Diabetes and work: The need of a close collaboration between diabetologist and occupational physician.

AIM: The Italian Society of Occupational Medicine (SIML), the Italian Diabetes Society (SID) and the Association of Diabetologists (AMD) joined a working group that produced a consensus paper aimed to assess the available evidence regarding the interplay between specific working conditions, including shift- and night-time work, working activities at high risk of accidents and work at heights, working tasks requiring high-energy expenditure, working activities at extreme temperatures and diabetes. DATA SYNTHESIS: Diabetes is a group of metabolic disorders caused by defects in insulin secretion and/or action affecting millions of people worldwide, many of whom are or wish to be active members of the workforce. Although diabetes, generally, does not prevent a person from properly performing his/her working tasks, disease complications can significantly compromise a person's ability to work. Therefore, it appears evident the need to understand the relationship between occupational risk factors and diabetes. The working group included in the document some practical recommendations useful to ensure diabetic workers the possibility to safely and effectively undertake their jobs and to adequately manage and treat their disease, also in the workplace. In this perspective concerted action of all the workplace preventive figures, occupational physicians and diabetologists should be strongly encouraged. CONCLUSIONS: Further studies are necessary to define workplace-based interventions, which should be minimally invasive towards the work organization, allowing diabetic workers to fully realize their work skills while improving their wellbeing at work.

First case report of vanadium metallosis after ceramic-on-ceramic total hip arthroplasty.

The development of metallosis as a complication following rupture of a hip replacement is known to occur as a result of contact with metal components of the prosthesis (1).In such cases, high cobalt (Co), chromium (Cr) and molybdenum (Mo) levels in the blood have been reported by several Authors (2).Recently, it has been stressed that the clinical investigation should focus on general reactions to high circulating metal levels, such as toxicity for the central nervous system (CNS) and the immune system (3).Despite the increasing interest of literature in ceramic-on-ceramic hip arthroplasty (4),little is known about these complications, and in particular of metallosis. To our knowledge this is the first description of a condition of extensive metallosis and radiographic signs presenting as a result of wear of a ceramic-on-ceramic prosthesis.

A pilot risk assessment study of strontium chromate among painters in the aeronautical industry.

OBJECTIVE: A method for risk assessment of occupational exposure to strontium chromate (SrCrO4) in painters employed in the aeronautical industry is described. METHODS: Assessment was made of 21 male workers of the painting division, potentially exposed to SrCrO4 (exposed), and 20 male workers of the tests and warehouse divisions (controls). All participants completed a questionnaire about work tasks, lifestyle habits, hobbies and diet. Personal active sampling for the determination of Cr and Sr was performed both during paint-spraying and during other operations in the painting division area. On the same day as environmental sampling, urine samples were collected at the beginning and end of the work shift in exposed workers to determine urinary chromium (CrU), and only at the end of the shift in controls. In the second half of the shift, a blood sample was taken in 10 exposed workers and 10 controls, to determine Cr in plasma (CrP) and in red blood cells (CrRBC). RESULTS: During paint-spraying, Cr concentrations ranged between 1.38 and 17.10 microg/m3, versus 0.02 to 0.07 microg/mi in the painting division area, while the Sr concentration was 22.90 microg/m3 in the paint-spray booth versus 0.07 microg/m3 in the painting division area. CrU at the end of the work shift, CrP and CrRBC, did not show significant differences between exposed workers and controls. Moreover, in exposed workers there were no differences between CrU measured at the beginning and at the end of the work shift. CONCLUSIONS: This approach, consisting of simultaneous environmental and biological monitoring, suggested no absorption of chromium in the painters thanks to the efficacy of the technical, organizational and personal protection measures adopted. However, the evident exposure to high levels of SrCrO4 during paint-spraying highlights how absolutely essential it is to ensure strict compliance with all the preventive measures foreseen by the EU and national regulations for occupational exposure to carcinogens.

Environmental factors affecting the urinary excretion of inorganic arsenic in the general population.

OBJECTIVE: To assess the critical issues concerning the use of urinary inorganic arsenic (iAs), including As3, As5, monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA), as biomarker of internal dose in order to monitor environmental and occupational exposure to inorganic As, considering the influence of diet and drinking water on excretion of iAs. METHODS: The design protocol stipulated collection of weekly urine samples from 6 male subjects for 5 consecutive months. In all the urine samples, iAs was determined by Hydride Generation-Atomic Absorption Spectrophotometry (HG-AAS). In the subjects with iAs higher than 35 microg/L, Biological Exposure Index (BEI) proposed by the American Conference of Governmental Industrial Hygienists (ACGIH), urinary arsenic speciation was performed by HPLC-ICP-MS. Exposure to airborne As was evaluated monthly using personal environmental samplers worn for 8 hours. Throughout the study, the participants filled out a daily food diary, also detailing types of water drunk. RESULT: Exposure to airborne As was invariably below the limit of detection, equal to 1 ng/m3. A total of 77 urine samples were collected. iAs was always detectable and was higher in 7 urine samples, obtained from 5 of the 6 subjects examined, than the BEI. Among foods with a high As content, the intake of seafood and fish within 72 hours before providing the sample seems to be the principal source of the iAs concentrations, while the intake of rice or drinking water showed no influence on this biological marker. Instead, drinking wine within 24 hours before urine sample collection can cause a significant increase in the excretion of iAs. CONCLUSIONS: In populations that eat large amounts of fish and seafood, the use of iAs to monitor occupational and environmental exposure to inorganic As seems to present some problems, and urinary As speciation may be essential at least in cases with As measurements above the biological limit values. In any case, a diet sheet reporting all foods eaten within 3 days of urine collection seems to be an indispensable tool to ensure a correct interpretation of the results.

Immune effects of polychlorinated biphenyls, smoking and alcohol.

Polychlorinated biphenyls (PCB) have been shown to exert some immune effects. Here we analysed their effects also on immune parameters not previously studied such as TCR alpha-beta, TCR gamma-delta and regulatory T cells (Treg), taking into account the specific and cumulative interference of smoking and alcohol. The study subjects consisted of 26 male workers in a steel works factory, employed in the electrical maintenance sector, with previous exposure to a mixture of PCB (exposed subjects), and 30 male workers with no occupational exposure to PCB (controls). All subjects were given a questionnaire and peripheral venous blood samples were taken to determine serum PCB (33 congeners), total cholesterol and triglycerides, leukocytes, total lymphocytes and the T lymphocyte subpopulations (TCR alpha-beta, TCRgamma-delta, CD4+ and Treg lymphocytes). PCB, even though at a very low concentration, were significantly higher in exposed subjects than controls, and were significantly correlated with age. Monocytes% and CD4+ were significantly reduced in the exposed subjects as compared to the controls. The serum concentration of PCB positively correlated with TCR alpha-beta, and negatively with TCRgamma-delta. Treg lymphocytes showed a positive dependence on tobacco smoking, while the monocytes percentage and CD4+ showed a negative and positive dependence, respectively, on alcohol intake. Our results seem to show some effects of slight exposure to PCB in particular reducing the relative concentration of TCRgamma-delta. This effect can favour indirectly the increase in Treg induced by smoking, the anti-inflammatory or proinflammatory/fibrogenetic/angiogenetic effect of which, exerted by produced cytokines, particularly TGF-beta, deserves further clarification.

[Lesser validity of urinary benzene than S-phenylmercapturic acid for measuring occupational and environmental exposure to very low concentrations of benzene]. / Minore validità del benzene urinario rispetto all'acido S-fenilmercapturico nel rilevare l'esposizione occupazionale ed ambientale a concentrazioni molto basse di benzene.

AIM: To study the validity of urinary benzene as a biomarker of low and very low exposure to this toxicant, as compared with t,t-muconic acid (t,t-MA) and S-phenylmercapturic acid (SPMA), also taking into account the influence of cigarette smoking and co-exposure to toluene on the urinary excretion of benzene. MATERIALS AND METHODS: The results obtained in two different studies were compared: in the first, workers occupationally exposed to low concentrations of benzene (18 fuel tanker drivers and 23 filling station attendants) were compared with 31 controls and in the second, workers exposed to very low concentrations of benzene (the same 23 filling station attendants) were compared with the 31 controls. Exposure to airborne benzene and toluene was monitored with passive personal samplers (Radiello). Then the urine collected at the end of the work shift was analyzed for t,t-MA, SPMA and urinary benzene. All participants also filled out a questionnaire about their lifestyle habits. RESULTS: There were no differences among the three groups in terms of age and smoking habit. Occupational exposure to benzene and toluene and the urinary concentrations of t,t-MA, SPMA and urinary benzene were higher in the fuel tanker drivers than the filling station attendants and higher in the latter than in the controls. Cigarette smoking was found to be associated with urinary excretion of t,t-MA, SPMA and urinary benzene at both low and very low exposure to benzene. The biomarkers t,t-MA, SPMA and urinary benzene were almost always correlated, for both low and very low exposure to benzene. Notably, for low exposure to benzene a dependency relation was found with the levels of t,t-MA, SPMA and urinary benzene on both cigarette smoking and airborne benzene, whereas for very low exposure to benzene there was a dependency relation of SPMA on cigarette smoking and airborne benzene, of urinary benzene only on cigarette smoking and of t,t-MA on none of the variables considered. CONCLUSIONS: For occupational exposure to low concentrations of benzene, urinary benzene and SPMA showed a comparable validity, while for exposure to very low concentrations of this toxicant the validity of SPMA was confirmed while urinary benzene was found to be less useful. Cigarette smoking was the main factor conditioning the excretion of all the biomarkers of benzene in conditions of both low and very low exposure to the toxicant, so for the analysis of occupational exposure to benzene it is best to recommend abstention from smoking at least in the hours immediately before urine collection.

Applicability of urinary benzene to biological monitoring of occupational and environmental exposure to very low benzene concentrations.

OBJECTIVE: To verify whether urinary benzene is an applicable biomarker of occupational exposure to very low concentrations of benzene, considering the influence of cigarette smoke and benzene-toluene co-exposure. MATERIALS AND METHODS: 23 filling station attendants with occupational exposure to benzene and 31 controls were analyzed. Occupational and environmental exposure was monitored and t,t-muconic acid (t,t-MA), S-phenylmercapturic acid (SPMA), urinary benzene and creatinine in the urine samples were tested. RESULTS: Occupational exposure to benzene and toluene was significantly higher in the filling station attendants than in the controls, whereas t,t-MA, SPMA and urinary benzene were not different in the two groups. Instead, the smoker group showed significantly higher values for the above biomarkers than the non-smoker group, each of which included both exposed workers and controls. SPMA was dependent on airborne benzene and cigarette smoking, and urinary benzene only on cigarette smoking, while t,t-MA was not dependent on either of these variables. CONCLUSIONS: At very low concentrations of occupational exposure to benzene, urinary benzene is less valid than SPMA as a biomarker, even if both are strongly influenced by smoking habit. Abstention from smoking should therefore be recommended for at least two hours before urine collection.

[Influence of non-occupational sources on the levels of biomarkers of internal dose for use in biological monitoring of occupational exposure to extremely low concentrations of benzene]. / Ruolo dei fattori non occupazionali nel condizionare i livelli di indicatori di dose interna utilizzati per monitorare l'esposizione occupazionale a concentrazioni molto molto basse di benzene.

OBJECTIVES: To study how traditional (t,t-muconic acid--t,t-MA and S-phenylmercapturic--SPMA) and new (urinary benzene) urinary biomarkers of internal dose can contribute to exclude an occupational source of exposure to extremely low concentrations of benzene, also analyzing the influence that non-occupational sources of exposure, such as cigarette smoking and urban pollution, can have on the levels of these biomarkers. MATERIALS AND METHODS: Assessment was made of 6 workers employed at a groundwater purification plant polluted by benzene (exposed) and 6 administrative clerks employed at the same plant (controls); both groups included smokers and non-smokers. Environmental monitoring (fixed and personal samplings lasting 8 hours) and biological monitoring (determinations of t,t-MA, SPMA, urinary benzene, and urinary creatinine so as to apply suitable adjustments) were performed in exposed workers on 10 successive days, including also rest days (background exposure), and in controls only once. RESULTS: Airborne benzene always resulted lower than the limit of detection of the analytical method in both fixed and personal samplings done on exposed workers and controls during working days, while personal samplings done on exposed workers during rest days showed benzene concentrations even higher than 5 microg/m3, that is the limit value for ambient air quality. Concentrations of t,t-MA, SPMA and urinary benzene did not show differences between exposed workers, regardless of whether they were studied on working or rest days, and controls and appeared to be largely within the reference value range for the Italian population. All biomarkers of internal dose examined in the study showed significantly higher values in smokers than non-smokers. In the latter, SPMA was always below the limit of detection, while urinary benzene resulted higher than the limit of detection in 60.0% and 87.5% of the determinations done on working and on rest days, respectively. CONCLUSIONS: In situations of occupational exposure to extremely low doses of benzene or of absence of exposure, the application of an integrated environmental--biological monitoring approach, involving the determination of SPMA and/or urinary benzene, together with a careful evaluation of those factors determining non-occupational exposure to the toxicant, seems indispensable in order to be able to exclude the presence of occupational exposure. In these particular situations of occupational exposure to benzene, the interpretation of the results of environmental and biological monitoring should not only consider the TLV or BEI, but also the limit value for ambient air quality and the reference value for the general population, since benzene is able to determine genotoxic carcinogenic effects even at exposure to extremely low concentrations of the toxicant.

Lead exposure in firearms instructors of the Italian State Police.

BACKGROUND: Several studies evaluated exposure to lead in relatively small groups of firearms instructors and shooters, mainly operating at indoor ranges. OBJECTIVE: To assess the levels of lead exposure in a large sample of firearms instructors of the Italian State Police (SP) operating at either indoor or outdoor ranges. METHODS: A crosssectional study was conducted in firearms instructors working in indoor (No. 188) and outdoor (No. 188) ranges compared with 170 foodplant workers. The personal and work characteristics and current blood lead (Pb-B) levels were evaluated The concentrations of environmental lead (Pb-E) were measured using personal samplers in 6 indoor and 6 outdoor firing ranges. RESULTS: The Pb-B levels in the two groups of firearms instructors were well below the ACGIH BEI, but significantly higher than in food plant workers. In the entire study sample the Pb-B level was seen to be influenced by age and job group. An excess risk of having Pb-B >100 microg/l was found in indoor range instructors and in those with greater job seniority. Pb-E <25 pg/m3 was measured in all the firing ranges examined. DISCUSSION: The low Pb-B and Pb-E levels assessed are the result of primary and secondary prevention interventions carried out over the years by the Italian State Police. The current Pb-B levels also seemed to be poorly influenced by higher past environmental and/or occupational lead exposure. In fact a certain number of firearms instructors, mainly operating at indoor ranges and with greater job seniority, had Pb-B levels consistent with occupational exposure to lead. Environmental and biological monitoring of lead exposure and specific health surveillance are therefore still necessary in this job group topreventpossible adverse health effects of lead even at low doses.

[The role of the occupational physician in the assessment of accident risk]. / Il ruolo del medico competente nella valutazione del rischio infortunistico.

The prevention of accidents at work in Italy is a target still to be reached for the safety of workers in workplaces, despite the innovative provisions introduced by the Legislative Decree 81/08 and the decrease of the number of total and fatal accidents occurred in the period 2001-2008, as reported in the statistics of the Italian Workers' Compensation Authority (INAIL). The occupational physician performs a very important role in the accident risk assessment, based on his biomedical and ergonomic knowledge. His role is carried out during the phase of safety risk assessment, contributing to assess plants, machines, tools, personal protective equipments, to be used by the workers. His knowledge of the health status of workers, acquired by medical surveillance and aimed to prevent accidents by providing the fitness for work evaluation in relation to the presence of diabetes mellitus, musculoskeletal diseases, sleep disorders, or to the assumption of hypnotic drugs, when the employee works at height or as driver such as in the transport or construction industry, is not less important. Unfortunately, this latter role of the occupational physician is limited because the Italian Safety Legislation does not provide for the sanitary surveillance of all the workers employed in factories.

[The ISPESL-SIMLII surveys to develop and address updating and accreditation's projects in occupational medicine]. / Le indagini conoscitive ISPESL-SIMLII per lo sviluppo e l'indirizzo dei progetti di aggiornamento e accreditamento in medicina del lavoro.

The SIMLII set up a program of continuous training and accreditation of postgraduate specialists in Occupational Health in 2000, before continuous medical training (ECM) was formally introduced. Therefore, especially over the past few years, SIMLII has involved its membership to an ever increasing extent, in an attempt to understand their expectation as regards the scientific community and as regards a continuously evolving discipline that is subject to continuous changes in educational requirements. The surveys carried out by the National Institute of Occupational Safety and Prevention (ISPESL), in collaboration with SIMLII, provided data that, besides identifying the type of activity of the membership, attempted to assess members' compliance with the society's initiatives, with special reference to the Programme for continuous training and accreditation of postgraduates in Occupational Health and the issue of Guidelines.

[Sleep disorders in cement workers]. / I disturbi del sonno nei lavoratori dell'industria del cemento.

Obstructive Sleep Apnea Syndrome (OSAS) and Excessive Daytime Sleepiness (EDS) are sleep disorders which can increase cardiovascular risk. An health survey was performed on the cement workers to estimate the prevalence of sleep disorders and to investigate occupational, personal and health risk factors that could influence it. A total of 761 male workers, employed at 10 different cement plants of South Italy and Sicily, were examined. All subjects gave informed consent to take part in the survey. The following questionnaires were administered: Berlin Questionnaire to estimate the high risk of OSAS, Epworth Sleepiness Scale for EDS, a questionnaire posing questions about working conditions, personal characteristic, lifestyle, past history of disease and present illness. Statistical analysis was performed with the statistical package SPSS. The prevalence of high risk of OSAS and of EDS resulted respectively in 24.2% and 3.4% of workers. Sleep disorders detected with the two questionnaires were significantly associated. A positive and significant association between OSAS and respectively age, time of employment, BMI, ex-smoker status, neck, waist or hip circumferences, chronic fatigue and arterial hypertension was observed. Subjective variables regarding working conditions (job interest, evaluation oforganization of work and job satisfaction) and alcohol consumption were not associated with the high risk of OSAS. Shift work (2 and 3 shifts) was not associated with the high risk of OSAS. An healthy worker effect was observed for workers who changed from shift work (2 or 3 shifts) to fixed daytime work. For them, this change to fixed daytime work was conditioned by chronic disease like hypertension and obesity. EDS was not dependent, associated or correlated with any of the occupational, personal or pathologic variables investigated in the study. In conclusion the research showed no relationship between working conditions, particularly shift work, and the high risk of OSAS, and the influence of obesity in determining the high risk of OSAS, itself a potential cardiovascular risk factor. The interest of occupational physician has been focused on introducing in health surveillance also measures of health promotion regarding sleep disorders with the aim of preserving health condition in workers.

[Validity of urinary 2-thiothiazolidine-4-carboxylic acid (TTCA) as biomarker of exposure to very low concentrations of carbon disulphide: preliminary results]. / Validiti dell'acido 2-tiotiazolidin-4-carbossilico (TTCA) urinario quale indicatore biologico dell'esposizione a concentrazioni molto basse di solfuro di carbonio: risultati preliminori.

The possibility to use urinary 2-thiothiazolidine-4-carboxylic acid (TTCA) as biomarker of occupational exposure to very low doses of carbon disulphide (CS2) was evaluated preliminarily in 10 workers employed in a chemical plant where rubber vulcanization accelerators are produced, and in 10 workers, residents in the same geographical area and not occupationally exposed to CS2 and dithiocarbamates (DTC). Exposure to airborne CS2 was assessed, only for exposed workers, by both personal and area samplers. For the determination of TTCA, a spot urine sample was collected for each worker, exposed and non exposed, at the end of work-shift. A questionnaire probing lifestyle and dietary habits and non occupational exposure to CS2 and DTC was administered to all workers involved in the study. Environmental exposure to CS2 in 2007 ranged between 0.21 mg/m3 and 0.73 mg/m3 for personal sampling, and between 0.23 mg/m3 and 0.41 mg/m3 for area sampling. Urinary TTCA levels resulted very low and did not show any significant difference between exposed (Median: 10.8 microg/g creat; Range: 6.1-26.4 microg/g creat) and non exposed workers (Median: 9.3 microg/g creat; Range: 3.0-33.0 microg/g creat), while higher, but not significant concentrations of TTCA were observed in smokers than in non smokers (p = 0.09). No correlation was found between urinary TTCA levels and environmental exposure to CS2, age, body mass index, smoking and dietary habits. In conclusion, the low sensibility and specificity in the assessment of occupational exposure to low doses of CS2 in workers compared to general population subjects, makes urinary TTCA a biomarker with a low usefulness in biological monitoring. ACGIH, besides, should also introduce "B" (background) notation, at present not considered for the BEI indicated for urinary TTCA.

[Continuing medical education and accreditation for excellence set up by the Italian Society of Occupational Health and Industrial Hygiene (SIMLII): results of a survey among members]. / Formazione continua e accreditamento di eccellenza promossi dalla Società Italiana di Medicina del Lavoro e Igiene Industriale (SIMLII): risultati di un'indagine conoscitiva tra i soci.

BACKGROUND: The SIMLII set up a program of continuous training and accreditation of postgraduate specialists in Occupational Health in 2000, before continuous medical training (ECM) was formally introduced. Therefore, especially over the past few years, SIMLII has involved its membership to an ever increasing extent, in an attempt to understand their expectations as regards the scientific community and as regards a continuously evolving discipline that is subject to continuous changes in educational requirements. OBJECTIVES AND CONCLUSIONS: The self-administered questionnaire in a survey carried out in 2005 by the National Institute of Occupational Safety and Prevention (ISPESL), in collaboration with SLMLII, provided data that, besides identifying the type of activity of the membership, attempted to assess members' compliance with the society's initiatives, with special reference to the Programme for continuous training and accreditation of postgraduates in Occupational Health and the issue of Guidelines.

Effect of lead on the levels of some immunoregulatory cytokines in occupationally exposed workers.

Lead (Pb) may affect humoral and cellular immunity, acting on lymphocytes as well as on granulocytes and monocytes. Cytokines and nitric oxide (NO) play a central role in the immune balance. In this study, plasma levels of nitrites and nitrates (NOx), IL2, IL4, IL6, IL10, TNF-alpha and INF-gamma, were measured in healthy workers with very low (Pb-B=3.2-18.0 microg/dL) and low (Pb-B=9.1-46.0 microg/dL) Pb-exposure compared to non-exposed workers. Low Pb-exposed workers (Pb-B=9.1 -46.0 microg/ dL) were found to have significantly higher plasma IL-10 levels, and tendentially higher plasma TNF-alpha levels compared to non-exposed workers. This is the first report of a significant increase of plasma IL-10 levels in Pb-exposed workers. Plasma IL-10 increase was influenced by blood Pb levels even after correction for main confounding factors. No difference was found in plasma NOx levels between Pb-exposed and non-exposed workers, which is in agreement with previous findings exclusively regarding groups in the general population. Low Pb-exposure can induce an increase of pro-inflammatory cytokines, such as TNF-alpha, with a consequent increase of other cytokines, such as IL-10, considered a T cell cross-regulatory factor, suggesting possible interference of Pb in the system of immunophlogosis.

Evaluation of tumor necrosis factor-alpha and granulocyte colony-stimulating factor serum levels in lead-exposed smoker workers.

Inorganic lead (Pb) is able to modulate the immune response even at low to moderate exposure levels. It inhibits in vitro and in vivo activities of neutrophil leucocytes and influences their blood count in humans. Neutrophil functions are governed by a number of cytokines. Pb has been shown to affect leukocyte production of some of these cytokines in vitro. The objective of this study is to assess serum tumor necrosis factor-alpha (TNF-alpha) and granulocyte colony-stimulating factor (G-CSF) levels of thirty-three male lead-exposed (E) workers at a lead recycling plant as compared with twenty-eight male non-exposed (NE) workers at a food processing plant, whose current smoking habit was known. Serum TNF-alpha and G-CSF levels were measured by a quantitative sandwich enzyme immunoassay. Blood lead levels (Pb-B) were significantly higher in E (geometric mean (GM) 30.7 microg/dl, GSD 1.7; min-max: 9.1-81.6 microg/dl) workers than controls (GM 3.6 microg/dl, GSD 1.7; min-max: 1.0-11.0 microg/dl). E workers had significantly higher serum TNF-alpha (median: 107.1; min-max: 11.1-623.0 pg/ml) and G-CSF levels (median: 53.0, min-max: 31.1-197.0 pg/ml) than NE workers (TNF-alpha: median: 12.0; min-max: 9.4-18.8 pg/ml; G-CSF: median: 34.3, min-max: 25.1-52.2 pg/ml). In particular, the TNF-alpha level was shown to be significantly influenced by lead exposure and smoking habit, as well as by interaction between these two factors. Both serum TNF-alpha and G-CSF levels were correlated with Pb-B and absolute neutrophil count. This study is the first to detect higher serum levels of G-CSF in E over NE workers. Our data confirm that exposure to low to medium doses of lead may interfere in the complex cytokine network involved in inflammation, especially in workers who are current smokers.

[Significance and limitation of creatinine adjustment for urinary chromium and arsenic in biological monitoring of occupational exposure to these metallic elements]. / Significato e limiti della correzione per creatinina del cromo e dell'arsenico urinari nel monitoraggio biologico dell'esposizione professionale ai due elementi metallici.

Creatinine adjustment has been used to remove the influence of the effect of urine dilution on exposure biomarkers measured in spot samples. This research aimed to determine the reliability of creatinine adjustment for urinary chromium and arsenic in subjects from general population considering interferences able to influence creatinine excretion. 444 male subjects were examined and each participant was administered an anamnestic questionnaire. Chromium and arsenic were determined on second morning void urine samples by atomic absorption spectrophotometry and creatinine by Jaffè method. Urinary creatinine showed a significant negative decrease with age increasing (p < 0.001). Chromium concentrations resulted higher in subjects with renal disease, particularly after creatinine adjustment (p = 0.014). Age was negatively correlated with urinary creatinine (rho = -0.23; p < 0.001), and positively with chromium (rho = 0.13; p = 0.007) and arsenic (rho = 0.17; p = 0.004), only after creatinine adjustment. A positive correlation was also found between unadjusted chromium and arsenic (rho = 0.10; p = 0.039) and between urinary creatinine and both unadjusted chromium (rho = 0.32; p < 0.001) and arsenic (rho = 0.18; p < 0.001). An high coefficient of correlation was observed between unadjusted chromium (rho = 0.88; p < 0.001) and arsenic (rho = 0.90; p < 0.001) and the respective adjusted values. Multiple regression showed a dependence of urinary creatinine and adjusted chromium and arsenic concentrations on age. In conclusion, although chromium and arsenic seem to have a renal kinetics of excretion comparable to the creatinine one, the influence of age on creatinine elimination suggests that the expression of urinary values of these metallic elements as microg/L is more reliable.

[Influence of cigarette smoking on the excretion of urinary benzene in filling-station attendants]. / Influenza del fumo di sigaretta sulla concentrazione di benzene urinario negli addetti alla distribuzione di carburante.

The influence of cigarette smoking on concentrations of urinary benzene, a sensitive and specific biomarker proposed for biological monitoring of exposure to very low doses of benzene, was investigated in 24 filling-station attendants and 31 workers non occupationally exposed to benzene. Environmental monitoring was performed by personal passive samplers "Radiello", and a spot urine sample was collected at the end of the work shift, from all subjects, for the determination of urinary benzene. Exposure to benzene resulted significantly higher in filling-station attendants (mean 23.3 +/- 17.0 microg/m3; range 4.5-66.3 microg/m3) than in controls (mean 4.6 +/- 2.6 microg/m3; range < 3-11.5 microg/m3), while concentrations of urinary benzene did not show any significant difference between the two groups. Considering all subjects as a single group, it was observed that urinary benzene concentrations were positively correlated with the number of cigarettes smoked during the sampling time (rho = 0.38; p = 0.047) and with airborne benzene levels (rho = 0.32; p = 0.019), and negatively correlated with the time elapsed between the last smoked cigarette and urine collecting (rho = -0.40; p = 0.045). Multiple regression analysis confirmed the influence of cigarette smoking on urinary benzene concentrations. In conclusion, our study showed the validity of urinary benzene as a biomarker for biological monitoring of exposure to very low doses of benzene, although cigarette smoking determined a prevalent etiological role at the low environmental benzene concentrations observed.

[Evaluation of plans for reclamation from products containing asbestos to ensure safety to the workers and the general population]. / Valutazione dei piani di lavoro per la bonifica di materiali contenenti amianto al fini della sicurezza dei lavoratori e della popolazione generale.

Fifty-two working plans for abatement of asbestos-containing materials (ACM) were examined being presented over 12 months at a Public Occupational Health Service in Apulia (Italy) by authorized companies. Most of the interventions took place in urban areas and civil buildings and lasted few days with employment of a limited number of workers. They mainly consisted in removal practices. The weight of ACM abated varied from 30 to over 14,000 kg. Air monitoring of asbestos fibres was included not in all plans. When airborne fibres were detectable, the threshold of environmental pollution (20ff/L) was sometimes reached or exceeded. This finding appeared to be relevant for asbestos exposure of workers and general population. A higher fibre dispersion occurred during abatement of amounts of ACM more than 1,000 kg. The Occupational Health Service should be legally and operatively able to make regular workplace inspections, especially when large quantities of ACM have to be abated.

[A case of occupational lung disease (welder lung) in a mechanical worker]. / Un caso di polmone del saldatore in un saldo-carpentiere forte fumatore.

A case of welder's lung is reported in a male hard smoker who had worked as welder-carpenter for almost 30 years. In order to establish an etiologic diagnosis, given the informed consent from the worker, open lung biopsy was performed that allowed to obtain sufficiently large specimens of affected lung to make histological, immunohistochemical and mineralogical examination. In such a way the pathologic features were accurately defined and a multidisciplinary approach was applied to differential diagnosis. The worker is recommended to undergo a strict health surveillance because of the reported association of welder's lung with lung cancer, especially in smokers.