Occupational low-level exposure to hard metals: cobalt and tungsten biomonitoring as an effective tool to evaluate the effectiveness of industrial hygiene interventions for risk management.

Purpose: The aim of the study was to assess the exposure to Cobalt (Co) and Tungsten (W) in a group of hard metal tool sharpeners through a combined approach of air and biological monitoring, and to evaluate the effectiveness of a control and improvement intervention carried out in collaboration with the medical officers of the local Health Protection Agency, by biomonitoring.Methods: We enrolled 132 workers from 17 companies of the province of Brescia, northern Italy. The study was performed in two phases: (1) an environmental and biomonitoring survey to assess the workers' exposure to Co and W at their usual working conditions; (2) a further biomonitoring survey 3 months after the enforcement of a control and improvement intervention, to assess its effectiveness.Results: Workers were found to be exposed to low concentration of airborne dust containing Co and W but after the intervention we recorded a significant decrease of the urinary concentrations of both Co and W. The extent of the decrease was correlated to the number of preventive industrial hygiene interventions that were carried out.Conclusions: Biological monitoring of Co and W in the hard metal tools manufacturing industry is a sensitive and effective method to evaluate the effectiveness of prevention practices.

Trace elements and diabetes: Assessment of levels in tears and serum.

Tear film is critical for the well-being and homeostasis of the ocular surface. Although the composition of the tear film is well known, the composition of metallic elements have yet to be analysed. Despite trace elements metabolism has been reported to play a role in the pathogenesis of diabetes mellitus, a metabolic disease that affects several aspects of homeostasis, little is known in the literature regarding concentration and possible variation of metallic elements in tear film. We studied the concentrations of several essential and non-essential metallic elements in the tear fluid and serum of patients with type II diabetes mellitus and a group of non-diabetic controls. Serum and tear fluid were collected from 97 patients: 47 type II diabetic patients and 50 non-diabetic controls. Regarding tear film, there were statistically significant differences in Zinc, Chrome, Cobalt, Manganese, Barium, and Lead between groups; the values of all metallic elements were found to be statistically significant higher in patients with mellitus type II diabetes. Regarding serum values there was a statistically significant difference in Chrome, Cobalt, and Selenium values; the concentrations of Chrome and Cobalt were higher in the control group, while Selenium concentration was higher in diabetic patients. In patients with type II diabetes, metal elements with higher concentrations in tears compared to serum were: Lead, Barium, Manganese, Cobalt, and Chrome. In the control group, the metal elements with the highest concentration in tear film compared to serum were Chrome, Manganese, Barium, and Lead. In this study, we attempted to evaluate the possible effect of a disease, such as diabetes, on the metabolism of metallic elements. Although our evidence was very interesting, it is probably limited in its accuracy due to the fact that individuals in the control group harboured ocular pathologies. This work lays the foundation for future studies.

[Interdisciplinary training opportunities for residents in occupational medicine: the experience of the ERC Tour 2012]. / Nuove opportunità formative interdisciplinari per i medici specializzandi: l'esperienza dell'ERC Tour 2012.

This paper describes the experience of the School of Occupational Medicine of the University of Brescia at the current edition of the New York and New Jersey Education and Research Center--Historical Perspectives Tour on Occupational Safety and Health, that involved 5 different industrial and environmental sites, appropriate for understanding the complex occupational health and safety problems. In every site, the participants have interacted with workers and professionals and discussed about the specific work processes, to better understand the risk faced by the workers, occupational pathologies that can occur, personal protective equipment used and preventive measures adopted. This experience has been successful in provide interdisciplinary educations to occupational safety and health professionals in training in order to prepare them for the collaboration and cooperation required to solve the complex occupational health and safety problems they will face in their future careers.

[Focus on health surveillance of health workers exposed to blood-transmissible biological agents: results and perspectives of a multicenter working group]. / Focus sulla sorveglianza sanitaria dei lavoratori della sanità esposti ad agenti biologici trasmissibili per via ematogena: risultati e prospettive di un gruppo di lavoro multicentrico.

The biological risk from exposure to bloodborne pathogens in health care environments represents a frequent and widespread risk, involving a large number of exposed workers. On the basis of the available scientific innovations, the recent legislation regarding health and safety of workers and the experiences of SIMLII guidelines on health surveillance (HS) workers exposed to biological risk, a multicenter study was carried out, involving nine relevant hospitals and about 32 000 healthcare workers (HCW). A review of the literature was performed, with particular reference to the last 10 years. For each hospital, protocols of HS have been examined according to tasks and biological risk from bloodborne viruses (HBV, HDV, HCV, HIV) as well as management of HCW infected with this pathogens. Differences of risk management in the hospitals, in relationship also with recommendations of the literature have been evaluated. The literature supplies important indications for HS management of HCW exposed to bloodborne pathogens, with relevant information also for patient safety. Preventive examinations are in line with the recommendations of literature and similar across the hospitals for HCV and HIV, while they are different for HBV. Periodic surveillance was different for the frequency, among the hospitals and also as compared to national SIMLII guidelines. As for management, no differentiation among the hospitals was detected as referred to different risk of exposure, while differences were observed around definitions of restrictions. Finally, good medical practices to support occupational physicians in the prevention and management of HCWs' exposed to biological risks are suggested.

[Role of the occupational physician in occupational injuries prevention: across ethics, science and good practices]. / Ruolo del medico competente nella prevenzione degli infortuni sul lavoro: tra etica, scienza e buone prassi.

Occupational injuries (OI) are a relevant issue in workplaces, being responsible for a range of individual and socio-economic consequences, with an enormous toll paid by workers, enterprises and society. Despite all these issues, OI prevention has not received significant field research attention, with studies mainly addressed to reporting data a posteriori instead of evaluating the effectiveness of prevention programs. In addition, the role of occupational physician (OP) seems to be largely underplayed. OP may and should be involved in OI prevention and control, in respect of codes of ethics, current legislation and scientific evidence. A multifaceted intervention in foundries, which showed effectiveness in reducing OI rates and improving quantitative and qualitative outcomes, gave us the opportunity to highlight OP's key role in implementing good occupational health and safety practices in workplaces.

[Vaccinations for health care workers exposed to biohazard. Evidences and good medical practices]. / Il Medico Competente e le vaccinazioni nel settore della sanità. Evidenze scientifiche e buone prassi.

Biohazard in healthcare settings is an issue for Occupational Physician (OP), owing to the potential relevant adverse effects for health care workers (HCW) and for the non complete effectiveness of primary prevention. Vaccination represents an effective tool to minimize risk of occupational and nosocomial transmission for many relevant communicable diseases. Implementation of vaccination campaigns may however present some critical aspects. The present study evaluates available scientific evidences and reports an Italian multicenter study (9 Hospitals, 3200 HCW), suggesting good medical practices in vaccination, while highlighting the role of the OP in a multidisciplinary context.