[Occupational exposure to ionizing radiation in hospital. Analysis of individual risk by area and occupational category]. / Valutazione dell'esposizione a radiazioni ionizzanti in ospedale. Analisi del rischio individuale per reparto e per mansione.

An analysis of occupational radiation exposure from 1988-2008 of 43 medical, 41 nurses and 4 nuclear medicine technicians of interventional cardiology, nuclear medicine, radiology-neuroradiology, urology and orthopedics has been performed. The mean annual effective dose to the whole body of all monitored workers are decreasing; one vascular surgeon, has exceeded 20 mSv/year. The doses received by physicians in the hands were up in radiology, urology and cardiology. Currently, interventional cardiology-hemodynamic is the most department-average exposure. Nurses are overall less exposed, the great exposure is in nuclear medicine, where the technicians are included.

Occupational exposure to electromagnetic fields in physiotherapy departments.

To assess occupational exposure to electromagnetic fields, 11 microwave (MW), 4 short-wave diathermy and 15 magneto therapy devices were analysed in eight physiotherapy departments. Measurements taken at consoles and environmental mapping showed values above European Directive 2004/40/EC and ACGIH exposure limits at approximately 50 cm from MW applicators (2.45 GHz) and above the Directive magnetic field limit near the diathermy unit (27.12 MHz). Levels in front of MW therapy applicators decreased rapidly with distance and reduction in power; this may not always occur in work environments where nearby metal structures (chairs, couches, etc.) may reflect or perturb electromagnetic fields. Large differences in stray field intensities were found for various MW applicators. Measurements of power density strength around MW electrodes confirmed radiation fields between 30 degrees and 150 degrees , with a peak at 90 degrees , in front of the cylindrical applicator and maximum values between 30 degrees and 150 degrees over the whole range of 180 degrees for the rectangular parabolic applicator. Our results reveal that although most areas show substantially low levels of occupational exposure to electromagnetic fields in physiotherapy units, certain cases of over-occupational exposure limits do exist.

Protection of third parties in current legislation and preventive practice.

The problem of safety and the management of risks to third parties, which may be caused by a change in the mental or physical health of an employee, is one which affects a number of different areas (infectious diseases, psychiatric illnesses, conditions of drug and alcohol abuse, etc.). Italian legislation deals with the issue of fitness for work through a variety of laws, decrees and regulations which, because many of them were issued in different historical circumstances, are not always mutually harmonized. The growing complexity of the workplace makes the role of the Occupational Physician more complex, and to this person the law assigns the exclusive task of monitoring the health of employees in the cases covered by the current regulations. In our opinion, the Occupational Physician, to the best of his knowledge and conscience, having taken into consideration all the aforementioned factors, must take each case on its merits, in the most responsible manner possible, weighing up the complexity and delicacy of the aspects discussed earlier, and decide to deliver a verdict of fitness and/or to break or not to break the obligation of confidentiality, tending, in our view, to favour the need to safeguard collective health, or that of third parties, should there be a conflict of interest.

[Interactions between solvents and noise: state of the art]. / Interazione tra solventi e rumore: stato dell'arte.

There are several environmental and occupational scenes where a co-exposure of noise and solvents occurs, therefore between a neurotoxic and a ototoxic agent. Epidemiological and experimental studies with simultaneous exposure to noise and solvents like toluene, styrene and carbon disulfide have been analysed. These studies investigate possible ototoxic effects through audiometry, auditory brainstem response, potential recall and reflex decay test. The current available data show that with high exposure levels, that are responsible for tissue damage by themselves, the interaction between noise and solvents could occur. The present knowledge can not permit a conclusion for low exposure levels.

[Occupational chronic obstructive pulmonary disease: Italian law (decree no. 336/1994) and epidemiological evidence]. / Broncopneumopatia cronica ostruttiva professionale nel DPR 336/1994 e nell'evidenza epidemiologica.

BACKGROUND: In Italy, occupational diseases are required by law to be listed (however, any occupational diseases not included in the list may be compensated if workers demonstrate causation in court). The list is periodically updated in order to incorporate new findings from medical research. Decree no. 336/94 uses a less inclusive term (chronic obstructive bronchitis) than that used in the earlier decree, no. 482/75 (chronic obstructive pulmonary disease, COPD). Moreover, it includes fewer occupations that involve a risk of developing COPD. OBJECTIVES: In order to find an epidemiological basis that might justify the above changes to Italian law, risk of COPD was investigated in relation to occupation and time, using a case-referent design. METHODS: The same definition for COPD (clinical history of >2 years with shortness of breath and/or winter phlegm and an FEV1 less than 80% of the predicted value, only minimally reversible with bronchodilators and without marked change during the hospital observation period) was used in two case-referent studies. The first study was carried out from 1972 to 1980 (202 cases of COPD and 202 referents matched for age and sex) and the second from 1990 to 1997 (131 cases of COPD and 298 referents, every fourth eligible patient in each calendar year of observation). In both studies cases and referents were classified into 16 occupational categories, and office workers were the reference. All subjects were selected from male patients admitted to the Occupational Health Clinic in Padua. Smoking-adjusted (Mantel-Haenszel analysis, first study), or age-smoking-adjusted (logistic regression analysis, second study) Odds Ratio (OR) and 95% confidence interval (CI) for COPD were estimated in each occupational category and in two main groups: workers employed in occupations at either high or low risk for COPD. The latter OR and the fraction of exposed cases (pc) were used to estimate the population attributable risk (PAR) through: pc(OR-1)/OR. RESULTS: Significantly high risks for COPD in miners and chemical workers were observed in the first period, but not in the second time window. On the other hand, an increased time trend for OR estimates was found in welders, wood carpenters, construction and foundry workers. Among farmers, painters, cotton textile and refractory brick workers, the OR for COPD was significantly above unity in both time periods. PAR was 37% in the first and 52% in the second study. CONCLUSIONS: The restrictive definition of occupational COPD, which was introduced by Decree no. 336/94, contrasts with the epidemiological evidence showing that the risk of occupational COPD has increased over time: up to 50% of COPD cases referred to an occupational medicine physician might have an occupational origin.

Ascertaining the risk of chronic obstructive pulmonary disease in relation to occupation using a case-control design.

BACKGROUND: Recent community surveys have reported a risk of chronic obstructive pulmonary disease (COPD) in occupations involving exposure to organic dust and gas/vapour. Aims Our aim was to confirm these results using a case-control design on 131 COPD cases (FEV(1) < 80% of predicted value, minimally reversible with bronchodilators) and 298 controls, selected from registers for patients admitted to our Institute of Occupational Medicine. METHODS: Surrogates of past exposure were occupation, exposure assigned by a job-exposure matrix, and years spent in a given occupation. The odds ratio (OR) and 95% confidence interval (CI) for COPD were calculated using logistic regression models with office workers as the reference. RESULTS: Age-smoking-adjusted ORs (and CIs) were: 15.1 (3.2-71.6) in farmers; 7.2 (1.3-41.1) in cotton workers; 6.4 (1.6-25.5) in welders; 4.7 (1.3-16.4) in painters; 12.1 (1.3-108) in foundry workers; 6.50 (1.14-37.0) in refractory brick workers; and 3.1 (1.0-9.5) in construction workers. In farmers, cotton workers, welders and painters, the adjusted ORs significantly increased (by 6-9%) for each extra year of work, while in other occupations any such increase was of borderline significance. Adjusted ORs were 3.80 (1.21-12.0), 5.83 (1.82-18.6) and 8.86 (2.29-34.3) in workers exposed to high levels of mineral dust, gas/vapour/fume and biological dust, respectively. Consistent risk estimates were obtained for farmers, textile workers, painters and welders. CONCLUSIONS: Our findings confirm previous epidemiological evidence and are supported by recent observations that cigarette smoke, cotton and organic farm dust contain the same powerful pro-inflammatory agents, and that organic dust and irritant gas induce bronchitis by triggering the same effector molecules as cigarette smoke.

[Musculoskeletal diseases among a group of geriatric residence workers]. / Patologie muscolo scheletriche in operatori di una casa di riposo.

A total of 274 workers of a geriatric residence underwent physical and anamnestic examination in order to ascertain the existence of diseases associated with occupational risks of manual handling of patients. Data on musculo-skeletal disorder of the spine and of the upper limbs were collected. The correlation between manual handling of patients and musculo-skeletal disorder in this worker population is consistent with those already reported in the literature. Data was compared with prevalence estimates of musculo-skeletal disorder in worker population not exposed. This comparison showed significant increase of scapulo-humeral periarthritis in female over 35 years of age. In conclusion, this duty is a specific risk for the upper limbs; therefore more risk evaluation studies are needed. Also, a check for these types of disorders should be included in all duty specific medical exam protocols.

Susceptibility of healthcare workers to measles, mumps rubella and varicella.

Susceptible healthcare workers are at risk of acquiring and transmitting measles, mumps, rubella and varicella to or from patients. We tested 333 employees at Padova University Hospital, for specific IgG. Of the workers tested, 98.2% were positive for measles, 85.9% for mumps, 97.6% for rubella and 97.9% for varicella. Eventhough participants born before 1957 were not all positive, they had a higher prevalence of immunity. We suggest serological screening in high-risk areas (paediatrics, oncology, radiotherapy, infectious diseases, maternity and the laboratory) and vaccination of susceptible employees.

[Diseases in hospital workers]. / Le patologie del personale ospedaliero.

Occupational diseases and labour accidents in health care workers (Azienda Ospedaliera di Padova) were evaluated from 1990 to 2000; the information collected is compared with the same data of Regione Veneto and INAIL. 262 occupational diseases were found; nurses are more affected than other health care workers. In both reports (Azienda Ospedaliera di Padova and Osservatorio epidemiologico della Regione Veneto) half of the occupational diseases and injuries are represented by allergic disease. Low back pain is also equally represented in Azienda Ospedaliera and in Osservatorio epidemiologico results (5.3% and 6.6% respectively). Among the labour accidents reported to INAIL from 1994 to 2000, 25% of them were represented by falls and slips, 23% by car accidents, 17% were caused by tools, 17% by movement of goods and persons, 8% by contact with splinters, liquids, dusts, 5% by assaults and 5% by contact with blood or body fluid. The latter result is widely underestimated in the INAIL report, because these events usually produce a temporary inability of less than 3 days; in fact, they represent more than half of the labour accidents treated at the Azienda Ospedaliera di Padova. Medical surveillance (in exposure to aldehydes, anaesthetic gases, chemioterapic drugs) has shown many other occupational health problems that often need specific structural intervention (restructuration and restoration of workplaces in health care environments), and work organization changes.

[Occupational exposure to electromagnetic fields in physiotherapy departments]. / Esposizione professionale a campi elettromagnetici negli ambulatori di fisioterapia.

An assessment of the electromagnetic fields emitted from short and ultrashort wave diathermy sources and from magneto therapy operating at a frequency of 50 Hz was made to evaluate the occupational exposure to the operators. Operators were exposed to electromagnetic fields which rarely exceed the recommended limits of International Commission on Non-Ionizing Radiation Protection (ICNIRP) and American Conference of Governmental Industrial Hygienists (ACGIH). Only a measurement of electromagnetic fields near short wave diathermy equipment operating at a frequency of 27.12 MHz exposed operators to levels above those recommended by ICNIRP at a distance of 1 metre. Magnetic fields of magneto therapy exceeded residential exposition of 1 microtesla, at a distance of 4 metres.

[Organization of health and safety activities in health care centers]. / Organizzazione delle attività di prevenzione e sicurezza nelle aziende sanitarie.

The paper proposes a model for health and safety organization in health care units and hospitals which takes account of the risk assessment procedures required by law and the quality assessment of the measures thus taken. A redefinition is given of the role of Medical Director and of the functions, aims and standards on which health and safety service and the services of an authorized occupational health physicians must be based.

[Health surveillance: scope, tools, efficacy, prospects]. / La sorveglianza sanitaria. Scopo, strumenti, efficacia, prospettive.

According to experts of the European Commission, NIOSH and OSHA, health surveillance's goal is the both health protection and occupational diseases prevention (including injury and uneasiness). This goal is pursued by assigning workers according to his or her working capacity without any health prejudice. Currently available instruments to protect workers' health include: (i) medical surveillance before employment, (ii) medical surveillance before placement in a job involving exposure to toxics, (iii) medical surveillance at periodic intervals during employment, (iv) medical surveillance at termination of employment. Studies carried out on the efficacy of medical surveillance show the capacity both of identifying health problem and of being perceived as a benefit for workers. An appropriate application of medical surveillance should take into account points as efficacy, guidelines, costs and benefits, and effectiveness. This entails the need to carry out research aiming (i) to make the importance of currently used preventive instruments explicit and (ii) to study new approaches to be applied in occupational health care.

[Analysis of a preventive health service]. / Analisi di un servizio di medicina preventiva.

This paper reports the experience and organization of an Occupational Health Service for health-care workers, in order to improve the effectiveness of the unit. The Authors describe the activities of the unit, its organization, and evaluate the amount of working time spent in the different activities.

[Risk during manual movement of loads]. / Rischio da movimentazione manuale dei carichi.

The estimation of risk from manual movement of loads in health care workers was carried out in 8 hospitals of Veneto Region, North-eastern Italy. 49 medical wards, 53 surgical wards, 23 surgery departments and 21 emergency and diagnostic services were examined. Operationally, a check-list was used to analyze the organization of the work (staff, duties, typology of patients to mobilize) and the work environment. Results show that 61% of the medical wards and 75% of the surgical wards have a higher risk. In particular, the medical wards of geriatrics and neurology, the wards of neurosurgery, heart surgery, orthopedics, the big burns center and geriatric surgery resulted in greater risk. Similarly, 70% of the emergency and diagnostic services and all surgical areas were estimated to be at risk. Given this reality, it has been determined that there are inadequacies in both organizational and structural aspects. In all the examined situations, the risk related to the relationship non self-sufficient patients/nurse was greater when mechanical help was lacking. In 70% of the cases the nursing staff transported patients with the bed. Concerning structural inadequacies, insufficient space was verified in over 50% of the examined wards. Preventive measures should be taken on the two aspects considered, variation of the work organization and the reclamation of work environment. But above all, the need for mechanical help should be emphasized, in order to reduce to a minimum the manual load thus preventing the onset of low-back pain in the nursing staff.

Repeated case-control studies as a method of surveillance for asthma in occupations.

Our aim was to establish whether the case-control design may be applied in surveillance for occupational asthma. In a region with intensive manufacturing industries, we carried out one case-control study from 1974 to 1978 and another from 1989 to 1993; 325 and 387 pairs of cases of asthma and of age- and sex-matched control subjects, respectively, were selected. Current risks were found to be higher than past estimates for painters, farmers, millers/bakers, textile, wood/ furniture, and chemical workers. High risks for asthma have recently appeared in leather, polyurethane plastics, hospital and food industry workers, welders, and shoemakers. It is concluded that the case-control approach may be used to describe variations in asthma risk by occupational categories and time. A method to measure the efficiency of the diagnostic process for occupational asthma is also proposed.

[Reduction of the lung cancer risk among dairy ranchers: dose response relationship with the traditional indicators of professional exposure]. / Riduzione del rischio di cancro polmonare negli allevatori di bovini da latte: relazione dose-risposta con i tradizionali indicatori di esposizione professionale.

An epidemiological study of mortality was carried out in the Province of Padua in a cohort of family farmers. The subjects, identified from the SCAU files, were enrolled in the cohort if informations were available on complete registry data, date of beginning and of termination of farm work, size of farm, and number of dairy cattle. The 2,415 farmers selected were followed-up for mortality through the registry offices of their Communes of residence. The cause of death was obtained for the 541 decedents. The standardised mortality ratio (SMR) was the ratio between observed and expected mortality, calculated on the basis of the mortality rates in the regional general population. The lung cancer SMR was 0.54 (0.36-0.79; observed = 27) among the 1641 dairy farmers, and 0.78 (0.46-1.25; observed = 17) among the 774 arable farmers. Among dairy farmers, moreover, lung cancer SMRs showed a significant trend across the quartiles of length of work, number of cattle, area of farm, age at beginning farm work, and age at work termination. Dairy farmers are known to be exposed to higher airborne endotoxin concentrations, and it is reasonable to assume that this cumulative exposure further increases with years of work, number of cattle, and area of farm. Microbial endotoxin might have protected dairy farmers against lung cancer through a host factor, the Tumor Necrosis Factor, produced by alveolar macrophages.

[Mortality by tumors and other causes in dairy cattle and other agricultural workers in Veneto]. / Mortalità per tumori ed altre cause in allevatori di bovini da latte e in altri agricoltori nel Veneto.

The study was conducted to verify a reduction in mortality from tumors in dairy farm workers, exposed to endotoxins, which increase in the host a cytotoxic antitumoral. From the SCAU files of the Province of Padova, we selected 2.415 subjects with informations on: date of hire, date of work termination, number of dairy cattle, area of the farm. The vital status was ascertained through the Communes of residence, and for the 541 decedents the cause of death was established. The standardized mortality ratio (SMR) was calculated on the basis of age-sex-cause-calendar period specific mortality rates in the Veneto. In the 1.641 dairy farm workers, SMRs were significantly low for total tumors (= 81) and lung tumors (= 66), and significantly high for brain tumors (= 283). In other 774 farmers, no significant SMRs were observed. The data will be further processed to verify a dose-response relationship with the occupational risk indicators. Smoking habits will be collected.

[Carcinogenic risk of extremely-low-frequency electromagnetic fields: state of the art]. / Rischio cancerogeno da campi elettromagnetici elf: stato dell'arte.

This paper summarizes the published literature and current problems relating to possible cancerogenic effects of occupational and residential exposure to ELF electromagnetic fields at levels slightly above ambient background. There are several suggestions that such an exposure may increase the risk of cancer, but these studies failed to provide conclusive indications. The present state of uncertainty led to a variety of recommendations and statements being made concerning restrictions to the exposure of people to ELF electromagnetic fields. Attempts to detect direct chromosomal damage from ELF electromagnetic fields have proven negative, while results on cancer promotion have been controversial. On the basis of several epidemiological studies on occupational exposure, an increased risk of leukemia, brain cancer and male breast cancer is apparent; the literature on residential exposure provides some evidence of an effect on childhood cancer, especially leukemia; however, when interpreting these results some major methodological concerns should be kept in mind. In conclusion, the public concern and potential public health impact of this environmental agent argue strongly for addressing further research in order to identify mechanisms of action on biological systems, to define the proper assessment of exposure and to obtain good epidemiological evidence.

[Biotransformation in occupational medicine: the role of hepatic cytochrome P-450 in the mechanism of action and the biological monitoring of occupational toxic compounds]. / La biotrasformazione in Medicina del Lavoro: ruolo del citocromo P-450 epatico nel meccanismo d'azione e nel monitoraggio biologico dei tossici occupazionali.

Biotransformation is an important step in the investigation of occupational toxic chemicals. This is because the knowledge of the metabolic pathways and the enzymes involved in the activation and/or detoxication of xenobiotics may help in understanding the mechanism of toxicity and to rationalize the biological monitoring of exposed subjects. The largest enzymatic system involved in the biotransformation of industrial chemicals is cytochrome P-450, a family of haemoproteins capable of metabolizing a vast number of lipophilic, structurally different compounds. The study of the various metabolic reactions of this peculiar group of enzymes has greatly contributed to a) the clarification of the mode of action of several classes of occupational toxic and/or carcinogenic compounds, such as aromatic amines, polycyclic aromatic hydrocarbons, halogenated alkanes, benzene compounds and others, and b) the improvement of risk assessment in the biological monitoring of the exposed subjects, by allowing the toxicological significance (activation/detoxication) of single metabolites to be better understood.