For this purpose, two different wound dressings and a garment soaked in artificial sweat were placed in the donor compartments of Franz cells for 24 hours. The concentration of silver in the donor phase and in the skin was determined by an electrothermal atomic absorption spectrometer (ET-AAS) and by inductively coupled plasma mass spectrometer (ICP-MS). The characterization of silver species in the textiles and in the skin layers was made by scanning electron microscopy with integrated energy dispersive X-ray spectroscopy (SEM-EDX). Additionally, the size distribution of silver nanoparticles in the textiles was performed by atomic force microscopy (AFM). On the surface of all investigated materials, silver nanoparticles of different size and morphology were found. Released silver concentrations in the soaking solutions (ie, exposure concentration) ranged from 0.7 to 4.7 µg/mL (0.6-4.0 µg/cm(2)), fitting the bactericidal range. Silver and silver chloride aggregates at sizes of up to 1 µm were identified both in the epidermis and dermis. The large size of these particles suggests that the aggregation occurred in the skin. The formation of these aggregates likely slowed down the systemic absorption of silver. Conversely, these aggregates may form a reservoir enabling prolonged release of silver ions, which might lead to local effects.

[Considerations on the use of meta-analyses in the orientation of knowledge and decisions in Occupational Medicine]. / Riflessioni sull'impiego della meta-analisi nell'orientamento delle conoscenze e delle decisioni in Medicina (del Lavoro).

In recent years, due to the need to elaborate the amount of information available from the scientific literature, the meta-analyses and systematic reviews have become very numerous. The meta-analyses are carried out to evaluate the association between two events when single researches haven't provided comprehensive data. On the other hand, a good meta-analysis must satisfy certain criteria, from the selection of the studies until the evaluation of the outcomes; to this purpose, the application of methods for quality assessment is a crucial point to obtain data of adequate reliability. The aim of this review is to give some introductory tools for a critical approach to meta-analyses and systematic reviews, which have become useful instruments also in occupational medicine.

[The Human Model, a tool for assessing preventive ergonomic postural appearance]. / Lo Human Model, uno strumento per la valutazione ergonomica preventiva dell'aspetto posturale.

D.Lgs. 81/08 requires the employer to design work systems, methods and tools in accordance to the ergonomic principles. In order to check the compliance of the design with current regulation, it is appropriate and effective to make use of simulation tools since the design phase. The paper describes a tool based on multi body approach. Once the gender and the anthropometric percentile of the worker have been specified, the tool simulates the postures that the worker is likely to assume during the execution of the work task. The tool can be used in the design as well as in the re-design phase, taking into account the different percentile of workers for a proper accommodation of the same.

Mortality from lymphohematopoietic neoplasms and other causes in a cohort of laminated plastic workers exposed to formaldehyde.

PURPOSE: A possible relationship between exposure to formaldehyde and leukemia-particularly myeloid leukemia-as well as of lymphoid neoplasms has been debated and is still controversial. We thus examined the issue using data from a cohort of workers of a laminated plastic factory sited in Piedmont, northern Italy. METHODS: The study cohort included 2,750 subjects (2,227 men and 523 women) who worked in the factory between 1947 and 2011, for at least 180 days. Follow-up ended in May 2011, for a total of 70,933 person-years of observation. We computed standardized mortality ratios (SMR) and 95% confidence intervals (CI) using national and (whenever available) Piedmont Region death rates. RESULTS: Overall, there were 417 deaths versus 493.4 expected ones (SMR = 84.5, 95% CI 76.6-93.0). The SMRs were 79.8 (95% CI 67.5-93.6) for total cancer mortality, 148.5 (95% CI 68.0-282.2) for oral cavity and pharynx (three deaths were registered, but not confirmed, as nasopharyngeal cancer), 48.3 (95% CI 13.1-123.7) for pancreas, 66.1 (95% CI 13.6-193.0) for larynx, and 96.7 (95% CI 72.0-127.2) for lung cancer. The SMR of all lymphohematopoietic malignancies was 68.6 (95% CI 31.4-130.3; nine observed deaths). This tended to increase with duration of exposure and to decrease with period at first exposure, always remaining below 100. There were four deaths from lymphoma (SMR = 74.1, 95% CI 20.1-189.6) and five deaths from leukemia (SMR = 92.4, 95% CI 29.9-215.3). CONCLUSIONS: We found no meaningful excess mortality from any lymphohematopoietic nor other neoplasms, except possibly for nasopharyngeal cancer.

Assessment of DNA damage and telomerase activity in exfoliated urinary cells as sensitive and noninvasive biomarkers for early diagnosis of bladder cancer in ex-workers of a rubber tyres industry.

The aim of the present study was to identify sensitive and noninvasive biomarkers of early carcinogenic effect at target organ to use in biomonitoring studies of workers at risk for previous occupational exposure to potential carcinogens. Standard urine cytology (Papanicolaou staining test), comet assay, and quantitative telomerase repeat amplification protocol (TRAP) assay were performed in 159 ex-rubber workers employed in tyres production and 97 unexposed subjects. In TRAP positive cases, a second level analysis using FISH (Urovysion) was done. Cystoscopy results were available for 11 individuals whose 6 FISH/TRAP/comet positive showed in 3 cases a dysplastic condition confirmed by biopsy, 1 comet positive resulted in infiltrating UBC to the biopsy and with hyperplasia and slight dysplasia to the urinary cytology, 1 comet positive resulted in papillary superficial UBC to the biopsy, 1 FISH/TRAP positive showed a normal condition, and 2 TRAP positive showed in one case a phlogosis condition. The results evidenced good concordance of TRAP, comet, and FISH assays as early biomarkers of procarcinogenic effect confirmed by the dysplastic condition and UBC found by cystoscopy-biopsy analysis. The analysis of these markers in urine cells could be potentially more accurate than conventional cytology in monitoring workers exposed to mixture of bladder potential carcinogens.

[Focus: baker's asthma. Epidemiology, diagnosis and treatment of baker's asthma]. / Focus: L'asma da farina - Epidemiologia, diagnosi e trattamento dell'asma da farina.

Baker's asthma, though having been recognized and studied since long time, still stays one of the most common causes of occupational asthma. Moreover, our understanding of the causative agents, the pathophysiological mnechanisms, the usefulness of medical surveillance, the proper treatment and prevention of the disease is still scanty. This is due to either to its complex pathogenesis or to possible confoundings, besides the still inadequate quality and standardization of the tools available as far as the allergologic diagnosis is concerned. Proper medical surveillance, validated causal therapies, efficient primary prevention are still uncertain. Change of employment or relocation is often impossible, particularly among artisan workers. Various evidences have been critically revised and summarized.

[Overdiagnosis and defensive medicine in occupational medicine]. / Overdiagnosis e medicina difensiva in Medicina del Lavoro.

In clinical medicine since some years overdiagnosis is giving rise to growing attention and concern. Overdiagnosis is the diagnosis of a "disease" that will never cause symptoms or death during a patient's lifetime. It is a side effect of testing for early forms of disease which may turn people into patients unnecessarily and may lead to treatments that do no good and perhaps do harm. Overdiagnosis occurs when a disease is diagnosed correctly, but the diagnosis is irrelevant. A correct diagnosis may be irrelevant because treatment for the disease is not available, not needed, or not wanted. Four drivers engender overdiagnosis: 1) screening in non symptomatic subjects; 2) raised sensitivity of diagnostic tests; 3) incidental overdiagnosis; 4) broadening of diagnostic criteria for diseases. "Defensive medicine" can play a role. It begs the question of whether even in the context of Occupational Medicine overdiagnosis is possible. In relation to the double diagnostic evaluation peculiar to Occupational Medicine, the clinical and the causal, a dual phenomenon is possible: that of overdiagnosis properly said and what we could define the overattribution, in relation to the assessment of a causal relationship with work. Examples of occupational "diseases" that can represent cases of overdiagnosis, with the possible consequences of overtreatment, consisting of unnecessary and socially harmful limitations to fitness for work, are taken into consideration: pleural plaques, alterations of the intervertebral discs, "small airways disease", sub-clinical hearing impairment. In Italy the National Insurance for occupational diseases (INAIL) regularly recognizes less than 50% of the notified diseases; this might suggest overdiagnosis and possibly overattribution in reporting. Physicians dealing with the diagnosis of occupational diseases are obviously requested to perform a careful, up-to-date and active investigation. When applying to the diagnosis of occupational diseases, proper logical criteria should be even antecedent to a good diagnostic technique, due to social outcome for the worker.

[The INSuLa Project: the knowledge survey of company physicians]. / Progetto INSuLa: I'indagine conoscitiva sui medici competenti.

The technological advancements, the occurrence of new emerging occupational risks and diseases, and the changes in the regulatory framework for occupational health and safety induce a constant evolution of occupational medicine. Consequently, the skills and training needs of the occupational physicians should be periodically revalued and upgraded in order to identify technical and operational issues and problems of this discipline. In this context, the aim of this national survey, carried out using a self-administered questionnaire submitted to a sample of 1,237 occupational physicians, has been to gain helpful information to ensure a continuous improvement of the quality and effectiveness of measures aimed at protecting the health and safety of workers. The questionnaire, that consists of 43 questions divided into 5 different areas (personal and professional information, training and updating needs of occupational physicians, professional activities and relationships with the corporate prevention system, relationships with the supervisory board of the Local Health Authority, relationships with the National Health Service), allowed to obtain personal and professional data, to assess the training needs and demands of occupational physicians and to evaluate their relationships with the other stakeholders of the Italian prevention system and with the National Health Service. The preliminary results of this survey appear extremely important. In fact, this findings, highlighting the current problems of occupational physician, constitute the starting point to identify, develop and implement management methodologies, operative procedures and training programs that are effective and modern.

[Prevention, diagnosis and management of the allergy risk in agriculture]. / Prevenzione, diagnosi e gestione del rischio allergologico in agricoltura.

The agricultural sector represents a working environment in which nowadays allergies, mainly respiratory, are widely spread. In some cases, ubiquitous risk factors are involved, yet with a particular importance in the agricultural sector due to specific working occasions and housing conditions (see, for example, various pollens, mites and Hymenoptera). In other cases, specific risks arise mainly from the particular environmental conditions of the sheds allocated to the animals breeding or to the various cereals and fodder deposits. The result is the exposure to dust arising from the treated materials and the microbial and fungal agents present as pollutants. The underlying mechanisms of respiratory manifestations in the agricultural environment are still under study and have conflicting aspects. The agricultural sector still has, even in the developed countries, obvious lacks regarding both primary and secondary prevention. The main lack is present in the information and training activities which have proved to be efficient also in this occupational field. We will present some upgrading on the mentioned topics.

Lung cancer mortality in European men: trends and predictions.

Lung cancer mortality in men from the European Union (EU) peaked in the late 1980s at an age-standardised (world standard population) rate over 53/100,000 and declined subsequently to reach 44/100,000 in the early 2000s. To provide a comprehensive picture of recent trends in male lung cancer mortality in Europe, we analyzed available data from the World Health Organization up to 2009 and predicted future rates to 2015. Lung cancer mortality rates in EU men continued to fall over recent years, to reach a value of 41.1/100,000 in 2005-2009. The fall was similar at all-ages and in middle-aged men (less than 2% per year over most recent years), but was appreciably larger in young men (aged 20-44 years, over 5% per year). A favourable trend is thus likely to be maintained in the foreseeable future, although the predicted overall EU rate in 2015 is still over 35/100,000, i.e., higher than the US rate in 2007 (33.7/100,000). Over most recent calendar years, overall male lung cancer rates were around 35-40/100,000 in western Europe, as compared to over 50/100,000 in central and eastern Europe. Within western Europe, lung cancer rates were lower in northern countries such as Sweden, but also Finland and the UK (below 30/100,000), where the tobacco-related epidemic started earlier and rates have long been declining, whereas mortality was high in Belgium (51.6), France (42.3), the Netherlands and Spain (around 43.0), where the epidemic started later but is persisting. Widespread measures for smoking control and cessation in middle-aged European men, i.e., in the generations where smoking prevalence used to be high, would lead to appreciable reductions in male lung cancer mortality in the near future. This is particularly urgent in central and eastern European countries.

Mortality from cancer and other causes in an Italian cohort of male rubber tire workers.

OBJECTIVE: To investigate mortality among workers of an Italian rubber tire factory employed between 1954 and 2008. METHODS: This cohort study included 6246 men, totaling 190,512 man-years of observation. Employment data were obtained from personnel records, whereas vital status and causes of death were ascertained from local authorities. We computed standardized mortality ratios (SMRs) using national and regional death certification rates. RESULTS: Mortality was significantly lower than expected for all cancers (SMR = 79) and all causes (SMR = 85). The SMRs were 99 for cancer of stomach, 78 for lung, 121 for urinary bladder, 116 for lymphoma, and 89 for leukemia, none being significant. Decreased mortality emerged for cancers of the oral cavity and pharynx (SMR = 45), esophagus (SMR = 29), colorectum (SMR = 71), liver (SMR = 57), and kidney (SMR = 33). CONCLUSIONS: This study shows no excess cancer risk among male rubber tire workers employed after 1954.

[Algorithms for the evaluation of chemical risk: the Piedmont Region's experience]. / Gli algoritmi per la valutazione del rischio chimico: l'esperienza della Regione Piemonte.

The programme InfoRisk, proposed by the Piedmont Region in 2002, has been an important reference point for the evaluation of chemical risk, both for companies and the regional prevention system alike. Nowadays, it is still considered necessary to take advantage of simple methods for the evaluation of this risk. However, the Piedmontese model requires some modification so as to keep it in line with the national and international rules and regulations governing the question and to find some solutions to problems that have arisen in its practical application. Most of these problems are tied to the use of the section of the evaluation technique, which is base on the estimate and not on the measurement of the exposure. Indeed, it has been confirmed in some cases that it is not possible to discard a more accurate evaluation which is not only able to make a correct application of the scientific evidence available in a correct manner, but also one that is supported by environmental monitoring campaigns. The main modifications proposed to the model are herein presented. The Work Group has endeavoured to maintain, whenever possible, the previous logic processes of the algorithm, so as to conserve its "user friendly" aspects and clarity that have so often been reported and appreciated by the operators who applied it.