Early diagnosis of hearing loss: otoacoustic emissions evoked by distortion products and pure-tone audiometry: Preliminary findings.

OBJECTIVE: Literary studies underline the effectiveness of distortion product otoacoustic emissions (DPOAEs), which are not affected by the collaboration of the subject examined, in the early diagnosis of hearing loss. Aim of the study is to compare the objective technique of DPOAEs with respect to the pure-tone audiometry in early diagnosis of hearing loss. MATERIALS AND METHODS: The clinical research was carried out on 852 workers. All subjects underwent pure-tone audiometry, tympanometry and distortion products. RESULTS: The results show: a) a prevalence of subjects with impaired DPOAEs higher than the prevalence of subjects with impaired audiometries in the studied samples; and, after division by gender: b) a prevalence of subjects with impaired DPOAEs higher than the prevalence of subjects with impaired audiometries only in men; c) a prevalence of impaired DPOAEs and of impaired audiometries in men higher than in women. CONCLUSIONS: The results suggest the higher effectiveness of DPOAEs compared to pure-tone audiometry in making an early diagnosis of hearing loss.

[Prolonged exposure to urban pollutants and arterial blood pressure: a whole evaluation of our researches]. / Esposizione protratta ad inquinanti urbani e pressione arteriosa: una valutazione d'insieme delle nostre ricerche

AIM: A significant relationship between exposure to cadmium and PAHs from urban air pollution and blood pressure has already been found. The aim of the study is to evaluate if other urban pollutants maintain a similar relationship in outdoor workers. MATERIALS AND METHODS: 349 subjects of both sexes were enrolled in the study; we evaluated values of environmental and biological monitoring of respirable dust, arsenic, lead, benzene, toluene, xylene and we measured blood pressure (BP) in upright and in supine position; to analyze data we used multiple linear regression. Also we valued our results in the light of those we have obtained in previous research. RESULTS: Multiple linear regression showed no significant results that demonstrate a relationship between BP and these pollutants. CONCLUSIONS: The results of our study lead to assume that exposure to urban pollutants studied has not connection with blood pressure, and to retain valid the relationship previously observed for cadmium and PAHs, which seem to be the only pollutants that can affect blood pressure.

[Stress and work-related injuries]. / Stress e infortuni sul lavoro.

OBJECTIVE: The aim of this study was to evaluate in scientific literature the more frequent work injuries among the occupational categories examined (construction workers, healthcare workers, night workers and shift work, drivers) and to identify occupational stressors that increase the risk of injury. MATERIALS AND METHODS: The research was conducted through review of the scientific literature between 1990 and 2014. Two hundred articles were found of which 42 selected in the following categories: construction workers, healthcare workers, shift workers, lorry drivers. RESULTS: The movement of machinery and working at height are due to injury for building sector and they were positively correlated with physical (r = 0,206) and mental (r = 0,254) stress. In health workers the injuries are more frequently bruises and sprains (50%). Studies showed a higher rate of injury in a group of shift workers compared to a control group on a rota basis (p <0.0001). Road accidents for drivers represent the most frequent cause of injury of which 13% comes from falling asleep, while 31% from distractions (OR = 3.16; CI = 1:22 to 8:24). CONCLUSIONS: Nurses have frequent injuries due to bruises, lumbago, punctures with needles and surgical wounds. Construction workers often suffer serious injury derived from falls at height, handling machinery. For workers on a rota basis, injuries are often related to lack of sleep. Road accidents in drivers are the most common injuries. A synergistic action finalized to promote health and safety organization, to ensure a work environment more secure, is advisable.

Ballet and stress. A pilot study.

BACKGROUND: Work-related stress is a complex problem requiring a work environment-based assessment. Artists like dancers represent a category of atypical workers potentially at high risk for work-related stress. Aim of our pilot study is to evaluate organizational stress in a population of professional dancers, using the HSE Indicator Tool for Work Related Stress. METHODS: We administered the Italian version of the HSE Indicator Tool to 38 ballet dancers, males and females. The questionnaire evaluates 7 key organizational dimensions: demand, control, managers' support, peer support, relationships, role and change. RESULTS: The standards required-ideal conditions are achieved in none of the above-mentioned dimensions. Change is the only dimension for which results fall between the 20th and the 50th percentile, while for other dimensions results fall below the 20th percentile suggesting the need for immediate corrective action. In male dancers an acceptable situation is highlighted for the dimension "change" compared to female dancers. In both sexes there is a high frequency of subjects complaining of verbal abuse, bullying and harassment. CONCLUSIONS: Despite the small sample size, our pilot study highlights the presence of heightened levels of organizational stress. Preventive measures targeted towards improving communication between managers and dancers and aimed at team building should be implemented.

Correlation between cadmium and blood counts in workers exposed to urban stressor.

The objective of this study was to assess the exposures to cadmium (Cd) in urban workers and the association between Cd exposure and values of blood counts. Urinary Cd, blood Cd, and blood counts were obtained from 355 outdoor workers; a subgroup of 99 subjects were monitored to evaluate personal exposure to airborne Cd. The mean value of personal exposure to Cd was 1.5 ng/m3 for traffic assistants and 1.2 ng/m3 for drivers. Urinary and blood Cd were correlated to the airborne Cd (respectively r=3 and r=4). The multiple linear regression models showed the associations among white blood cell, the percentage of neutrophils (NEU%), the percentage of lymphocytes (LYM%), and the concentrations of blood Cd (respectively R2=27, R2=37, R2=581). The subjects with blood Cd values higher than 1.2 µg/L showed an increase of LYM% mean values and a decrease of NEU% mean values with respect to the group with blood Cd values lower than 1.1 µg/L.

Occupational exposure to urban stressors and effects on atrial natriuretic peptide: preliminary results.

PURPOSE: The aim of this pilot study is to evaluate whether occupational exposure to low doses of pollutants present in the air of the city selected for the study could cause alterations in the concentration of atrial natriuretic peptide (ANP) in workers from the Municipal Police with outdoor tasks, compared to those with indoor tasks. METHODS: A total of 208 non-smoking male and female subjects were enrolled and divided on the basis of whether their tasks were mainly outdoors or indoors. The dosage of plasma ANP was carried out on all workers included in the study. Differences between means and frequencies were compared using student's t-test for unpaired data and chi-square test with Yates' correction, and they were considered significant when the p value was <0.05. RESULTS: Even after the subdivision of the total sample on the basis of sex, mean plasma levels of ANP were higher but not statistically significant in traffic police compared with controls. CONCLUSIONS: The preliminary results suggest that further studies should be conducted before the influence of urban pollution on ANP could be confirmed or rejected.

Work related etiology of amyotrophic lateral sclerosis (ALS): a meta-analysis.

BACKGROUND: The aim of this meta-analysis was to evaluate the association between ALS and occupational exposure to physical (ELF-EMF) and chemicals (solvents, heavy metals and pesticides) agents. METHODS: We considered articles published from 1980 up to April 2013; in total, 750 publications were evaluated. The studies had to satisfy the following criteria: 1) cohort or case-control studies; 2) the presence of individual exposures; 3) clinical diagnosis of sporadic ALS or sporadic ALS on the death certificate. We followed the evaluation of quality in two steps. The first step classified studies according to a rating system based on a mix of criteria developed by scientific organizations, especially developed for studies of risk factors for ALS. The ratings obtained range from I (highest) to V (lowest). The data on risk factors derived from studies with Armon ratings of I, II, and III can reach levels of evidence A (established risk factor), B (likely risk factor), or C (possible risk factor). The second step evaluated the exposure and a score from 1 to 4 was assigned to each item; an exposure with a score of 3 or 4 was considered sufficient. Different analyses were performed on ALS and exposure to metals, solvents, pesticides and electromagnetic fields. In our study the heterogeneity was assessed both by χ2-based Q-tests and through the index of inconsistency I² while the measure RR/OR and CI of 95% to estimate the relationship between ALS and the various considered risk factors was employed. RESULTS: The association between exposure to pesticides and ALS as a whole is weak and not significant. With regard to the results of individual studies the following critical synthesis can be reported: 1) the selected studies showed a low level of association between ALS and electromagnetic fields; 2) as regards the solvents, the association with ALS in some studies is combined with a slightly increased risk, particularly in women, and in others a slight but significant linear association is observed; 3) for the metals, in some cases there was a stronger association in women than in men; for individual metals, there was an association especially with chromium and lead; 4) lastly, with regard to the products of agricultural pesticides in general, there was an association with ALS in men but not in women, with a dose-response relationship. CONCLUSIONS: The lack of statistically significant association between occupational exposure and ALS is mainly due to the methodological diversity of the studies and the lack of prospective studies at the workplace.

Thyroid hormones in male workers exposed to urban stressors.

BACKGROUND: The occupational exposure to urban pollution may induce adverse effects on the human health. METHODS: Plasma levels of thyrotropin stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) of 50 outdoor workers and 50 indoor workers were compared. RESULTS: In the outdoor workers the TSH levels were significantly higher than in the control subjects (p =0.02) while the average of FT3 and FT4 values, was not significantly different compared to the controls (p > 0.05). CONCLUSIONS: The differences found for TSH levels between outdoor and indoor workers, though not high, suggest that, due to greater exposure to environmental pollutants, the outdoor workers are more susceptible to the development of function abnormalities of the thyroid gland compared to indoor workers.

Liver function in workers exposed of the cosmetics industry.

BACKGROUND: The purpose of this study is to assess whether occupational exposure to substances used in the cosmetic factories may cause effects on the liver and blood counts in exposed workers. METHODS: The study included 48 exposed workers and 86 unexposed controls. All workers included in the study underwent blood count, white blood count, total, direct and indirect bilirubin, transaminases, alkaline phosphatase and cholinesterase. The differences between the means and frequencies were compared using the Student's t-test and chi-square test with Yates correction and were considered significant when the p value was <0.05. RESULTS: The analysis of the results shows that 35.4% of workers in the cosmetics industry had liver test values above the range. We noted a statistically significant higher prevalence of GPT (p <0.05) and total bilirubin (p <0.05) in the workers of the cosmetics industry compared with the control group. CONCLUSIONS: The results obtained suggest that occupational exposure to low doses of substances used in the cosmetic industry is able to influence some liver parameters in occupationally exposed workers.

Coal plant: risk, disease and prevention with on environmental impact.

Urban pollution is a current problem, constituting a serious health risk. Many pollutants are present in the urban atmosphere, they are mainly anthropogenic, resulting from the combustion of coal. Several studies have shown the harmful effects of these pollutants, particularly on the respiratory system. Through a library review, we want to explore the effects on the health of general population and of outdoor workers exposed to the products resulting from the combustion of coal, in order to compare them with the estimated effects of the pollutants from the new generation coal plants, certainly less harmful to the environment. In recent years investments in "clean technologies" have resulted in a rapid and significant reduction of all polluting emissions: sulfur dioxide, dust, oxides of nitrogen, ash and gypsum resulting from the desulfurization process. To conclude in the light of the scientific literature we can say that the activation of coal plants based on technologies for the maximum containment and optimal treatment of the production cycle is essential to defend both the environment and the health of the population. Nevertheless it remains necessary to ensure a systematic monitoring of the environment of sanitation and food processing of the population living in the area, with a long-term follow-up.

Professional exposure to anaesthetic gases in health workers: estimate of some hepatic and renal tests.

OBJECTIVES: The aim of this study is to estimate whether the occupational exposure to low dose of anaesthetic gases could cause alterations of haematochemical hepatic and renal parameters in the health workers of a city hospital. MATERIALS AND METHODS: After excluding the main confounding factors, 154 exposed subjects and 98 not exposed controls were included in the study. The exposed subjects were divided in more exposed (group 1: n.54) and less exposed (group 2: n.100). Each worker included in this study underwent the CBC test (Complete Blood Count test). The differences between means were compared using the Student T test for unpaired data and considered significant when the p value was < 0.05. RESULTS: The mean values of serum albumin, alpha 1, alpha 2, beta and gamma globulins were significantly decreased in health workers of both groups compared to controls. The mean values of serum creatinine and gamma-GT were significantly higher in health workers of group 2 compared to controls. CONCLUSIONS: The obtained results suggest that occupational exposure to low dose of anaesthetic gases could influence haematochemical hepatic and renal parameters in exposed health workers.

Exposure to solvents in health care workers: assessment of the hepatic effects.

OBJECTIVES: The use of organic solvents has been linked to pathologies of different apparatuses. The purpose of this study is to analyze the liver damage induced by organic solvents. MATERIALS AND METHODS: We analyzed 556 workers, 278 exposed to organic solvents (group 1) and 278 not exposed to organic solvents (group 2). The exposed group was further divided into 2 subgroups: group 1A (139 workers exposed to considerable doses) and group 1B (139 workers exposed to negligible doses). Mean and standard deviation of some liver parameters was calculated. Statistically significant differences between the liver parameters in the different groups and subgroups were detected using the t-test. Multiple linear regression models were used to examine the associations between laboratory parameters and the independent variable. RESULTS: The data so far obtained showed the existence of statistically significant differences with regard to the total protein, total bilirubin, transaminase GOT and GPT, Gamma Glutamyl Transferase (gamma-GT). CONCLUSIONS: Our results confirm that exposure to solvents can alter some liver parameters. The blood tests we used can be useful tool for the assessment of the actual occupational hazards and to verify the effectiveness of the measures taken for the prevention and protection.

Evaluation of some cardiovascular risk parameters in health professionals exposed to night work.

BACKGROUND: Shift work and night work in particular represent a risk factor for the health of exposed workers; aim of our study is to evaluate whether night work may cause alteration of some cardiovascular risk parameters in health workers. MATERIALS AND METHODS: The research was carried out on 415 health workers, 163 exposed to night work and 252 not exposed. A blood sample was taken from each worker, between 8.00 a.m. and 10.00 a.m. before lunch time, to test total cholesterol, HDL cholesterol, and triglycerides. Blood pressure and heart rate were also measured. Workers with cardiovascular diseases, thyroid diseases, diabetes mellitus, dyslipidemia, those who made use of antihypertensive drugs, hypoglycemic and/or lipid-lowering drugs, subjects with body mass index (BMI) (kg/m2) higher than 30 were excluded. RESULTS: In the group of exposed compared to controls, increasing values of arterial pressure and heart rate, were not significant. The mean values of total cholesterol and triglycerides were significantly higher in exposed compared to controls while values of HDL cholesterol were significantly lower. CONCLUSIONS: Night workers have clinically significant changes in blood levels of total cholesterol, HDL cholesterol and triglycerides, such alterations are presumably related to poor food hygiene and to psychosocial stressors.

[Exposure to cadmium and plasma cortisol in workers exposed to urban stressor]. / Esposizione a cadmio e cortisolo plasmatico in lavoratori esposti a stressor urbani.

OBJECTIVES: The aim of this study is to estimate the exposure to Cd in a group of roadmen compared to a group of drivers by environmental monitoring and biological monitoring of blood and urinary Cd. It aims to evaluate whether exposure to Cd can affect plasma cortisol. MATERIALS AND METHODS: The initial sample was composed by 130 employees of Municipal Police Force (roadmen and drivers). After administration of a clinical-anamnestic questionnaire were excluded 50 subjects who presented confounding factors and 30 subjects who weren't comparable. On a final sample of 25 drivers and 25 roadmen were conducted environmental monitoring of Cd, biological monitoring of urinary and blood Cd and assessment of cortisol. RESULTS: Personal exposure to Cd in air was significantly higher in roadmen compared to drivers (p = 0.015). Urinary and blood Cd were significantly increased in roadmen compared to drivers (p = 0.18 and p = 0.025). There weren't significant differences in plasma cortisol between drivers and roadmen (p> 0.05). The multiple linear regression analysis shows that urinary and blood Cd are dependent on the environment Cd levels and on the job (driver or roadmen) (p = 0.014 and p = 0.012) and plasma cortisol isn't dependent on blood and urinary Cd. CONCLUSIONS: The results show a higher concentration of Cd in roadmen both in air and urine and they don't indicate an influence of exposure to low doses of Cd on plasma cortisol.

Professional exposure to ionizing radiations in health workers and white blood cells.

BACKGROUND: The aim of this study is to estimate if low dose of occupational exposure to ionizing radiations can cause alterations of plasma concentrations of total white blood cells, lymphocytes, monocytes and granulocytes (eosinophils, basophils, neutrophils), in the health workers of a big hospital. METHODS: 266 non smokers subjects of both sexes (133 health workers and 133 controls) were included in this study, compared on the basis of sex, age and working seniority. The complete blood count (CBC) was performed in all included workers. RESULTS: The differences between the mean values were compared using Student T-test for unpaired data. The frequencies of the single variables were compared using Chi (2) test with Yates correction. The differences were considered significant when the P values were < 0.05. The mean values and the distribution of the mean values of total white blood cell were significantly decreased in health workers of both sexes compared to controls. The average values of granulocytes neutrophils were significantly low in female health workers compared to female controls. CONCLUSIONS: The obtained results suggest that low dose of occupational exposure to ionizing radiations is able to influence some lines of the hematopoietic system in exposed workers.

Perceived stress and stress-related parameters.

BACKGROUND: The purpose of this study is to evaluate, using a questionnaire developed by our research group, whether occupational exposure to physical, chemical and psychosocial urban stressors can lead to alterations in perceived stress in a group of both male and female outdoor workers. The study also examines possible correlations between the levels of stress as inferred from the scores of the questionnaire and the levels of certain stress-related parameters (prolactin levels, consumption of coffee, chocolate, alcohol and cigarette smoking). METHODS: We evaluated a final sample of 480 subjects (342 male and 138 female). All workers included in the study were divided into three groups on the basis of scores of the questionnaire. RESULTS: About 60% of workers showed a moderate or severe stress condition, with a statistically significant prevalence of female workers and younger subjects. There was a statistically significant correlation between the questionnaire score and the mean levels of stress-related parameters. The increase of perceived stress increases significantly the mean levels of prolactin and the consumption of coffee, chocolate and cigarettes. There was no statistically significant differences for alcohol consumption. CONCLUSIONS: The results show that exposure to chemical physical and psycho-social urban stressors can influence perceived stress in outdoor workers. The questionnaire used in our research could be an useful instruments for physicians during the health surveillance visits

Environmental and biological monitoring of polycyclic aromatic hydrocarbon levels in outdoor workers exposed to urban stressor.

BACKGROUND: Purpose of this study is to evaluate and to compare the excretion of urinary 1-hydroxypyrene (1-OHPu) in traffic policemen (TP) and drivers (D) of a large Italian city and to evaluate the existence and the degree of correlation between airborne exposure to 15 different polycyclic aromatic hydrocarbons (PAHs) and 1-OHPu levels in the examined population. METHODS: 192 male workers, 115 TP and 77 D, were monitored for 1-HOPu. A subgroup of non-smoking workers (subgroup B: 59 TP and 15 D) was also examined and 15 environmental PAHs was monitored through the personal samplings for the measurement of the particulate phase. RESULTS: The 1-OHPu levels and the values of personal airborne exposure to PAHs were significantly higher among non-smoking TP than among non-smoking D (p < 0.05). In subgroup B the levels of environmental exposure to all the 15 PAHs measured in TP and only 6 of 15 PAHs measured in D were significantly correlated with the values of 1-OHPu (p < 0.05). CONCLUSIONS: Our results suggest that the use of 1-OHPu as an indicator of exposure to PAHs is reliable also for what concerns the study of the low-dose work-related exposure in urban outdoor workers.

Cadmium blood/urine levels and blood pressure in workers occupationally exposed to urban stressor.

BACKGROUND: Cadmium (Cd) is a metal, which induces hypertension in animals. This may not be relevant to the human population because the number of studies is inconsistent. OBJECTIVE: Our aim is to identify an association between levels of blood/urinary cadmium and blood pressure in a group of employees of the municipal police assigned to outdoor activities. MATERIALS AND METHODS: 349 subjects of both sexes were enrolled and sorted on the basis of gender, job function and smoking habit. Blood and urinary cadmium levels and blood pressure readings were collected for each subject. The data were subjected to statistical evaluation. Pearson correlation coefficient between the variables and a linear regression curve was drawn. After eliminating the confounding factors, the multiple linear regression analysis assessed statistical differences. Associations were considered significant at p < 0.05. RESULTS AND CONCLUSIONS: The Pearson correlation showed a positive association between urinary cadmium levels and blood pressure especially for groups of women and non-smokers. The simple and multiple linear regression and t-tests confirmed these associations and underlined the influence cadmium has on diastolic blood pressure, higher than systolic blood pressure. No association was found between blood cadmium and blood pressure. In conclusion, we can say that there is a statistically significant association between urinary cadmium and diastolic blood pressure, supporting the hypothesis that cadmium has a long-term effect on diastolic blood pressure (BP).

Arsenic and peripheral blood count in workers exposed to urban stressors.

OBJECTIVES: Previous studies have shown that arsenic at high doses can alter the hematopoietic system. The purpose of the present study is to see whether the same problems may be caused by chronic exposure to low doses. MATERIALS AND METHODS: A sample of 349 policemen of a big urban city was divided into 3 groups according to levels of urinary arsenic. The subjects were further divided according to gender, smoking habits, and work task. We calculated indices of correlation (r) and multiple linear regression (ß), between urinary arsenic, RBC, WBC, HB, HT, MCV, MCH, MCHC, platelets, reticulocytes and leukocyte formula (percentage of lymphocytes, monocytes, neutrophils, eosinophils and basophils). It was also calculated Student's t and chi-square test between the various groups to check for any differences. RESULTS: We found several statistically significant indices of correlation and regression (p(two-tailed) <0.05) between urinary arsenic, red blood cells, white blood cells, hemoglobin, hematocrit, reticulocytes, and all the cell lines of the white series. CONCLUSIONS: Chronic exposure to low doses of arsenic seems to cause decrease in red blood cells, hematocrit and hemoglobin. However, this response is dependent on the amount of absorbed dose, according to an ormetic mechanism. With regard to the white series, arsenic seems to provoke an inflammatory response; the scarcity of literature" available, and the great variety of results, however, not allow us to definitely characterize the damage caused by this metal on white series.

[Phlebopathies and occupation]. / Flebopatie e lavoro.

Chronic venous disorder is a public health problem that affects the western industrialized countries. The aim of this study is to evaluate the etiology and prevalence of venous disease of the lower limb in workers, and to identify some risk factors using a detailed and systematic analysis of the literature from 1964 to 2011. There is an important relationship between standing position at work and venous disease. The prolonged orthostatic position of the body implies: venostasis, high pressure and risks of blood clots and thrombosis; in standing workers there is an overproduction of reactive oxygen species (ROS) with oxidation of the components of cell membranes, endothelial damage and increase in vascular permeability. Other risk factors were investigated: sitting during work time, weight lifting-moving and exposure to heat sources, the data suggest that this risk factors are less important than orthostatic body position. Age, sex and familiarity are relevant as the extra-occupational risk factors. For a more accurate study of the role of the prolonged orthostatic position on the development of venous disease in the lover limb all authors should define exactly the population, the role and the length of standing time at work. They should also set a universal language to define the correct standing position (ie. within 1 m2 or steps) and time (ie. one hour or 50%-70% of work time). Attention should be given to prevention, to use early therapeutic measures in view of mortality as a consequence of venous disease, of the high social costs related to the loss of working days, of medical care and of residual disability.