[Epidemiological evidence of possible musculoskeletal, cardiovascular and neoplastic effects in professional drivers]. / Le evidenze epidemiologiche sui possibili danni muscoloscheletrici, cardiovascolari e neoplastici nei lavoratori del settore dei trasporti terrestri.

The road and rail transport sector, since the several work tipology and risk factors for workers safety and health, is an area where assessing exposure effects is very difficult. Muscoskeletal cardiovascular and neoplastic diseases are the disorders more frequently associated to professional drivers. The role of professional driving is rather well-defined in low back pain occurence, correlated to whole body vibration exposure. Professional drivers are at higher risk of ischemic cardiovascular diseases, but it is not clear whether the risk is attributable just to the occupational exposures or also to their life-style risk factors. Evidence of an excess of risk for lung, genito-urinary and hemolymphopoietic cancer is clear in the scientific literature for professional drivers. Anyway the lack in the control of confounding factors, in exposure assessment force to be very cautious in results interpretation.

[Reduction of tobacco smoking among physicians of a hospital in central Italy]. / Riduzione dell'abitudine al fumo di tabacco tra i medici di un'Azienda Ospedaliera dell'Italia centrale.

This study assessed the variations in smoking habit in physicians in a General Hospital in Central Italy in 12 years. Data were collected from medical records of workers who underwent health surveillance in 1998-99 and in 2010-11. The prevalence of smokers was 26.3% (male 25.6%, female 27.6%) in 1998-99 and 19.2% (male 19.8%, female 18.5%) in 2010-11. As compared to 1998-99, the prevalence of smokers in 2010-11 was reduced in both sex and in all age classes. Despite the relevant reduction, the prevalence of smokers among physicians remains still high. Occupational physicians could play an important role against tobacco smoking, as they can provide a brief counseling to all smoking physicians during medical health surveillance at workplace and take part in worksite health promotion programmes.

[Permanent education, updating and accreditation in occupational medicine: the contribution of the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII) in the first decade of the 21st century]. / Formazione, aggiornamento ed accreditamento in Medicina del Lavoro: il contributo della Società Italiana di Medicina del Lavoro e Igiene Industriale (SIMLII) nel primo decennio del 2000.

BACKGROUND: Permanent education of health workers is obligatory under Italian legislation and is managed by the Ministry of Health through its Permanent Education Programme. METHODS: In 2000 the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII), set up and implemented a programme of Permanent Education and Accreditation for specialists in occupational medicine, based on participation in "non-mandatory" and "mandatory" educational activities. "Non-mandatory" activities were chosen by the individual physician for education in topics related to occupational medicine. "Mandatory" educational activities, which were organised by the Society, included in-depth analysis of the Society's guidelines related to specific topics in occupational medicine. RESULTS AND DISCUSSION: The Guidelines study course played a pre-eminent role in the Society's permanent education programme and was greatly appreciated by all participants. The Board of the Society has recently approved a new Plan of Permanent Education, identifying the means (Guidelines, Consensus Documents) whereby occupational physicians can improve their professional standards. The Plan's aims are to facilitate accreditation and also to identify and promote high-quality updating programmes which will lead to recognition of 'professional excellence". Crucial to its success will be a 3-year on-line learning programme (MeLA) that SIMLII has just implemented, which will enable occupational physicians to acquire credits in "Occupational Medicine and Workplace Safety", as required by current Italian legislation. This article summarizes SIMLII activities over the past ten years in the field of permanent medical education for occupational physicians.

[Are targeted interventions needed in foreigner workers with latent tubercular infection? A study on anti-tubercular treatment compliance among health care workers]. / C'è esigenza di interventi mirati nei lavoratori stranieri affetti da infezione tubercolare latente? Uno studio sulla compliance alla terapia antitubercolare in operatori sanitari.

INTRODUCTION: Health care workers (HCWs) are at high risk of latent tubercular infection (LTBI). In this study predictors of anti-tubercular treatment interruption in HCWs with LTBI are evaluated. METHODS: 1056 HCWs with LTBI were followed up to register adverse events and predictors of treatment interruption. RESULTS: 289 workers did not complete the treatment. Predictors of treatment interruption were adverse events (OR 1.47; 95CI% 1.07-2.03) and to be born in South-America (OR 1.55; 95CI% 1.06-2.26). CONCLUSION: The higher risk in South-Americans supports the need of targeted formative interventions on these workers.

[The Italian Society of Occupational Medicine and Industrial Hygiene: one hundred years of history]. / La Società Italiana di Medicina del Lavoro e di Igiene Industriale: cento anni di storia.

This research project, in conjunction with the SIMLII foundation's 80th anniversary, is aimed to reconstruct the historical chronology of the institutional life of the Society: the Directive bodies, the by-laws, the main steps of the scientific activity, especially the Congresses of Occupational Health. The research will also analyze the most important elements of historical context explaining Society's evolution: the relationships between SIMLII and political-institutional and legislative framework, social and economic changes, medical science's evolution and the university teaching and research, and finally the interactions with the international context. The research covers the years since the first national meeting of Occupation Health, in 1907, in which scientific activity was particularly intense, although the foundation was officially only in 1929. The investigation of the documentation after the 2nd World War is aimed at reconstructing the reborn of the international relations and the social, cultural and economic changes occurred between 1968 and 1978 and the deep impact on industrial relations and the enactment of the "Statuto dei lavoratori" in 1970 and the Health Reform in 1978.

[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.

[Occupational accidents, work performance and obstructive sleep apnea syndrome (OSAS)]. / Infortuni e performances sul lavoro in lavoratori affetti da sindrome delle apnee ostruttive nel sonno (OSAS).

Although many patients with obstructive sleep apnea syndrome (OSAS) form part of the work force, the impact of OSAS on occupational accidents and on work performance is unclear. To address this issue, we investigated 100 referents workers without OSAS (50 blue-collar and 50 white-collar) and 331 workers affected by OSAS (144 blue-collar and 187 white-collar). Workers affected by OSAS had been involved in occupational accidents more often than referents (27.2% vs. 20%). The mean number of accidents/year was slightly higher in blue-collar workers with OSAS and significantly higher (p=0.013) in white-collar workers with OSAS than referents. Furthermore, workers with OSAS referred more impairments in work performance as difficulties in memory (p=0.000), vigilance (p=0.000), concentration (p=0.000), performing monotonous tasks (p=0.000), responsiveness (p=0.000), learning new tasks (0.006) and manual ability (p=0.023), with the mean number of impairments being higher (p=0.000) in workers with a more severe OSAS (referents = 0.32; mild OSAS = 1.11; severe OSAS = 1.70). These results suggest OSAS increases the risk of occupational accidents and impaired work performance. Given the impact of OSAS on fitness for duty assessment, occupational physicians should be aware of it and could play a strategic role in its diagnosis, in monitoring treatment, and in providing appropriate information.

[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.

[Smoking ban observance in a general hospital]. / Il rispetto del divieto di fumare in un'Azienda Ospedaliera.

Passive smoking is one of the main risk factors for severe chronic diseases. Hospitals are appropriate settings for promoting tobacco smoking cessation and preventing passive smoking. Moreover, since 2003 Italian Law (no 3/2003) forbids smoking in enclosed workplaces. The smoking ban should be strictly observed in hospitals. This study assessed smoking ban observance and exposure to ETS in a group of paramedical personnel working in a General Hospital (n=1037). Each subject answered a self-administered questionnaire. The prevalence of smokers was 31.2% in females and 31.5% in males. 83% of non-smokers and 66.6% of smokers approved the smoking ban in the hospital but 39.6% of non-smokers and 17.4% of smokers stated it was not observed. Percentages of, respectively, 57.0% and 31.1% in 2004 had dropped in 2005 and in 2006, after Law no 3/2003 was implemented. More than 90% of paramedical personnel declared that workers usually smoked in the workplace. 11.1% of non-smokers reported they were often exposed to ETS and 50% sometimes. These result show the smoking ban was not fully observed in the Hospital, where many workers reported they were exposed to ETS. Occupational Physicians should encourage health workers to stop smoking by offering appropriate counselling.

[Smoke habit in a population of apprentices in middle of Italy]. / Abitudine al fumo in una popolazione di apprendisti dell'Italia centrale.

This study assessed the smoking habit in 7,159 apprentices (females: 53.3%) in central Italy. In the period 1996-2006, each apprentice underwent a compulsory health examination to assess fitness for work carried out by specialists in Occupational Medicine. Demographic data and information on schooling, smoking habit, alcohol and coffee intake were collected by a questionnaire. Overall, 51.9% of apprentices were smokers. Smokers were fewer among female apprentices than among the males (48.3% vs 55.9%; chi-square test, p < 0.001). No decrease in the prevalence of smokers was evident during the study period. Low educational level, and daily intake of alcohol and coffee significantly increased the risk of being a smoker. Finding a high percentage of smokers among Italian apprentices with a low educational level who are employed in jobs for which few qualifications are required indicates the need for work-place activities against tobacco smoking habit. Specialists in Occupational Medicine who perform regular health surveillance of workers could play a role in the anti-smoking campaign by integrating their routine work with brief counselling sessions aimed at preventing smoking in young workers and helping smokers to stop and by collaborating in work-place health promotion programmes.

[Urinary 1-naphthol in the general population of Umbria]. / 1-Naftolo urinario nella popolazione generale umbra. Risultati preliminari.

INTRODUCTION: Naphthalene, the most volatile polycyclic aromatic hydrocarbon (PAH), was recently classified as possible human carcinogen by International Agencies for Research on Cancer Humans may be exposed to naphthalene from a wide variety of sources, including occupation, environment, personal habits. We assessed urinary excretion of 1-naphthol (1-NAF), biomarker of naphthalene exposure, in non-occupationally exposed subjects. MATERIALS AND METHODS: Urinary 1-NAF, 1-hydroxypyrene (1-OHP), biomarker of exposure to pyrene and cotinine, biomarker of smoking habits, were measured in 104 adults (53 men, 51 women). RESULTS: 1-NAF concentrations overlapped in males and females (median: men 0.35 Microg/g creat; women: 0.46 microg/g creat). Median concentration of 1-NAF was 6-fold higher in smokers compared to nonsmokers (respectively, 7.7 microg/g creatinine vs 1.3 microg/g creatinine). Between smokers, urinary cotinine was positively correlated to 1-naphthol (rho: 0.69; p < 0.01) and 1-OHP (rho: 0.53; p < 0.01). Higher 1-OHP concentrations were found in smokers (median: smokers 0.16 microg/g creatinine, not-smokers 0.05 microg/g creatinine;). CONCLUSIONS: In our study population, we found that 1-NAF excretion is much higher as compared to 1-OHP excretion. This is due to the ubiquitous presence of naphthalene in the environment. Smoking considerably increase the exposure to naftalene.

[Respiratory diseases in confined non-industrial working environments]. / Ambienti di lavoro indoor e malattie dell'apparato respiratorio.

Modern, non-industrial workplaces may, because of building techniques, widespread use of synthetic materials and artificial ventilation, create risks for the health and well-being of workers. Indoor air pollution by chemical, biological and sometimes physical agents constitutes a significant risk factor, particularly for the respiratory system. The most common effects of exposure to, and inhalation of, indoor air pollutants include acute and chronic inflammations, acute worsening of pre-existing respiratory symptoms or illnesses and airway sensitization to indoor allergens. Upper airway disturbances with an allergic or irritative aetiology are very frequent; Asthma and Hypersensitivity Pneumonitis are more rarely reported but may become severe and widespread when certain environmental conditions prevail. Respiratory infections may have a human source such as tuberculosis or viral diseases or may originate in ventilation systems such as Legionnaire's disease (Legionella pneumophila pneumonia). As all these pathologies may have high social and economic costs and appropriate therapy is not always available, the specialist in Occupational Medicine plays a pre-eminent role in early diagnosis and prevention of respiratory diseases linked to indoor air pollution in the workplace.

Indoor air quality and health in offices and other non-industrial working environments.

BACKGROUND: Over the last 30 years, transformation of indoor environments--in particular in office blocks--has been associated with complaints from workers of discomfort, malaise and even diseases termed Building Related Illnesses (BRI) which are classified as specific (e.g. Legionnaire disease, asthma, hypersensitivity pneumonia) or non-specific (e.g. the Sick Building Syndrome). METHODS: A review was made of data from international public health organisations, epidemiological, clinical and experimental studies and congress proceedings from 1990 to 2006 on the topic of indoor air quality and health in modern, non-industrial workplaces. RESULTS: Studies focused on ventilation, temperature and air humidity and specific pollutants such as Volatile Organic Compounds, particules asbestos fibres, environmental tobacco smoke, radon and biological agents. We can now measure microclimate parameters and many indoor air pollutant levels as well as their effects on health; we can also formulate indications of threshold and guideline values for some of these and make a preventive assessment for toxic emissions from construction and furnishing materials. A stepwise, multi-disciplinary approach--with the specialist in occupational medicine playing a major role--is most suitable for dealing with BRI and the effects of poor indoor air quality on health. CONCLUSIONS: Better criteria are needed to study emission of substances into the indoor environment, adequacy of ventilation, additive or synergistic effects of mixtures of chemicals and toxicity of micro-organism decomposition products. Objective clinical tests to assess the effects of indoor pollutants on health and indices for Indoor Environmental Quality in assessing buildings need to be improved.

Evaluation of fitness for work: the most challenging situations.

Evaluation of fitness for work (FW) is the final task of both health surveillance and risk evaluation. It's aim is to protect the physical and psychological health of workers and respect their professional skills. The Occupational Physician faces several difficulties in the evaluation of FW. Moreover, Italian legislation on this topic can be variously interpreted and this can cause conflicting evaluations. In this session, the most challenging situations in FW evaluation will be taken into consideration.

Induced sputum, exhaled breath condensate and nasal lavage fluid in electroplating workers exposed to chromium.

Occupational exposure to chromium may cause airway inflammation and bronchial asthma. In this study we investigated the effect of chromium on the respiratory tract of exposed and non-exposed electroplating workers using spirometry and analysis of induced sputum (IS), exhaled breath condensate (EBC) and nasal lavage fluid (NLF). In both groups spirometry was normal; chromium in induced sputum was higher in exposed workers (7.90 +/- 0.855 microg/L, vs 1.78 +/- 0.075 microg/L; p<0.001); no significant difference was found in induced sputum cellularity. Median nitrite concentration in EBC was significantly higher in exposed subjects (4.35 micromol/L, 5 degrees -95 degrees percentile: 1.88-10.13 vs 0.11 micromol/L, 5-95 percentile: 0-0.72) (p<0.001). IL-6 and TNF-alpha were not detectable in EBC. Median IL-6 concentration in nasal lavage fluid was higher in exposed workers (5.72 pg/ml, 5-95 percentile: 0-65.25 pg/ml vs 0.28 pg/ml, 5-95 percentile: 0-1.7 pg/ml) (p<0.01). No differences in Eosinophil Cationic Protein concentration were found. TNF-alpha was not detectable in NLF. Chromium in induced sputum correlated with nitrites in EBC. For the first time three non-invasive methods were used to assess changes in respiratory tract in workers exposed to chromium. The results suggest chromium exerts an inflammatory/irritative action on airways.

[The logo of the Italian Society of Occupational Medicine and Industrial Hygiene]. / Il logo della società Italiana di medicina del lavoro e igiene industriale.

In 2003 the Board of the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII) decided to adopt a graphic symbol of the Society, that would be easy recognizable and could be used for the 75th anniversary of its foundation, in 1929. The task of drawing up proposals for the symbol was entrusted to the Section of Occupational Medicine and Toxicology of the University of Perugia. The article explains the difficulties in adequately representing the various different types of information enclosed in the logo; in particular, in choosing the most appropriate way to represent the art of medicine between Mercury's caduceus and Aesculapius' symbol. The logo chosen by the Board of the Society on 11 November, 2003, is illustrated by its author, Professor Umberto Raponi. The symbol officially came into use for the 67th National Congress of SIMLII, held in Sorrento, 3-6 November, 2004.

Lead poisoning caused by Indian ethnic remedies in Italy.

BACKGROUND: Complementary or alternative medicine has become widespread in Western Countries and since the remedies are "natural" they are believed to be free of toxic effects and health risks. Ethnic remedies may contain lead, other metals and toxic substances. OBJECTIVES: To show how lead poisoning as a result of using ethnic remedies may be severe enough to cause serious damage to health, and to increase awareness among family doctors and occupational physicians of the risks associated with ethnic remedies. METHODS AND RESULTS: Description of ethnic remedy-related lead poisoning in 2 native Italian adults, with clinical, laboratory and toxicological data. CONCLUSIONS: When metal poisoning is diagnosed, ethnic remedies should be included among the putative sources so as to avoid erroneous attribution to workplace exposure and application of unneeded preventive measures.

[Report on the activities carried out in the research project of the Ministry of Instruction, University, and Research entitled "Environmental and occupational exposure to inorganic lead: assessment of toxic effects of current doses and related preventive measures"]. / Presentazione delle attività svolte nell'ambito del progetto di ricerca MIUR "Esposizione ambientale ed occupazionale a piombo inorganico: studio degli effetti tossici conseguenti alle dosi correnti e delle relative misure preventive".

It is here presented the project sustained by the Ministry of Public Instruction, University and Research "Environmental and Occupational Exposure to Inorganic Lead: assessment of human health effects due to current doses and preventive measures" ruled out between 2001 and 2003. The aim of the study was to investigate about the toxic effects related to current occupational exposures to inorganic lead (particularly those effects concerning blood pressure, carcinogenic risk, nervous and immunological systems), to identify hypersusceptibility conditions, particularly the ALAD genetic polymorphism and to evaluate the role of traditional biomarker and the possibility of introducing new ones. In the present article the procedures followed during the project lasting and the contribution of each Unit are described. The results of the research, presented in detail in the current issue, do confirm the inadequacy of the biological exposure index nowadays ruled by Lex 25/2002.

[Effects of inorganic lead exposure on the autonomic nervous system and on the variability of heart rate among workers at a battery plant]. / Effetti dell'esposizione a piombo inorganico sul sistema nervoso autonomo e sulla variabilità della frequenza cardiaca in lavoratori di una fabbrica di accumulatori.

Inorganic Lead can cause a toxic effect on Central Nervous System, Peripheral Nervous System and Autonomic Nervous System (ANS). A damage of the ANS can determine an heart rate variability (HRV) reduction. In this study 43 battery workers exposed to inorganic lead with mean PbB = 31.63 microg/dl (DS 14.77 microg/dl) and 35 not exposed subjects underwent to an evaluation of heart rate variability by specific tests. Heart rate variability in the exposed group was, for some tests (lying to standing, lying to standing-standing to lying) reduced compared with not exposed subjects and for other tests (Valsalva manouvre, lying to standing-standing to lying) correlated with PbB and Zinc Protoporphyrin (ZPP), but not with BMI, age and smoking habits. This study, like others conducted on similar populations, suggest an effect of occupational inorganic lead exposure on Autonomic Nervous System and heart rate variability

Needs, education and accreditation in occupational medicine in Italy.

In Europe, continuing medical education is one of the main instruments for improving physicians' performance and ensuring adequate health care for citizens. Recent regulations have made such continuing education compulsory in Italy. Considering the particular features of occupational medicine, the Italian Society of Industrial Medicine and Industrial Hygiene (S.I.M.L.I.I.) recently set up a specific education and accreditation programme for occupational physicians, called the "Excellence Accreditation Scheme". The programme is based on the findings of a survey among occupational physicians, carried out in collaboration with the National Institute of Occupational Safety and Prevention (I.S.P.E.S.L.), which enquired into their training and continuing education needs. The programme started in 2003, and its first edition-presented here-involved more than 400 physicians specialising in occupational health.