Aortic stiffness and pulse wave reflection in young subjects with migraine: A case-control study.

BACKGROUND: Migraine has been associated with an increased risk for ischemic stroke and other cardiovascular (CV) events, including angina, myocardial infarction, and CV death, but the mechanisms that link migraine to CV disease remain uncertain. We hypothesized that aortic pulse wave velocity (PWV), a direct measure of aortic stiffness and an independent predictor of stroke and CV disease, may be increased in young migraineurs with no overt CV disease or major CV risk factors. METHODS: We studied 60 subjects with migraine (age 33 ± 8 years, 85% women, blood pressure 119/74 ± 11/9 mm Hg) and 60 age-, sex-, and blood pressure-matched healthy control subjects. In all participants, carotid-femoral PWV and aortic augmentation index were determined by applanation tonometry. Cases and controls were free from overt CV disease, diabetes, and major CV risk factors. RESULTS: Subjects with migraine had a higher aortic PWV (7.6 ± 1.2 vs 6.4 ± 1.1 m × s(-1), p < 0.001) and aortic augmentation (heart rate-adjusted augmentation index, 0.17 ± 0.13 vs 0.08 ± 0.15, p < 0.001) than matched control subjects. Migraine patients with aura (n = 17) had higher aortic PWV than those without aura (n = 43; 8.2 ± 1.2 vs 7.4 ± 1.1 m × s(-1), p = 0.027). Age, mean arterial pressure as a measure of distending pressure, and migraine (all p < 0.05) independently predicted aortic PWV when a consistent number of CV risk factors was simultaneously controlled for. CONCLUSIONS: Migraine is independently associated with increased aortic stiffness and enhanced pressure wave reflection. This finding, obtained in young subjects without major CV risk factors, may represent one possible mechanism underlying the increased CV risk in migraine patients.

[Italian Program for Surveillance of Acute Pesticide-Related Illnesses: cases identified in 2005]. / Sistema di Sorveglianza delle Intossicazioni Acute da Fitosanitari: la casistica rilevata nel 2005.

In 2005, the Italian System for Surveillance of Acute Pesticide-Related Illnesses (SIAF) identified 625 cases, among which 520 unintentionally exposed. The majority of these subjects were men (75%) and aged 26-65 years (65%). About 63% of all exposures occurred at work. Severity for these illnesses was low for 94% and moderate for 5%. Four cases were classified as illnesses of high severity. Some 70% of all the reported exposures occurred between May and September. The active ingredients responsible for the largest number of cases were: glyphosate (n. 56), copper sulphate (n. 55), methomyl (n. = 52), metam-sodium (n. 24). Three episodes of collective environmental exposure to soil fumigants involving 23 subjects were also detected.

[Evaluation and management of pesticide risk in agriculture: the experience of the Region of Lombardy (Italy)]. / Valutazione e gestione del rischio da antiparassitari in agricoltura: l'esperienza della Regione Lombardia.

The evaluation of chemical risk in agriculture is complicated because of difficulties in obtaining measures representative of working conditions. This is the reason why experiences finalized at producing risk estimates are running. In this frame, a Regional working group has developed the project "Pesticide exposure and risk profiles in agriculture". Priority scenarios have been selected and the main variables correlated with pesticide exposure have been pointed out. A value for each variable has been defined. The sum of these values allows the definition of "Exposure Indices" (EI), which can be reduced by multiplication for a coefficient calculated based on use of personal protective devices, training and education and equipment conditions. A Risk Index is calculated as the product of EI per a toxicity index, calculated based on the risk phrases of the substances used ("Risk Profile"). Risk Profiles allow the production of risk estimates and the definition of the appropriate preventive interventions. Next phase will be addressed at the validation of the model, to be carried out through the determination of the levels of concordance between the risk class allocation obtained from the model and the one obtained from environmental and biological measures, in the same groups of workers.

[Cluster of malignant mesothelioma cases in a thermostat manufacturing industry]. / Cluster di casi di mesotelioma maligno in una azienda produttrice di termostati.

BACKGROUND: Malignant mesothelioma is a rare disease and the identification of a cluster of cases suggests a possible presence of an asbestos contamination source. OBJECTIVES: To describe 3 cases of malignant mesothelioma (2 pleural and 1 peritoneal) that occurred in workers employed in the same thermostat factory. METHODS: Since this occupational sector is not traditionally known for asbestos exposure the Lombardy Mesothelioma Registry proposed to Local Occupational Health Unit to investigate this industry. RESULTS: From the first inspection of the plant, an environmental asbestos contamination (ropes covering oven handle and gasket) was found. But the greatest source of exposure was identified in the melamine resin reinforced with asbestos that constituted some internal parts of thermostats and that were sheared and perforated by the workers. So the 3 cases were defined as occupational diseases and legal procedures were initiated. CONCLUSION: The results underline the importance of a close cooperation within Local Occupational Health Units and Mesothelioma Registry in the identification and evaluation of asbestos occupational exposure otherwise not recognized, determining thus the loss of precious information.

Evaluation of skin and respiratory doses and urinary excretion of alkylphosphates in workers exposed to dimethoate during treatment of olive trees.

This article describes a study of exposure to dimethoate during spraying of olive trees in Viterbo province in central Italy. Airborne concentrations of dimethoate were in the range 1.5 to 56.7 nmol/m(3). Total skin contamination was in the range 228.4 to 3200.7 nmol/d and averaged 96.0% +/- 3.6% of the total potential dose. Cotton garments afforded less skin protection than waterproof ones, which were in turn associated with higher skin contamination than disposable Tyvek overalls. Total potential doses and estimated absorbed doses, including their maxima, were below the acceptable daily intake of dimethoate, which is 43.6 nmol/kg body weight (b.w.). Urinary excretion of alkylphosphates was significantly higher than in the general population, increasing with exposure and usually showing a peak in the urine sample collected after treatment. Metabolite concentrations were influenced by the type of individual protection used: minimum levels were associated with the closed cabin and maximum levels with absence of any respiratory or hand protection. Urinary alkylphosphates showed a good correlation with estimated absorbed doses and are confirmed as sensitive biologic indicators of exposure to phosphoric esters.

[Lombardy regional project: prevention of occupational tumors]. / Progetto regione lombardia: prevenzione dei tumori professionali.

In Lombardy, the regional project "Prevention of occupational cancers" is ongoing. The main objectives of this project are to identify work environments in which there might be a possible exposure to carcinogenic substances and to elaborate preventive measures. A casual sample of 250 working settings representing the different economic activities has been selected and evaluated. The 10% of the examined workplaces showed a possible exposure to chemical carcinogens. The most common carcinogens were trichloroethylene, preparation of plastics materials containing acrylonitrile-butadiene-stirene, formaldehyde, wood dust, hexavalent chromium, silica and polycyclic aromatic hydrocarbons. Galvanic industries, Bitumen production and placing companies and Plastics processing plants will be studied for environmental and biological monitoring and for the development of preventive measures.

[Pesticide poisoning referred to the Poison Center of Milan in 1995-1998]. / Intossicazioni da prodotti antiparassitari rilevate dal Centro Antiveleni di Milano nel periodo 1995-1998.

From 1995 through 1998 the Poison Control Centre of Milan identified 7594 cases of suspected or confirmed cases of acute pesticide poisoning. Domestic use products accounted for 4483 (59%) of the cases. Of these, 84% occurred at home and 48% in children under five. The most frequently reported domestic use products were pyrethrins/pyrethroids (26%), fertilizers (19%) and camphor/naphthalene (12%). Of 3111 cases (41%) due to agricultural products, 10% were children under five and 69% were males. Half of the poisonings from agricultural products occurred at home, the remainder at workplace. The products most frequently reported were organophosphates (26%), pyrethrins/pyrethroids (9%), and carbamates (9%). These preliminary data indicate the importance of implementing prevention programs to reduce pesticide poisonings with particular reference to young children.

[Consultations at the Poison Center of Rome on pesticide poisoning referrals]. / Consulenze prestate dai Centri Antiveleni di Roma in riferimento a prodotti antiparassitari.

From 1 January 1998 to 31 October 1999 the two Poison Control Centres active in Rome provided 923 telephone consultations for individuals and health care providers on suspected poisonings involving pesticides. Exposures more frequently reported in association with suspected cases were insecticides (n. 636), including organophosphates (n. 300), carbamates (n. 155), pyrethroids (n. 102), and organochlorines (n. 79). Children aged 1-4 years accounted for 22% of all suspected poisonings (n. 200). Each case was classified as to the likelihood of a relationship between the reported pesticide exposure and the occurrence of health effects. Around 18% of suspected pesticide poisonings (n. 168) were subsequently classified as definite, around 43% (n. 390) as possible, and around 37% were considered unlikely (n. 344).

[Pesticide poisonings compensated by the INAIL in 1995-98]. / Infortuni da antiparassitari indennizzati dall'INAIL nel periodo 1995-98.

The present paper describes agricultural pesticide-related accidents compensated by the Italian national institute for insurance of occupational accidents (INAIL) from January 1995 to December 1998. During the period under study, 643 accidents claims were examined by INAIL and 549 received compensation. The Italian regions with the highest number of compensation during the period under study were Puglia (no. 102), Sicily (no. 66), Emilia-Romagna (no. 61), and Veneto (no. 55). The national annual rate of pesticide-related accidents, estimated by dividing the number of cases receiving compensation by the number of insured agricultural workers was 12 per 100,000 per year. The regions with the highest rates were Puglia and Marche (27 per 100,000 per year), Liguria (22 per 100,000 per year), and Sicily (18 per 100,000 per year). Most of the cases (70%) occurred among male workers. The agents most frequently reported to have caused the accidents were fungicides (32.2%). For a relevant number of cases (34.2%) the exposure was not specified.

[Acute poisoning with methomyl and other pesticides in the province of Ragusa, Sicily]. / Intossicazioni acute da methomyl ed altri antiparassitari in provincia di Ragusa, Sicilia.

In 1995-96, the Occupational Medicine Service of the province of Ragusa, Sicily, examined all cases of pesticide poisonings among persons seen in two local emergency departments, identifying 86 cases due to unintentional pesticide exposure. Methomyl, a highly toxic carbamate, was indicated for 51% of all cases. The most frequently reported symptoms included nausea and vomiting (48%), excessive perspiration (33%), and dyspnea (16%). Fifty-nine cases (69%) were hospitalized, 5 in intensive care. The methomyl cases occurred more frequently during summer months while the cases from all other pesticides showed no seasonal patterns. These observations point out the relevance of identifying acute pesticide poisonings in the province of Ragusa and suggest that ongoing registration of these events should be a public health priority.

[National surveillance system for acute poisoning caused by pesticides]. / Piano di sorveglianza nazionale per la rilevazione delle intossicazioni acute da antiparassitari.

In the present paper is presented the surveillance system for pesticide-related illnesses proposed by the Istituto Superiore di Sanità, in collaboration with the Ministry of Health. Through the collaboration of local or regional poison control centres and local health departments with public hospitals and emergency departments, cases of acute pesticide-related illnesses among persons seeking health care will be registered according to standard procedures. Data collected locally will be transmitted to the Istituto Superiore di Sanità for registration and evaluation of the association between symptoms and type of exposure and for severity of illnesses related to pesticide exposure. These data will be analysed at regular intervals in order to estimate the magnitude of the problem of acute pesticide-related illnesses in Italy and to identify priority areas for implementing public health prevention and intervention programs.

Cancer risk among male farmers: a multi-site case-control study.

Farmers may experience exposure to several hazardous substances, and cancer risk in this occupational group is considered an important public health issue. In order to examine the association between cancer and farming among male agricultural workers, a hospital-based case-control study was conducted in five Italian rural areas. The cancer sites selected for the study were: lip, oral cavity and oropharynx, oesophagus, stomach, colon, rectum, lung, skin melanoma, skin non-melanoma, prostate, bladder, kidney, and non-Hodgkin's lymphoma. In all, 1525 newly diagnosed cases, aged 20-75 years, were ascertained in hospital records, covering the period between March 1990 and September 1992, and for 1279 of them, a detailed exposure information was collected by a standard questionnaire. Data analyses were performed comparing each cancer site to a control group, including a subset of the other cancer sites in the study. Unconditional logistic regression models were used in the statistical analyses. Increased risks of cancer associated with agricultural work were found for stomach (OR = 1.4, 95%CI:0.9-2.0), rectum (OR = 1.5, 95%CI:0.8-2.7), larynx (OR = 1.4, 95%CI:0.8-2.5), and prostate (OR = 1.4, 95%CI:1.0-2.1). The excess of prostate cancer was specifically related to application of pesticides (OR = 1.7, 95%CI:1.2-2.6).

[Health surveillance: from risk presumption to risk assessment]. / La sorveglianza sanitaria: dalla presunzione del rischio alla valutazione del rischio.

A working group of the Occupational Medicine and Industrial Hygiene Association of Lombardy, the National Association of Occupational Health Physicians the National Society of Prevention Operators made a paper in order to rationalize the sanitary surveillance, observing the laws in force and following the European Directives. The authors, thinking that everyday experience not very useful health examinations are carried out and that the sanitary surveillance should be planned according to the real working risks, give methodological directives about the way to make the mandatory clinical examinations less frequent, to the firms, to the occupational health physician and to the public occupational health operators of the local health units that must supervise the sanitary surveillance.

[Application of article 35 of the DPR 303/56: experience of the operators of the Public Occupational Services and competent physicians. Sample survey]. / Applicazione dell'art. 35 del DPR 303/56 in Lombardia: esperienze degli operatori delle ASL e dei medici competenti. Indagine campionaria.

In the last three years 450 requests of derogation to the article 35 of legislative decree 303/56 reached one third of the Public Occupational Services, with a clear progressive increase of their number. The working risks derogation is most frequently requested for are: solvents, welding fumes and metallic dusts. The operators of the Public occupational Services employed these criteria to grant the derogation: the effectiveness of the prevention, the low concentrations of the harmful agents, the occasionality of the unhealthy working, the risk lack or scarcity. In the 80% of the cases the operators of the Public Occupational Services made an inspection in only two cases they notified breaches of the law. 350 (70%) of the requested derogation were granted, 10 (20%) are now under evaluation, 90% (20%) were not allowed. In conclusion we point out that the use of the article 35 in industries with an adequate safety organization, by means of the dilution of the periodical clinical examinations, allows to better fit the health surveillance programs to the real working risks.

Cancer risk among female agricultural workers: a multi-center case-control study.

BACKGROUND: Cancer risk among women engaged in farming has been poorly investigated. This group of female workers is of particular interest, however, since they may experience exposure to several potential agricultural hazards. METHODS: A hospital-based case-control study was conducted in five Italian rural areas to examine the association between cancer and farming among women. The areas selected were located in three different regions (i.e., Piedmont, Tuscany, and Emilia-Romagna). The following cancer sites were selected for the study: stomach, colon, rectum, lung, skin melanoma, skin non-melanoma, breast, cervix and corpus uteri, ovary, bladder, kidney. Cases of non-Hodgkin's lymphoma were also included. Altogether, 1,044 newly diagnosed cases aged 20-75 years were ascertained from hospital records from March 1990 to September 1992, and for 945 of them detailed information was collected by a standard questionnaire. The analyses of data were performed comparing each case series to a reference group drawn from among the other sites. Unconditional logistic regression models were used in the statistical analyses. RESULTS: Statistically significant increased risks in association with farming were estimated for skin melanoma (OR 2.7, 95% CI 1.2-5.8) and bladder cancer (OR 2.7, 95% CI 1.2-6.1). Lung cancer was also found increased but not at a statistically significant level (OR 1.7, 95% CI 0.7-4.4). An OR lower than unity was observed for postmenopausal breast cancer (OR 0.4, 95% CI 0.3-0.7). CONCLUSIONS: The present study suggests that women in farming might experience increased risk of cancers, not usually found in excess among male farmers, as well as a protective effect for postmenopausal breast cancer. The role of different patterns of exposure or gender specific responses should be considered in further studies.

Mortality among male licensed pesticide users and their wives.

BACKGROUND: We evaluated the mortality pattern of male licensed pesticide users and their wives in central Italy. METHODS: The cohort consisted of 2978 male farmers licensed for buying and handling toxic pesticides during the period 1971-1973 and 2586 farmers' wives. The Standardized Mortality Ratio (SMRs) and their 95% Confidence Intervals (95% CI) were computed on the basis of regional death rates. RESULTS: We found a lower than expected overall and cancer mortality. Non-Hodgkin's lymphoma was increased among women (SMR = 2.29, 0.62-5.86) but not in male farmers (SMR = 0.90, 0.24-2.30), while both sexes were characterized by an increased risk of leukemia (men: SMR = 1.44, 0.69-2.64; women: SMR = 2.41, 1.04-4.76), mainly due to myeloid leukemia (men: SMR = 2.43, 0.98-5.00; women: SMR = 3.14, 1.02-7.33). CONCLUSIONS: Men and women tend to share the same mortality profile. The statistically significant increase of leukemia with a threefold increased risk of the myeloid subtype only among women suggests that different pattern of exposure or biological differences between genders should be considered in evaluating health risks in agricultural settings.

Mortality among workers in an Italian cigarette factory.

A cohort study was conducted to evaluate the mortality pattern among female and male workers in a cigarette factory. The study followed 972 female workers and 761 male workers with at least 6 months of cumulative employment from 1 January 1962 through 1 July 1996. Among women, mortality from all causes of death [standardized mortality ratio (SMR) = 0.9; 95% confidence interval (CI) = 0.8-1.1] and mortality from all malignant neoplasms (SMR = 1.1; CI = 0.9-1.3) were consistent with reference rates. Male workers had a significantly reduced overall mortality (SMR = 0.8; CI = 0.7-0.9), while mortality from all malignant neoplasms was as expected (SMR = 0.9; CI = 0.7-1.0). Among female workers the frequencies of deaths from diseases of nervous system (SMR = 2.0; CI = 1.1-3.4) and from non-Hodgkin's lymphoma (NHL) (SMR = 2.7; CI = 1.0-5.6) were elevated at a statistically significant level. No association between duration of employment and diseases of nervous system was observed. A higher risk for NHL, based on three deaths, was reported among female workers with 15 or more years of employment (SMR = 8.1; CI = 2.2-21.0). Although based on small numbers, the excess of NHL here reported suggests that potential exposure to foliar residues of pesticides should be thoroughly considered in tobacco manufacturing.

[New aspects in the evaluation of risk factors for fetal development]. / Nuovi aspetti nella valutazione di fattori di rischio per lo sviluppo embrionale.

Much knowledge concerning the effects of xenobiotics on prenatal development derive from experimental studies, which are generally performed on laboratory animals according to standardized protocols. Conventional in vivo studies should be integrated by other models within a scientifically-based risk assessment strategy. The paper reviews a few in vitro and/or in vivo approaches: identification of critical effects through the characterization of the pathogenesis as well as the use of dose-response relationships; alternative models to identify reproductive risks from single substances and/or mixtures present in the environment; interactions between in vitro and in vivo studies in the risk assessment of solvents: embryonic metabolism in teratogenicity; interactions between experimental and epidemiological studies to understand the pathogenesis of embryolethality; risk assessment of the effects of prenatal exposure to ionizing radiations.