Long-Term Functional Outcome after Internal Delorme's Procedure for Obstructed Defecation Syndrome, and the Role of Postoperative Rehabilitation.

PURPOSE: To evaluate long-term functional outcomes of Internal Delorme's Procedure (IDP) in patients refractory to conservative treatment for Obstructed Defecation Syndrome (ODS), and to compare those who received postoperative rehabilitation with those who did not. MATERIALS AND METHODS: All patients with ODS refractory to nonoperative therapy were identified across three regional pelvic floor referral hospitals, and IDP was performed. Postoperatively selected patients received biofeedback therapy. Functional outcomes were established using the Cleveland Clinic Constipation (CCC) score and obstructed defecation score (OD score) preoperatively at 12 months and at the last available follow-up. Patient satisfaction was assessed with a visual analogue score. RESULTS: From October 2006 to September 2013, IDP was performed in 170 patients: 77 received postoperative biofeedback and 93 did not. Mean follow-up was 6.3 years (range 1-8 years). CCC and OD scores improved significantly in both groups after 12 months and at the last follow-up (p > 0.05). When comparing two groups while there was no significant difference between CCC and OD scores at 12 months, score was significantly better in the group that received rehabilitation at the last follow-up (p = 0.001). Patient satisfaction was higher in the rehabilitation group (67%) compared with those without rehabilitation (55%). Clinical recurrence was recorded in nine patients who did not have postoperative rehabilitation. CONCLUSIONS: It has been demonstrated that IDP is associated with good long-term functional outcomes. Patients receiving rehabilitation had a better long-term follow-up, a higher overall satisfaction, and lower recurrence rate when compared with the patients who did not receive postoperative rehabilitation.

[Pilot study: Apricena Marble District quarry workers and COPD]. / Studio pilota: addetti alle cave di pietra nel distretto del Marmo di Apricena e BPCO.

The aim of the present article was to verify the Chronic Obstructive Pulmonary Disease (COPD) prevalence in a cohort of quarry workers who belong to the Apricena Marble District. We studied 70 workers. They received a questionnaire about the disease and confounding factors. The spirometry showed that the FEV1 was normal in 95% of workers, instead 5% showed values lower than former (Average: 73%). TNF alpha and IL-1 Beta in Exhaled breath condensate (EBC) were lower than the method limit in all workers. Our cohort is limited, but we could retain that the lung disease is not present in workers taken into consideration. Our results are in according to Rushton who demonstrated that only a prolonged occupation, higher than thirty years, is able to induce lung disease.

[Manufacture of upholstered furniture and work-related upper limb musculoskeletal disorders: an industrial sector prevention project]. / Produzione del mobile imbottito: un progetto di ricerca finalizzato alla prevenzione delle patologie da sovraccarico biomeccanico degli arti superiori. Presentazione delle caratteristiche del comparto.

BACKGROUND: In cooperation with the IRCCS Fondazione Maugeri and the IRCCS Fondazione Ospedale Maggiore Policlinico - EPM-CEMOC, of Milan, the Local Health Unit in Bari, Italy carried out a research project, sponsored partly by the Italian Ministry of Health, on upper limb work-related musculoskeletal disorders (UL-WMSDs) in a specific manufacturing sector, the upholstered furniture industry. This "sofa district" is widely represented with approximately 14,000 workers and 500 factories over a wide geographic area of southern Italy. Advanced technology in the manufacturing process is combined with workers performing intensive arm-hand tasks. OBJECTIVES: The aim of the study included: a) assessment of exposure to repetitive strain and movements of the upper limb in a representative sample of the factories using the OCRA method, b) analysis of the annual prevalence and incidence rates, c) definition of possible improvement via ergonomic solutions in the various factories. METHODS: Via a network of occupational physicians a total of more than 6000 subjects were examined over a 5-year period. Case-definition was assessed through standardized procedures. RESULTS: A detailed description of the manufacturing process of the upholstered furniture industry and of the characteristics of the working population is provided Exposed groups at risk were:filling preparation workers, leather-cutting operators, sewing and upholstery-assembly workers. CONCLUSIONS: Data collected in private companies of different size in this extensive industrial "sofa area" emphasize the importance of prevention through adequate ergonomic solutions and the need to improve training programmes covering the whole area.

[Upper limb work-related musculoskeletal disorders (UL-WMSDs): a retrospective cohort study in three large factories of the upholstered furniture industry]. / Patologia da sovraccarico biomeccanico degli arti superiori: studio retrospettivo di coorte in tre grandi aziende del mobile imbottito.

BACKGROUND: The epidemiological evidence of work-related musculoskeletal disorders (UL-WMSDs) due to repetitive strain and movements in the various industries has been collected in the literature mainly through cross-sectional surveys. In particular there are no contributions so far regarding the upholstered furniture industry with a longitudinal design. OBJECTIVES: The aim of the study was to evaluate the incidence rate of WMSDs such as hand-wrist and shoulder tendonitis, carpal tunnel syndrome, and epicondylitis in exposed workers of three large companies of the upholstered furniture industry in a large geographic area of southern Italy. METHODS: The OCRA method, recommended by international standard ISO 11228-3 and EN 1005-5, was used for risk assessment. The following work tasks were considered:.filling preparation workers, leather-cutting operators, sewing and upholstery-assembly workers. A total population of 5,278 subjects (exposed n=2927, controls n=2351) was investigated. The person/year at risk parameters were calculated from 1 January 2000, or from the date of engagement if later, until the first diagnosis of WMSD or, in absence of disorders, until the end of the study, i.e. 31 December 2004. Disorders occurring after the first were not considered. A multiple regression analysis was used to evaluate relationships between rates. RESULTS AND CONCLUSIONS: Incidence rates correlated with risk classes of the OCRA index. An incidence rate of WMSDs higher than 1.2 cases per 100 person/year may be considered as a threshold value to suspect an occupational exposure to repetitive strain and movements warranting further investigation. The analysis of single factors did not show a greater predisposition of the female gender, with the single exception of the carpal tunnel syndrome (RR 2.92; 95% CI 1.57-5.43). Shoulder disorders affected mainly male leather-cutting operators (RR 4.97; 95% CI 2.03-12.16) and among all the factors influencing risk (frequency, force, posture, additional risk factors, pauses) posture seems to play a significant role.

[Prevalence of upper limb work-related musculoskeletal disorders (UL-WMSDs) in workers of the upholstered furniture industry]. / Prevalenza delle patologie da sovraccarico biomeccanico degli arti superiori negli addetti del comparto del mobile imbottito.

BACKGROUND: The upholstered furniture industry, the so-called "triangle of the sofa industry", is a geographic area of national and strategic economic importance in southern Italy. The single tasks are carried out mostly manually, with the characteristics of a handicraft approach. OBJECTIVES: The aim of the survey was to assess the prevalence of upper limb work-related musculoskeletal disorders (UL-WMSDs) in 30 factories of the sofa industry located in a large geographic area of the Puglia and Basilicata Regions. METHODS: In the period 1 January-31 December 2003 a network of occupational physicians investigated a population of 5.477 subjects (exposed n=3481, controls n=1996, M=3865, F=1612) in 30 different factories of the area. More than 60 percent of the total workforce studied was employed in large-sized companies (>500 employees). The following work tasks were considered: filling preparation workers, leather-cutting operators, sewing and upholstery-assembly workers. Case-definition was assessed through standardized procedures: symptoms by questionnaire plus physical and laboratory/imaging findings. RESULTS: Cumulative prevalence rates of UL-WMSDs as at 31 December 2003 reached values of up to 30% in high risk groups. Prevalence rates showed good correlation with the concise OCRA index used for assessment of exposure to repetitive strain and movements of the upper limb. The most frequently occurring disorders were tendon-related cysts and wrist tendonitis. Shoulder disorders were more frequent in male and female leather-cutting operators. CONCLUSIONS: This survey showed a significantly high prevalence of UL-WMSDs in sofa industry workers. It did not seem to be confirmed in this study that there was a greater female susceptibility to UL-WMSDs with the exception of carpal tunnel syndrome: gender difference seems to be less relevant at increasing levels of occupational exposure to repetitive movements and exertion of the upper limbs.

[Promoter effect induced by HgCl2 by studying the intercellular communication]. / Effetto promoter indoitto da HgCl2 attraverso lo studio della comunicazione intercellulare.

This work aims at assessing at molecular level the effect caused by the HgCl9 intercellular communication inhibition at non-cytotoxic doses. On the basis of our previous experiences, we exposed the human keratinocytes (HUKE) at 10 nM of HgCl2 for 24 hours Next, we estimated: a) the protein expression of connexines Cx43, Cx32 and Cx26 by western blotting; b) the amount of mRNA corresponding to the three connexines by semi-quantitative RT-PCR; and c) the production of reactive oxygen species in HgCl2 treated cells using a specific probe, i.e. DCF in confocal microscopy. Our study demonstrated a higher expression of the transcripts for Cx26, Cx32, Cx43, and a higher amount of proteins Cx43, Cx32 and Cx26, compared to the negative controls. Furthermore, we studied the effect of HgCl2 on the ROS production in keratinocytes, by the analysis in confocal microscopy carried out with the DCF, fit for marking the oxygen free radicals. In HgCl2 treated keratinocytes we obtained an increase of the ROS production compared to controls; and further the mitochondrions resulted the place of ROS production. The results of this study suggest that non-cytotoxic HgCl2 concentrations, might cause an unbalancing of the redox cellular state (ROS increased level), and we can assume that the activation of a redox signalling involves the inactivation of gap junctions.

[Evaluation of the occurrence of a rare work related disease in a cohort of workers employed in the processing of paper]. / Valutazione dell'occorrenza di una malattia professionale "rara" in una coorte di lavoratori addetti alla lavorazione della carta.

The aim of our study is evaluating occupational exposure in a factory named "Poligrafico Zecca dello Stato" in Foggia. The workers had a occupational disease "chlorine related parodontal disease" indemnified by INAIL (Italian Occupational Assurance). The study demonstrated the workers have been indemnified worked as engineer, drying and electrolysis process employed. The study showed that the workers indemnified without legal action were different in respect of workers that take legal action, because the last showed, paradoxically, a chlorine occupational exposure. The explanation of this paradox might be the production cycle non acknowledge by operators.

[Symptoms and musculo-skeletal changes among personnel of the State Police exposed to mechanical risk]. / Sintomi ed alterazioni muscolo-scheletriche in personale della Polizia di Stato esposto a rischio biomeccanico.

The aim of this present study was to inquire about spine morfo-functional alterations among policemen with jobs regarded as potentially hazardous, in order to identify preclinical alterations of column and to plan adequate preventive measures. A physiopathologic and working anamnesis was carried out by means of questionnaire about personal data, jobs, reported rachidian symptomatology and presence of orthopedic diseases, given to policemen on duty in Bari. Every chosen worker was subject to orthopedic and neurological examination, radiography of column, Formetric tridimensional examination, telethermography of spine. We stratified the sample on the basis of age and job. Under the jobs we individuated 4 biomechanical hazardous activities, performed separately or together: driving motorcycle, driving car, flying helicopter, video terminal use. The whole sample, formed by 211 subjects, all male, had the average age of 39 years (Standard Deviation: +/- 4). About the reported rachidian symptomatology, only 41 (17, 98%) subjects were asymptomatical, contrary to clinical results, that were normal in almost the entire sample, with the exception of 3 workers (1, 31%), who had neurological clinical alterations. Structural alterations were checked by radiography among 64, 9% of subjects. The Formetric examination found alterations in different tract of rachis, also coexiting between each other. The telethermographic changes affected 63,99% of the sample and involved especially the lumbar tract (38,86%), dorsal region (18%) and cervical zone (7,1%). The relative frequency of dorsal tract increased with growing of age. The morfo-functional changes of the sample seem to depend rather on the performed job, than on degenerative process of age, partly because the average age of the sample is not much elevated and because the enlistment in Italian Police Force is subordinated to verification of optimum conditions, also characterized by absence of anomaly of column. The absence of clinical alteration, in contrast to reported rachidian symptomatology by 82,02% of subjects and with discovered objectivity, demands more clinical attention in presence of symptomatology and proposes supplementary non-invasive techiniques of investigation, as the telethermography and the formetric tridimensional examination.

Role of tumour necrosis factor alpha and interleukin 1 beta in promoter effect induced by mercury in human keratinocytes.

In the progress of a carcinogenetic process, the promoter effect was seen as the final event able to determine uncontrolled proliferation. The promoter effect begins with an inhibition of gap junctional intercellular communication. Previously we observed an inhibitory effect of Mercury (HgCl2) on Gap Junction Intercellular Communication of Human Keratinocytes in culture. Here we evaluate the effect of Mercury on gap junctional intercellular communication, on cytokines intracellular concentrations and on cytokines secretion of Human Keratinocytes. In particular, we report a reduction of the intracellular concentrations and secretions of Tumour Necrosis alpha and Interleukin 1 beta. It is known that the inhibitory effect on Gap Junctional Intercellular Communication is correlated with a promoter effect induced by carcinogens. In this paper we discuss the relationship between the inhibition of gap junctional intercellular communication and cytokine production, and whether these effects are related in an xenobiotic carcinogenesis process. Our considerations could be seen as too adventurous, but they may set the stage for an open discussion of our results according to the literature. An intriguing relationship appears to develop when comparing the effects of proinflammatory mediators on GJIC. Although highly speculative, a review of the current literature would suggest that the GJIC inhibition induced by mercury might be the beginning of the promoter effect, but the role induced by cytokines on initiated cells to stimulate its proliferation remains to be determined We think that the reduction of TNF-alpha, and in part IL-1beta, induced by mercury might favour the cancer. We hypothesise that the reduction of cytokines and inhibition of the gap junction intercellular communication are correlated and they may play a role in the xenobiotic carcinogenesis process.

The study of gap junctional intercellular communication in keratinocytes as screening of promoter effect induced by industrial and environmental toxic substances.

BACKGROUND: Disordered functioning of gap junctions between normal and initiated cells has been proposed as one possible mechanism of tumour promotion. Many putative carcinogens such as peroxisome proliferators, are known to activate various signal transduction mechanisms and modulate gap junctional intercellular communication (GJIC). They act as tumour promoters on pre-existing "initiated" cells, rather than as genotoxic initiators. OBJECTIVES: The aim of this article is to provide a screening-tool to evaluate the promoter carcinogen effect of environmental and occupational chemical contaminants, focusing on their ability to alter GJIC. METHODS: GJIC was investigated in serum-free cultured primary human keratinocytes, by directly evaluating the intercellular transfer of a microinjected fluorescent dye (Dye transfer). The expression of caspase 3, which is the ultimate target to be activated of both mitochondrial- and non-mitochondrial-linked pro-apoptotic pathways, was evaluated using Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). RESULTS: Mercury chloride (10 nM), mono-methyl Mercury (250 nM) and Trichloroethylene (500 I1M) were shown to significantly inhibit GJIC. Conversely di-methyl mercury, lead acetate and epichloridine had no effect on GJIC. All Trans Retinoic Acid completely reversed the inhibitory effect on GJIC induced by HgCI2 but not that induced by mono-methyl mercury and trichloroethylene. The result of a RT-PCR assay on total RNA cell extract showed that treatment of keratinocytes with 10 nM HgCl2 resulted in a decrease of the pro-apoptotic caspase 3 expression. CONCLUSIONS: In this work a protocol is designed to study gap junction intercellular communication in primary cultures of human keratinocytes which could be used as a reliable screening tool to test the promoter carcinogen effect of various environmental and occupational contaminants.

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.

Effects of methylmercury on the microvasculature of the developing brain.

The study, undertaken with the aim of further investigating the effects of methylmercury (MeHg) exposure on the developing brain, was performed in the cerebellum of chick embryos, chronically treated with a MeHgCl solution dropped onto the chorioallantoic membrane, and in control embryo cerebella. Quantitative evaluations, performed by cold vapour atomic absorption spectrophotometry, demonstrated a high mercury content in the chorioallantoic membrane, encephalon, liver and kidney of the treated embryos. The morphological observations showed severe neuronal damage consisting of degenerative changes of the granules and Purkinje neurons. The effects on astrocytes were even more severe, since they were extremely rare both in the neuropil and around the vessel wall. Compared with the controls, the cerebellar vessels of MeHg-treated embryos showed immature morphology, poor differentiation of endothelial barrier devices, and high permeability to the exogenous protein horseradish peroxidase. These findings support the hypothesis that MeHg-related neuronal sufferance may be secondary to astrocytic damage and suggest that the developmental neurotoxicity of this compound could also be related to astrocyte loss-dependent impairment of blood-brain barrier (BBB) differentiation.

[Survey on educational needs in occupational medicine in Italy]. / Indagine conoscitiva sul fabbisogno formativo in medicina del lavoro in Italia.

The importance to correctly address continuing education among occupational health professionals in Italy has been particular in the focus of the Scientific and Professional Medical Community also in consideration of the recent regulations implemented in the field of Continuing Medical Education (CME). The Italian Society of Occupational Medicine recently developed an advanced programme of Continuing Medical Education for Occupational Physician. In order to correctly asses the education needs and collect valid information of Occupational Physicians in Italy we administered a target questionnaire among a group of them. The results are analyzed and discussed.

[Excellency accreditation by the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII)]. / L'accreditamento d'eccellenza della Società Italiana di Medicina del Lavoro e Igiene Industriale.

BACKGROUND: The Italian Society for Occupational Health and Industrial Hygiene (Società Italiana di Medicina del Lavoro e Igiene Industriale)--SIMLII--has taken a systematic approach to the topic of permanent education of occupational health physicians over the last 4 years, developing its own project entitled "SIMLII Permanent Education and Excellency Accreditation". OBJECTIVES: The SIMLII Project, which is addressed to occupational health specialists and physicians authorized under Law 277/91, art. 55, is based on the participation of "obligatory" and "non-obligatory" educational activities and on assessment of professional activity. "Obligatory" educational activities are events organized directly by SIMLII and consist of a detailed study of the guidelines concerning specific occupational health topics. The "non-obligatory" events are those regarding occupational health that the physician chooses voluntarily, with accreditation by the Ministry of Health and/or by SIMLII. The occupational health physician who enrolls for the 3-year course must obtain a total of 180 SIMLII training credits in the 3 years (60 per year). Assessment of activity performed is made at the end of the 3 years of training according to criteria set out by SIMLII and approved by the membership, via a self-administered questionnaire. METHODS AND RESULTS: The SIMLII Project has laid great emphasis on drawing up guidelines on topics specific for occupational health. These guidelines are developed by groups of experts selected by SIMLII and deal with topics that the occupational health physician most frequently encounters in the course of his/her professional activity. There are 405 participants in the first 3-year training course covering the whole of Italy. The aim of the Italian Society for Occupational Health and Industrial Hygiene, via excellency accreditation and drawing up of guidelines for particularly important topics, is to provide useful tools to satisfy the training requirements of its membership, to improve the quality of professional services and to emphasize the uniqueness and specific nature of occupational health within the medical specialties.

[Implementation of parliamentary act D. Lgs 25/02 and definition of "moderate risk"]. / Applicazione del D.Lgs 25/02 e definizione di "rischio moderato".

This paper describes the position of the Joint Working Group of the Italian Association of Industrial Hygienists (AIDII), the Italian Society of Occupational Health and Industrial Hygiene (SIMLII) and the Italian Society of Toxicology (SITOX) on "Analysis of Parliamentary Act D.Lgs 25/02 and role of the Scientific Societies in the definition of Limit Values". The positive aspects of the new law which implements the European Directive 98/24 are discussed, including the abolition of the rigid periodicity of medical examinations as stated by the old rule D.P.R. 303/56. The Authors also address various parts of the law which appear to be unclear and controversial and highlight the expected difficulties arising for the employers and the safety and health professionals during the application of this new piece of legislation. Moreover, a number of discrepancies are noted between the new Italian law and the original Directive or other current Italian rules such as i. the translation of the term "slight risk", as from the original Directive, into "moderate risk", and the resulting non compulsoriness of health surveillance and biological monitoring of the workers in presence of a "moderate risk", ii. the concurrent exclusion, under the same circumstances, of the occupational physician from risk assessment procedures and iii. the upward modification of the previously established (D.Lgs 277/91) occupational exposure limits for lead. Moreover, the Authors examine and criticize--both in semantic and in toxicological terms--a recent proposal for the definition of "moderate risk" made by an ad hoc Consulting Committee of the Labour Ministry, in which the term "moderate" has been interpreted either as "low" or as "irrelevant for health effects", clearly two very different meanings. Besides, it would be inappropriate to define the conditions of a moderate risk based only on the level of exposure to the chemical (expressed as a fraction of the corresponding limit value), without considering the two other components of risk assessment for that chemical (hazard and susceptibility). Even worse would be the use of simplified models based on "algorithms", which might be useful in a preliminary phase of risk assessment, but easily could lead to an under- or over-estimation of risk, particularly when used by non professionals. In conclusion, the Working Group recommend that the new law be amended in order to clarify its most controversial aspects, whose misinterpretation could severely jeopardize the protection of the workers' safety and health at work.

[Effects of noise on cortical mechanisms involved in the development of linguistic sounds]. / Effetti del rumore sui meccanismi corticali di elaborazione dei suoni linguistici.

So far studies about noise effects on speech perception have been focused on the development of hearing loss and other related pathologies. However, behavioral findings indicate that speech perception and intelligibility are disrupted in presence of noise in certain clinical groups in a way that is unpredictable on the basis of the audiogram performed in silence. This observation suggests that even soft noise can modify the cerebral mechanisms underlying speech information processing. Confirming the behavioral results, electric and magnetic brain measurements showed that noise presented to healthy subjects decreases the amplitude and increases the latency of brain responses to speech sounds. Recently, further experimental data allowed us to have a deeper knowledge of the neural mechanisms interventing in difficult listening conditions. In particolar, speech sounds presented in noisy background evoke bioelectric responses in neural populations located in the right cerebral hemisphere, that otherwise would not be activated. These findings can in future contribute to unveal new aspects of the noise pathology and its assessment in an early pre-clinical stage.

[Assessment of heart rate variability (HRV) as a stress index in an emergency team of urban police]. / Valutazione della variabilità della frequenza cardiaca (HRV) come indice di stress in addetti al pronto intervento nella polizia urbana.

Stress is usually defined as the experience of negative events or the perceptions of distress and negative affect that are associated with the inability to cope with them. The parameter most suitable for large-scale field studies is the determination of endocrine activity by measurement of salivary cortisol. The aim of the present study is to identify the presence of sources of stress in an emergency team of urban police and to objective such stress using the PSS (Professional Stress Scale) test and bioumoral markers as salivary cortisol and interleukin 1 beta (IL1-B). Moreover it will be determined the Heart Rate Variability (HRV) that is able to mirror the sympathetic-parasympathetic balance. We studied 30 policemen who belonged to an emergency team. Thirty policemen made cardiologic exams as ECG, Heart Eco-doppler and Holter Ecg during the work and during the holiday. Particularly we studied HRV using frequency-domain based HRV measures. The results were evidenced as the differences of the spectral power. As control we used the same subjects during the holiday. T test was performed to evaluate the differences between the means, the Chi Square's Test was performed to determine the statistically significant association between PSS subscales, HRV, salivary cortisol and IL1-B concentrations. The study of HRV demonstrated a statistically significant association between HRV parameters during the holiday, salivary cortisol concentrations and PSS test. IL1-B, instead, was not associated with HRV parameters. Several precedent studies agree with our results. Our study has suggested a work related stress in urban police employed in an emergency team. We might conclude that salivary IL1-B and cortisol are useful markers of stress. The study of HRV parameters gave evidence that LF/HF during the holiday is a useful marker of work stress, because it correlated with cortisol difference during the work. Conclusively we can believe that the HRV parameters evaluated during the work are useful as confront, instead the HRV parameters during the holiday are surest indexes of work stress. Probably the effect of stress on the heart aren't present during the work because the work experience reduces these effects, they appear during the holiday when the imagination could make the conflicts or the problems more complex than they are. It might be useful to repeat this study after some structure organizational modifications and after training that will teach the workers coping strategies. If we consider only the bioumoral and PSS results, we might conclude that the stress discovered in this study is not hazardous for the health when the workers have adequate holidays, but if we evaluate the HRV parameters, we have believe that, for a heart health, it's necessary either to increment the holidays or, it can appear paradoxical, to work again.

[Occupational asthma and biological damage: adequate compensation?]. / Asma professionale e danno biologico: tutela privilegiata?

The evaluation of the damage to biological and relational capacities of the subject is the novel approach of the Italian Insurance Regulation Decree N(o) 38/2000 for compensating occupational asthma (OA). In this study we aimed to apply retrospectively the novel rating system to mild OA. From a data base of 201 diagnosis of OA collected in the 1987-97 decade 85 eligible consecutive cases of mild asthma according to the criteria of NIH/WHO guidelines on asthma were studied. Records on compensation were documented for 41 subjects. The average difference between novel scales and the actual rating individually assessed by Italian National Agency for compensation through criteria used at that time was 45.6 +/- 20%. The average difference between novel scales and rating calculated with guidelines considering the measurement of non-specific bronchial hyperreactivity developed by international experts and American Thoracic Society, endorsed by American Medical Association, was 41.5 +/- 12%. Within the actual rating individually assessed with previous Italian Insurance criteria no significant relationship (r=-0.20, p=0.2) was shown with bronchial responsiveness to methacoline expressed as provocative dose causing a 20% fall in FEV1 (PD20FEV1 microg of mch). A significant (p<0.05) relationship was observed with age at the time of OA diagnosis (r=0.37, p=0.017) and with duration of exposure (r=0.34, p=0.034). This study suggests that scales of the Insurance Regulation Decree N(o) 38/2000 grading mild OA underevaluate biological damage/impairment with reference both to previous practice in Italy and to international criteria guidelines. Among the parameters of evaluation methacoline challenge should be considered an adequate tool in measuring biological damage in OA for medicolegal purpose.

[Immunologic effects of exposure to low levels of inorganic mercury]. / Effetti immunitari da esposizione a basse dosi di mercurio inorganico.

OBJECTIVE: The immune system is a target for the toxic effects of inorganic mercury, both in humans and animals. In humans it has been observed that occupational and environmental exposure to inorganic mercury may cause both clinical (autoimmunity, hypersensitivity) and subclinical effects (cellular and humoral immunologic variable modifications). To obtain a better definition of these effects with respect to the exposure levels, a multicentre study was performed on 117 workers exposed to very low doses of inorganic mercury and 172 subjects from the general population of the same geographical area with environmental exposure to mercury from dental amalgams and dietary fish intake. RESULTS: The white blood cell count was included in the normality range for all subjects and there was no difference between exposed and non exposed subjects. The immunologic variables studied showed an increase of the CD4+ and CD8+ number in exposed workers compared to non-exposed subjects, with a statistically significance only for CD4+, while no difference was observed regarding CD4+, CD8+, NK+ percentage and CD4+/CD8+ ratio. A significative decrease of serum IL-8 and an inverse correlation between serum levels of this cytokine and HgU were observed in exposed workers compared to non exposed subjects. No association between immunologic variables and both dental amalgams and dietary fish intake was found in subjects not occupationally exposed to inorganic mercury. DISCUSSION: The decrease in IL-8 serum levels observed in exposed workers might suggest an immunosuppressive effect of occupational exposure to very low doses of inorganic mercury. This result suggests the need to revise of current HgU BEI after further definition of its prognostic significance.