[Smoking in the workplace: role of occupational physicians]. / Abitudine al fume di tabacco nei luoghi di lavoro: ruolo del Medico del Lavoro Competente.

In many industrialized countries smokers have been observed in high prevalence among workers with poor educational status, who are usually exposed to major occupational risks. The smoking habit and passive smoking may by themselves, or through interactions with other occupational risk factors, cause the onset of serious diseases. Therefore health reasons and the legal obligation to observe the smoking ban in the workplace make it essential to prevent and combat smoking in the workplace and to promote smoking cessation in workers who smoke. This initiative should benefit not only workers' health and well-being but also company finances. The Occupational Physician should engage in diverse activities ranging from encouraging young people not to start smoking to providing programmes to encourage workers who smoke to abandon the habit. For example, he or she should i) inform managers, supervisors and workers about the high risks linked to smoking, passive smoking and obligations established by law ii) collect information about the smoking habit among workers and supply workers with the so-called minimal clinical intervention during routine health surveillance appointments and iii) collaborate with specific health promotion programmes in the workplace.

[Why an accurate diet for employees]. / I perché di una corretta alimentazione dei lavoratori.

A study leaded in 2005 by the ILO on diet habits in different countries pointed out that poor diet at the workplace (leading to malnutrition or overweight and obesity) costs up to 20% & in lost productivity. Obesity is a major cause for absenteeism and can modify physiologic and immune responses to neurotoxins and chemical agents. Obese subjects show a higher risk to develop cardiovascular diseases, musculoskeletal disorders, due to exposure to vibrations, etc; quite often these workers are discriminated, are more sensitive to work-related stress and might experience a reduced self-esteem. Obesity can cause relevant working handicaps linked to reduction of agility, to early fatigue and to difficulties in identifying and use of suitable PPE. As a consequence, obese workers show a higher rate of work accidents and may receive some restrictions in the fitness assessment carried out by the occupational health physician during periodical examinations.

[Tobacco's smoke in the workplaces, webpages in the ISPESL's website]. / Il fumo di tabacco in azienda nel sito dell'ISPESL.

The authors present the section, part of the ISPESL's website, dedicated to tobacco smoke at work. In this subdivision many topics regarding problems caused by tobacco smoke in the workplaces are gathered and discussed so that different personnel responsible for health and prevention at work can find a technical answer to take part to the improvement of the psychophysical welfare of both smokers and non smokers. The general information section has collected the relative Italian and international laws regarding smoking in the workplace along with representative court cases, and some publications and essays which have been presented on this topic. Inside the section dedicated to the employers and companies, the authors have posted useful importation on smoking in the workplace which includes some tools that can turn to be interesting to those who are supposed to be involved with prevention, the updated addresses of the national public antismoking centers, experiences and activities against tobacco smoke of national and international companies, events regarding smoke at work, informative sheets and leaflets for smokers, link to other site that argue about this topic. Moreover, there is a section dedicated to a forum where Internet user can share their experiences and thoughts on workplaces free from tobacco smoke.

[Latex allergy in health care workers: frequency, exposure quantification, efficacy of criteria used for job fitness assessment]. / Allergia a latice nei lavoratori della sanità: frequenza, quantificazione dell'esposizione, efficacia di criteri per la formulazione del giudizio di idoneità.

BACKGROUND: The main purpose of this study was to evaluate the latex allergy prevalence in a large population of health care workers, to quantify latex exposure deriving from use of gloves and to verify the efficacy of job fitness evaluations in allergic workers. METHODS: In the period 2001-2002, latex allergy prevalence was evaluated in 1962 health care workers by means of a self-administered questionnaire, clinical evaluation and specific allergological tests. Also, the total protein content (by means of Lowry method modified EN455-3: 1996) and the antigenic latex proteins (by means of RAST inhibition) in 4 different types of gloves were measured. Job fitness assessments for latex allergic workers were made in accordance with the criteria established by the Italian Association of Preventive Medicine for Health Care Workers criteria. The efficacy was verified one year later. RESULTS: 1557 questionnaires out of 1962 (79.35%) were completed; 504 (32.4%) reported work-related symptoms, in particular 283 subjects had probable irritant contact dermatitis, 66 allergic contact dermatitis and 118 reported irregular non-specific symptoms related to the use of both vinyl and latex gloves; 20 subjects out of the remaining 37 had a latex allergy (1.3% out of the 1557 workers responding to the questionnaire), 8 subjects had only urticaria while 12 subjects had urticaria associated with respiratory symptoms and/or angioedema. The measurement of total protein and antigenic protein content showed the highest levels in powdered latex examination gloves, the lowest levels in surgical powder-free latex gloves. Low concentrations of antigenic proteins were also found in nitrile gloves. Job fitness evaluations were efficacious in 11 out of 20 workers, and inefficacious in 3 cases (6 workers had resigned). CONCLUSIONS: This study revealed a very low prevalence of latex allergy probably due to the fact that we examined an unselected population, and only symptomatic subjects were considered; moreover, in our hospital, vinyl examination gloves had been prevalently used during the last ten years. The criteria followed for job fitness assessment seem to be efficacious on the whole. In spite of a low prevalence of latex allergy, we found a high frequency of irritant contact dermatitis in the examined workers, mainly due to the lubricant powder in both synthetic and natural rubber gloves. Most workers made a complete recovery when they started using powder-free gloves. The high biocompatibility of powder-free gloves was confirmed by the measurement of total protein and latex antigenic protein content in the gloves used in the hospital. Moreover, it should be noted that latex antigenic proteins were also demonstrated in nitrile gloves, this is a relevant information since nitrile gloves are often used as an alternative in latex allergic workers.

Analysis of micronuclei in peripheral blood lymphocytes of traffic wardens: effects of exposure, metabolic genotypes, and inhibition of excision repair in vitro by ARA-C.

The cytokinesis-block micronucleus (MN) assay in peripheral lymphocytes was used to assess the genetic effects of the occupational exposure to traffic fumes in policemen from the Municipality of Rome. The study population consisted of 192 subjects engaged in traffic control (exposed, 134 subjects), or in office work (controls, 58 subjects). Groups were balanced for age, gender, and smoking habits. The average benzene exposure during the workshift was 9.5 and 3.8 microg/m(3) in exposed individuals and controls, respectively. All subjects were genotyped for CYP1A1, CYP2E1, GSTM1, GSTT1, and DT-diaphorase polymorphisms. The incidence of micronuclei and micronucleated cells was recorded in 1,000 binucleated cells harvested 66 hr after mitogen stimulation. Regression analysis of data showed that MN frequency was mainly modulated by the age (P = 0.001) and gender (P = 0.001) of the study subjects (relatively higher in the elderly and females), whereas it was unaffected by the occupational exposure to traffic fumes and smoking habits. A weak (P = 0.02) association between lower MN frequency and the GSTM1 null genotype was also observed. In order to improve the sensitivity of the method to excision-repairable lesions, a modified protocol, with exposure of cells to the repair inhibitor cytosine arabinoside (Ara-C) during the first 16 hr of growth, was applied to 78 subjects (46 exposed and 32 controls). The results confirmed the higher MN frequency in females (P < 0.05), but failed to demonstrate any significant effect of chemical exposure (occupational or related to smoking habits). When the frequency of MN induced by Ara-C (i.e., spontaneous values subtracted) was considered, a significant inverse correlation with age was observed (P = 0.005), possibly related to the age-dependent decrease in repair proficiency.

Harm to the liver among employees of the Municipal Police Force.

The purpose of the study is to assess whether employees of the Municipal Police Force of a big city exposed to urban pollution are at risk of hepatotoxicity. The usual clinical practice tests like AST, ALT, gamma-GT, AP, conjugated and total bilirubin were carried out, accompanied by a questionnaire designed to identify the possible risk factors and the principal non-professional confounding factors for hepatotoxicity. The study covered 118 male Municipal Police employees performing traffic duties and 118 male blood donors engaged in office work. There were significant differences between exposed and controls with regard to the average AST and ALT values and values above the normal laboratory range; this was also the case for the distribution. The results suggest that there may be the possibility of liver damage among asymptomatic members of the Municipal Police Force and that periodic hepatic screening, with the above-mentioned tests, could be useful. It is presumed that chemical agents present in urban air in big cities may cause damage to the liver, even at exposure levels that fluctuate around the admissible environmental concentrations.

Environmental and biological monitoring of traffic wardens from the city of Rome.

A molecular epidemiological study on Roman policemen is ongoing. The results of a first assessment of the occupational exposure to aromatic compounds of 66 subjects engaged in traffic control and of 33 office workers are presented in this paper. Passive personal samplers and urinary biomarkers were used to assess exposure to benzene and polycyclic hydrocarbons during work shifts. The results obtained indicate that benzene exposure in outdoor workers is about twice as high as in office workers (geometric mean 7.5 and 3.4 micrograms/m3, respectively). The distribution of individual exposure values was asymmetrical and skewed toward higher values, especially among traffic wardens. Environmental benzene levels recorded by municipal monitoring stations during work shifts (geometric mean 11.2 micrograms/m3) were in the first instance comparable to or greater than individual exposure values. However, several outlier values were observed among personal data that greatly exceeded average environmental benzene concentrations. Among the exposure biomarkers investigated, only blood benzene correlated to some extent with previous exposure to benzene, while a seasonal variation in the excretion of 1-hydroxypyrene and trans-muconic acid was observed in both study groups. In conclusion, these results suggest that outdoor work gives a greater contribution than indoor activities to benzene exposure of Roman citizens. Moreover, relatively high-level exposures can be experienced by outdoor workers, even in the absence of large-scale pollution episodes.

Hypertension and chronic exposure to noise.

The effects of noise on various cardiovascular parameters are conflicting and uncertain. In the current study, the authors studied 52 workers who were employed in a bedframe factory who were chronically exposed to noise and who had poor hearing. An additional group of 65 workers who had jobs in the light-metal sector and another group of 64 office workers served as two control groups; none of the controls were exposed to noise, and none had hearing defects. Blood pressure was measured for each person in the supine and standing positions, and an electrocardiogram was also performed. Sound-level measurements were taken in the workplaces. Mean systolic and diastolic blood pressures and diastolic blood pressure distributions were significantly higher in the noise-exposed group than in both control groups. Among the three groups, there were significantly different frequencies of hypertension, drops in blood pressure, and electrocardiogram anomalies. Within the group of bedframe workers, those exposed to a personal daily level of exposure (i.e., equivalent continuous noise level for exposure to noise for each individual workers in an 8-hr shift) that exceeded 90 dBA had a higher mean diastolic blood pressure and a higher frequency of diastolic hypertension than workers exposed to a personal daily level of exposure of < 90 dBA. The findings suggested that (a) work performed by the bedframe group had some effects on the cardiovascular system, (b) noise is a cardiovascular risk factor, and (c) cardiovascular effects are relative to intensity and type of exposure. Vascular damage often accompanies auditory damage, but--depending on individual susceptibility--the cardiovascular system can respond in various ways.

Chronic venous disorders and occupation.

BACKGROUND: Chronic venous disorders in the general population are a significant socio-medical pathology. The importance and role of venous pathologies in the occupational field are underestimated and the data in the literature are incomplete and contradictory. METHODS: A study was made of 336 male workers: 112 industry workers, 120 stoneworkers, and 104 office workers. A targeted questionnaire was administered to all workers regarding occupational and extraoccupational risk factors for venous pathologies. The same workers were clinically examined, and a venous check-up and specific tests were done in clinostatic and orthostatic postures. RESULTS: The prevalence of chronic venous disorders, including major and minor pathology, was significantly higher among industrial workers (39.28%) than among stoneworkers (24.16%, P=.019) and office workers (22.11%, P=.010). Only for major pathology was the mean age higher in phlebopathic workers than in non-phlebopathic; furthermore, the proportion of workers standing for >/=50% of the work shift was higher in phlebopathic than in non-phlebopathic. These differences were significant in all working groups. The results showed a positive relationship between the prevalence of phlebopathy and increased age and number of hours spent standing. Considering workers of the same age classes, a higher prevalence of phlebopathy was found between those who stood for >/=50% of their shift and those who stood for <50% of the time. CONCLUSIONS: The results suggest that professions involving standing, particularly for those standing for >/=50% of the shift, can influence the development of chronic venous disorders and a diagnostic clinical protocol to be used by occupational physicians in screening working populations for the prevention of venous disease is suggested.

Liver damage among shoe repairers.

BACKGROUND: The risk of hepatotoxicity in the shoe industry has already been suggested, however, there has been no investigation among the craftsmen who repair shoes. METHODS: A group of 33 shoe repairers who work in supermarkets, and who use the same glues which contain mixtures of potentially hepatotoxic solvents were identified. A control group of 61 workers not exposed to hepatotoxic substances was also examined. All participants completed a questionnaire designed to identify potential risk factors and the main non-occupational confounding factors for hepatotoxicity. Laboratory tests, commonly used in clinical practice, were done to check whether they were useful markers of hepatotoxicity due to exposure to solvent mixtures, and to investigate which tests should be used in the screening campaigns. RESULTS: The exposed workers had a higher prevalence of elevated mean alanine aminotransferase (ALT), aspartate aminotransferase (AST), conjugated bilirubin (P=0.0001), and alkaline phosphatase (AP) (P=0.004) than controls did. The number of workers who had values outside the upper limit of normal for our laboratory was significantly higher (ALT P=0.034, AST P=0. 037, conjugated bilirubin P=0.014). Exposed workers all had a ratio of ALT to AST greater than 1, with a mean of 1.5; it was > 1.6 in more than half the exposed workers. CONCLUSIONS: The findings suggest that there is the possibility of liver involvement among even asymptomatic shoe repairers, and that periodic liver screening may be useful; furthermore, use of these tests (especially the ratio of ALT to AST) for craftsmen who repair shoes, and are exposed to solvent mixtures, is advisable even when environmental monitoring indicates levels below the threshold limit values (TLVs).

[Hepatotoxic occupational risk factors]. / Fattori di rischio professionali epatotossici.

In this review the authors present a synthetic and critical analysis of the most recent epidemiological, clinical and experimental studies on the main risk factors thought to cause occupational liver diseases. The aim was to list the main occupational hepatotoxic substances in order to enable the earliest identification of possible occupational liver pathologies and the application of suitable means of prevention in the workplace. The following data emerge from a critical analysis of the studies reported. The list of potentially hepatotoxic substances is certainly very long and reliable evidence of specific toxicity only exists for some; many of these substances are used not only in the professional world, but often outside the workplace. The main route through which lesions occur is by inhalation and, in the case of many substances, also through the skin. In clinical terms, occupational liver pathologies may take an acute, subacute or chronic form, often with comparable symptoms to those found following non-occupational exposure. No particular histological features can be seen, nor are there specific diagnostic means to evaluate individual chemical substances. With regard to the data reported, the authors reach a few conclusions: when formulating an etiological diagnosis of occupational toxic hepatopathy, it is important to bear several aspects in mind such as the characteristics of the workplace (type of activity performed, products handled, working conditions, etc.), lifestyle (hobbies, use of drugs, etc.), varying individual susceptibility; each of these factors contributes to the onset of morbid conditions whose target is the liver.

[Chronic noise exposure and the cardiovascular system in aircraft pilots]. / Esposizione cronica a rumore e apparato cardiovascolare in piloti di aeromobili.

The aim of this study was to assess whether pilots are exposed to any risk of effects on the cardiovascular apparatus, whether chronic exposure to noise can be a risk factor for this occupation, the importance of intensity, length and type of exposure to noise, and if any relationship exists between audiometric deficits and cardiovascular effects. The study comprised 416 pilots subdivided into two groups according to the different levels of chronic exposure to noise, and a group of 150 control subjects not exposed to noise. The results showed: a) a higher prevalence of hypertension, nearly always diastolic, and of ECG abnormalities in the group of pilots of turboprop aircraft compared to jet plane pilots and to controls (p < 0.005 and p < 0.01 respectively); b) a higher prevalence of orthostatic hypotension in the two groups of pilots than in the controls (p < 0.05); c) a higher prevalence of hypertension with audiometric deficit compared to hypertension without audiometric deficit both in the more heavily and in the less heavily exposed to noise (p < 0.05), and a higher prevalence of hypertension with audiometric deficit in subjects exposed to higher levels of noise compared to hypertension with deficit but in subjects with lower levels of exposure (p < 0.05); d) a higher prevalence of abnormalities of basal, maximum effort and recovery ECG in pilots exposed to higher noise intensity (p < 0.05); e) improved hypertensive response to ergometric test in pilots with basal hypertension; f) subjects with a maximal load up to 120 W belonged prevalently to the group exposed to more intense noise (p < 0.001), while those with maximal load up to 210 W (p < 0.001) belonged to the group exposed to less intense noise. Considering that pilots are comparable for traditional cardiovascular risk factors, including age, both within the group and with the controls, the results confirm 1) that pilots could be exposed to the risk of effects on the cardiovascular apparatus, 2) that noise could be one of the risk factors and that cardiovascular effects could be related to intensity, type and length of exposure, age being the same, 3) that vascular damage is often accompanied by hearing loss even if the response of the auditory apparatus is different from the response of the cardiovascular apparatus, 4) that the postural diminution of arterial blood pressure might be a sign of a cardiovascular effect of noise. Lastly, a higher hypertensive response in hypertensive pilots suggests that basal hypertension is not reversible. Also a longer exposure to noise seems to influence the cardiovascular apparatus, causing a decrease in the response to work loads due to a lower sympathetic adaptability. The altered response of sympathetic activity to the postural modifications in the more exposed subjects and the response to lower work loads in pilots exposed to more intense noise, suggests a hypothesis of catecholamine depletion and alteration of baroceptor sensitivity as a consequence of chronic sympathetic activation due to chronic exposure to noise.

Vascular effects of occupational exposure to low-dose ionizing radiation.

Damage to the microcirculation caused by high-dose ionizing radiation is well known but data concerning low-dose exposure are scant and contrasting. We employed capillary microscopy to study dermal microcirculation damage resulting from occupational exposure to ionizing radiation doses lower than 5 rem/year (maximum permissible dose in Italy). We studied 145 physicians (60.7% radiologists, 33.8% orthopedic specialists, 5.5% cardiologists) occupationally exposed to ionizing radiation and a control group of 106 subjects in comparable but different occupations not exposed to ionizing radiation or to other skin hazards. All subjects were administered a clinical protocol and underwent capillary microscopy of the fingernail-fold. Capillary microscopy alterations were classified as absent, mild, moderate, marked and severe. Our data confirm that occupational exposure to low-dose ionizing radiation can lead to morphological and functional alterations of the dermal microcirculation, which can be identified early by capillary microscopy.

Liver damage in pharmaceutical industry workers.

A group of workers who were employed at a pharmaceutical manufacturing company and who participated in the entire production cycle were studied. Numerous substances, including iodo-chloro-oxyquinoline, erythromycin, disinfectants, small amounts of cortisones, and preserving agents (prevan and parabenzoates), were used in the manufacturing processes. A control group comprised individuals who were not exposed to hepatotoxic substances. This investigation was designed to determine the risk of hepatotoxicity in the pharmaceutical industry, and a protocol was used that allowed for ease of screening. In the presence of a physician, all subjects completed a clinical history questionnaire. They all underwent a general clinical examination, and specific blood chemistry tests were performed. Certain liver indices that were correlated with cytotoxicity were significantly higher in the pharmaceutical workers than among the controls. The findings confirmed that there was a problem of hepatic involvement among workers in this sector, indicating that the clinical-biohumoral screening protocol used in this study was valid for identifying subjects at risk of hepatotoxicity.

Noise and gastric secretion.

In view of the increasing incidence of diseases such as gastritis and ulcers in workers exposed to noise, we assessed whether noise does in fact affect gastric secretion. Then, considering the conflicting findings published on the effects of noise on gastric secretion, we also investigated whether the response was related to differences in baseline secretion, and whether it was further modified by a hydroalcoholic meal. We studied 50 dyspeptic subjects engaged in various types of work but not occupationally exposed to noise. They were exposed to a "pink noise" stimulus of 95 dB administered through earphones, lasting 15 minutes. Gastric secretion sometimes remained unchanged, sometimes increased, or sometimes even decreased in relation to the baseline hydrochloric acid secretion. The hydroalcoholic meal did not generally modify the effects of noise. These findings might help explain the differences in previous reports on this question.

Vascular effects of noise.

The possible vascular effects of noise were studied. A study of the carotid vessels was made with Doppler ultrasonography in two groups of subjects exposed to various intensity of noise. The following data were studied: age, blood pressure, serum cholesterol, blood glucose, smoking habits, excess weight, electrocardiographic anomalies, family history of vascular disease, connection with duration of exposure and the type of noise and with audiometric deficits, and cerebrovascular modifications after postural changes and after a stress test. The control group comprised subjects not exposed to noise. The findings confirm that noise does play a role in causing vascular modifications that can be detected early by use of Doppler ultrasonography. This technique is predictive and could be useful in screening campaigns, following the method suggested here.

Study of some cardiovascular parameters after chronic exposure to noise.

Research has focussed lately on noise as a risk factor for cardiovascular diseases. Recent findings, which have not been well confirmed, indicate that it does appear to affect heart rate, blood pressure and the electrocardiogram. This study involved two groups of subjects (with 75 and 225 in each, respectively) classified on the basis of different intensity of exposure to noise. Non-occupational risk factors studied (cholesterol, blood glucose, smoking, body mass index, family history of cardiovascular problems) revealed no significant differences between the two groups. Audiometric deficits and time exposure to noise were also studied. Blood pressure was measured at rest, an electrocardiogram was taken, and a cycloergometric stress test was made. The prevalence of hypertension and electrocardiographic modifications in basal conditions and under the stress test differed to a significant extent in relation to the different exposures to noise.