Formaldehyde and Acetaldehyde Exposure in "Non-Traditional" Occupational Sectors: Bakeries and Pastry Producers.

INTRODUCTION: Formaldehyde, a colorless and highly irritating substance, causes cancer of the nasopharynx and leukemia. Furthermore, it is one of the environmental mutagens to which humans are most abundantly exposed. Acetaldehyde was recently classified as carcinogen class 1B and mutagen class 2 in Annex VI EC regulation. Occupational exposure to the two aldehydes occurs in a wide variety of occupations and industries. The aim of this study is to deepen exposure to the two aldehydes in the non-traditional productive sectors of bakeries and pastry producers. METHODS: The evaluation of exposure to formaldehyde and acetaldehyde was conducted in Italy in 2019, in specific tasks and positions of 11 bakeries and pastry producers (115 measures, of which 57.4% were in fixed positions and the rest were personal air sampling). The measurements were performed using Radiello© radial diffusion samplers. A logarithmic transformation of the data was performed, and the correlation between the two substances was calculated. Moreover, linear models considering the log-formaldehyde as the outcome and adjusting for log-acetaldehyde values were used. RESULTS: The study identified high levels of acetaldehyde and formaldehyde exposure in the monitored workplaces. Higher mean values were observed in the leavening phase (8.39 µg/m3 and 3.39 µg/m3 for log-transformed data acetaldehyde and formaldehyde, respectively). The adjusted univariate analyses show statistically significant factors for formaldehyde as the presence of yeast, the presence of type 1 flour, the use of barley, the use of fats, the type of production, the use of spelt, and the presence of type 0 flour. CONCLUSIONS: The measurements confirmed the release of formaldehyde and acetaldehyde in bakeries and pastry industries, especially in some phases of the work process, such as leavening.

[Mortality and cancer risk in agricultural nursery workers: a cohort study in Tuscany Region (Central Italy)]. / Mortalità e rischio cancerogeno nei florovivaisti: uno studio di coorte in Toscana.

OBJECTIVES: to follow-up mortality of agricultural nursery workers of the province of Pistoia (Tuscany Region, Central Italy). DESIGN: the cohort of nursery workers of the Pistoia province was assembled from two sources: subjects who obtained a pesticide license (PAT) and subjects who had been working in agricultural nursery, based on the 2003 regional census (LIF). Vital status and causes of deaths were ascertained through the official records of the municipalities and the Tuscany Mortality Register. The follow-up period for PAT cohort was from 01.01.1984 to 31.12.2015 and for LIF cohort was from 01.01.2003 al 31.12.2015. SETTING AND PARTICIPANTS: the total cohort included 2,732 males and 326 females: the PAT cohort included 1,602 males and 106 females, and the LIF cohort included 1,130 males and 220 females MAIN OUTCOME MEASURES: general and cause-specific Standardized Mortality Ratios (SMRs) and 95% confidence intervals were calculated for the entire cohort and for the PAT and LIF sub-cohorts. Expected deaths by age and gender for each cause of death were obtained from applying the respective rates in the Tuscan population. RESULTS: overall mortality was lower than expected, with notable deficits for all cancers and some specific causes in both genders. Among males, increased SMRs were observed for pancreas (17 observed cases: SMR 129; CI95% 75-207), prostate (22 cases: SMR 121; CI95% 76-183), bladder (18 cases: SMR 139; CI95% 83-220) cancer, and also for multiple myeloma (5 cases: SMR 120; CI95% 39-281). Among females, increased SMR for cancer of digestive system and peritoneum was observed (3 cases: SMR 152; IC95% 31-445). The analyses by calendar period also shown excess for cancers of the genital and urinary system and the lymphohematopoietic system. CONCLUSIONS: although overall deficits for all causes and all cancer were observed, there were notable exceptions for some specific cancer causes, that might be related to pesticides exposure.

Asbestos in toys: an exemplary case.

OBJECTIVES: DAS was an artificial clay which, once molded, hardened at room temperature. It was largely used as a toy between 1963 and 1975 in Italy, Netherlands, Germany, UK and Norway. This case report describes and reports the presence of asbestos in DAS. METHODS: We investigated the presence of asbestos in DAS using light and electron microscopy on samples of the original material. We searched administrative documents at the State Archive of Turin and conducted interviews with past employees on annual production, suppliers, and purchasers. RESULTS: The analytical tests confirmed the presence of asbestos fibers in DAS: about 30% of its composition. The documents found at the State Archive confirmed the annual purchase of hundreds tons of raw asbestos from the Amiantifera di Balangero, the Italian asbestos mine. DAS was found to be used also within craftsmanship. CONCLUSIONS: Asbestos fibers in DAS may have caused exposure to production workers and a variety of users, including artists, teachers, and children. Over 13 years, about 55 million packs of DAS were produced and sold. The number of users is difficult to estimate but may have been in the order of millions. In Italy, a specific question on the use of DAS has been included in a routinely used mesothelioma questionnaire. As DAS was exported to other countries, our findings suggest that mesothelioma patients should be asked about their past use of DAS, in particular individuals not reporting a clear past asbestos exposure. Additionally, this discovery shows the incompleteness of records on asbestos uses and suggests to test items, including toys, imported from countries where asbestos is not forbidden.

Cancer and pesticides: an overview and some results of the Italian multicenter case-control study on hematolymphopoietic malignancies.

Exposure to pesticides is recognized as an important environmental risk factor associated with development of cancer. Epidemiological studies, although sometimes contradictory, have linked phenoxy acid herbicides with non-Hodgkin's lymphoma (NHL) and Soft Tissue Sarcoma (STS); organochlorine insecticides with STS, NHL, and leukemia; organophosphorous compounds with NHL and leukemia; and triazine herbicides with ovarian cancer. Exposure assessment is a crucial point in studying the association between cancer and pesticides. In order to investigate the association between hematolymphopoietic malignancies and occupational exposures, including pesticides, a population-based case-control study was carried out in Italy in 11 areas, 9 of which are agricultural or mixed areas. All newly diagnosed cases of hematolymphopoietic malignancies were collected in a 3-year period (1991-1993). The control group consisted of a random sample of the population residing in each area. The approach to infer exposures in agriculture was based on: the use of an agricultural questionnaire with 24 crop-specific questionnaires; expert agronomists who reviewed the collected information for each subject and translated it into pesticides histories. In total, 1925 cases and 1232 controls were interviewed in the nine agricultural areas. Increased risk was observed for some specific classes of pesticides. Furthermore, a nonstatistically significant increased risk of NHL was observed for subjects who were exposed to phenoxy herbicides not using protective equipment and a significant increased risk for exposure to 2, 4-dichlorophenoxy acetic acid (2,4-D).

[Pleural mesothelioma in cotton spinning workers]. / Mesoteliomi pleurici in lavoratori tessili addetti alla filatura del cotone.

BACKGROUND: Cases of malignant mesothelioma (MM) in the non-asbestos textile industry have recently been described, but asbestos exposure in spinning and looming has seldom been reported. Nevertheless, on a national level the Italian Mesothelioma Registry (Re.Na.M) contains numerous cases of MM with past non-asbestos textile work but classified as "unknown" exposure due to poor information. OBJECTIVES: The aim of this research was to investigate possible past occupational exposure to asbestos in this specific industrial sector. METHODS: The MM cases were collected from the Mesothelioma Registry of Brescia. Work histories were obtained via a standardized questionnaire. Investigations were conducted in textile machinery manufacturing plants in order to collect information regarding the possible use of asbestos parts; at the same time, the use of asbestos friction materials and the use of sprayed asbestos for noise abatement purposes or thermal insulation was checked in the cotton industry by interviewing the management of two companies where a cluster of MM was observed. RESULTS: The Mesothelioma Registry of Brescia retrieved and collected 15 MM cases with past work in the cotton spinning industry, 4 of them employed in the same company. Further search of asbestos use gave positive results as the use of friction materials has been widespread since the fifties, while sprayed asbestos was not found anywhere in the cotton industry. On the other hand, half of the cases were employed during the thirties and forties, when friction materials appear to have been asbestos-free. Therefore the other hypothesis of exposure could be direct manufacture of asbestos yarn. CONCLUSION: The results of this investigation indicate the attribution, at least, of possible asbestos exposure"for those cases employed in textile industries since the fifties, according to the Re.Na.M guidelines; for those cases employed before that period the same classification can be attributed on an epidemiological basis. Previous work periods need further investigation in order to demonstrate the circumstances of the occupational asbestos exposure, given the heterogeneity of work processes and machinery characteristic of this industrial sector.

Immunotoxic effects of chemicals: A matrix for occupational and environmental epidemiological studies.

BACKGROUND: Many biological and chemical agents have the capacity to alter the way the immune system functions in human and animals. This study evaluates the immunotoxicity of 20 substances used widely in work environments. METHODS: A systematic literature search on the immunotoxicity of 20 chemicals was performed. The first step was to review literature on immunotoxicity testing and testing schemes adopted for establishing immunotoxicity in humans. The second step consisted of providing a documentation on immunotoxicity of substances that are widely used in work environment, by building tables for each chemical of interest (benzene, trichloroethylene, PAHs, crystalline silica, diesel exhausts, welding fumes, asbestos, styrene, formaldehyde, toluene, vinyl chloride monomer, tetrachloroethylene, chlorophenols, 1,3-butadiene, mineral oils, P-dichlorobenzene, dichloromethane, xylene, 1,1,1-trichloroethane, ethylene oxide). The third step was the classification of substances; an index (strong, intermediate, weak, nil) was assigned on the basis of the evidence of toxicity and type of immunotoxic effects (immunosuppression, autoimmunity, hypersensitivity) on the basis of the immune responses. Finally substances were assigned a score of immunotoxic power. RESULTS: Tables have been produced that include information for the 20 substances of interest, based on 227 animal studies and 94 human studies. Each substance was assigned an index of immunotoxic evidence, a score of immunotoxic power and type of immunotoxic effect. CONCLUSIONS: This matrix can represent a tool to identify chemicals with similar properties concerning the toxicity for the immune system, and to interpret epidemiological studies on immune-related diseases.

Personal use of hair dyes and hematolymphopoietic malignancies.

In the context of a population-based case-control study in Italy, the authors investigated the possible association between the personal use of hair dyes and non-Hodgkin's lymphoma (NHL), leukemia, multiple myeloma, and Hodgkin's disease. They collected all incident cases of hematolymphopoietic malignancies; the control group was formed with a random sample of the general population. Overall, the authors interviewed 2,737 research subjects and 1,779 control subjects. Among women, the authors found no association between ever using hair dyes and the risk of hematolymphopoietic malignancies. However, for permanent hair dyes, the authors observed a slightly increased risk of lymphocytic leukemia (odds ratio [OR] = 1.3; 95% confidence interval [CI] = 0.8-2.2) and of follicular subtypes of NHL (OR= 1.3; 95% CI = 0.8-2.0). Women who used black hair dye colors were at an increased risk of developing leukemia (OR = 1.9; 95% CI = 1.0-3.4), in particular chronic lymphocytic leukemia (OR = 3.0; 95% CI = 1.1-7.5). In spite of the lack of information on the timing and frequency of hair dye use and the imprecision of the ORs, associations were suggested between leukemia and permanent black hair dye use and follicular NHL and the use of permanent hair dyes.

Non-Hodgkin's lymphoma, leukemia, and exposures in agriculture: results from the Italian multicenter case-control study.

BACKGROUND: The etiology of non-Hodgkin's lymphoma (NHL) and leukemia is still largely unknown, but exposure to chemicals, in particular pesticides, has been suggested to be a risk factor. METHODS: A large population-based case-control study was conducted in Italy with the aim of investigating the associations between pesticide exposure and NHL, and solvents and leukemia. Data presented in this article refer to 1,575 interviewed cases and 1,232 controls in the nine agricultural study areas. RESULTS: Exposure to nitro-derivatives and phenylimides among fungicides, hydrocarbon derivatives and insecticide oils among insecticides, and the herbicide amides are the chemical classes observed to be associated with the pathologies under investigation. CONCLUSIONS: The results of the case-control study suggest an increased risk for NHL and leukemia, and some chemical classes of pesticides, although few are statistically significant and some are based on few exposed cases. The results also show that men and women experience both similar and different risks for the same environmental agricultural exposures. Am. J. Ind. Med. 44:627-636, 2003.

[Experience of epidemiological surveillance of reproductive health in women employed in the health field]. / Sperimentazione di un sistema di sorveglianza epidemiologica per la salute riproduttiva di donne che lavorano nel comparto ospedaliero.

Aim of this paper is to describe the methodology adopted to build up an epidemiological surveillance system on the reproductive health of women employed by the Regional Health System (Hospital Division). The implementation of this system required the set up of a relational database, with personal and health data collected from the 1st January 1998 to the 31st December 1998. The goals of research were: to describe the phenomenon of unfavorable reproductive events such as: death at birth, low weight at birth, birth defects, spontaneous abortions, voluntary abortions (for reasons linked to the child's and the pregnant woman's health), premature births and post term births; to provide the basis for further analytical studies on working activities with exposures of particular interest (antiblastic drugs, ionizing radiations and ergonomic factors); to contribute to evaluate the state of enforcement of the specific legislation. We computed raw, age-specific and standardized rates of the studied population as far as natality, spontaneous and voluntary abortivity and birth defects are concerned. The results showed an increased number of spontaneous abortions. Investigations are still in progress and an estimate of risks associated with chemical and physical exposures in this sector will be determined.