[Role of some psycho-physiological factors on driving safety]. / Ruolo di alcuni fattori psico-fisiologici sulla sicurezza alla guida.

Within a research project on the role played by human factors on road accidents, the aim of the present study is to evaluate, in young adults, the relationships between driver behaviour and personality factors as well as to assess the neuroendocrine correlates of psychological and behavioural factors investigated. Another aim is to estimate in what measure the performance levels are affected by demographic, psychological and chronobiological variables. It has been found a positive relation between highway code violations, extroversion trait of personality and Sensation Seeking scores, so confirming that this component of personality can affect risky behaviour. Furthermore the subjects more oriented to morningness chronotype were found to be prone to adopt safe driving behaviour. Regarding the relations of the neuroendocrine parameters and driving behaviour a positive correlation was observed between dopamine levels and frequency of driving violations while a negative relationship was found between adrenaline levels and frequency of driving errors. In conclusion the identification of psycho-physiological variables related to driving risky behaviour might be a useful instrument to design traffic safety programs tailored to high risk subjects.

[Children feeding practices in Pakistani families immigrant to Italy]. / Indagine sulle abitudini alimentari dei bambini di famiglie pakistane emigrate in Italia.

BACKGROUND: Immigration to Italy from Asian countries is sharply increasing, but little we know about the integration of children born in Italy from migrant families. OBJECTIVE: To evaluate which changes in feeding practices has occurred in respect of their original culture. METHODS: A cross-sectional study investigated the eating habits of 53 children (aged 2-14 years), born in Italy from parents who recently moved from Pakistan. Data were collected through a questionnaire and interviews. RESULTS: Religious beliefs and poor economical conditions interact with the feeding habits of the families. Prolonged, but not exclusive breastfeeding is common. According the Pakistani uses, many beverages are introduced early in addition to maternal milk. Whereas protein intake is usually low in the first two years of life, it tends to becomes excessive during school-age. Besides the traditional diet, children widely use savoury and sweet convenience food.

Relation between psychoneuroendocrine profile in stressful conditions and antibodies to herpesvirus 6 and 7.

The aim of the present study is to evaluate whether the individual susceptibility to infectious disease is influenced by the psychological profile of cadets exposed to stressful events associated with military lifestyle in academy and if the neuroendocrine responses to stressful events is related with humoral immunity estimated by measuring antibody titres to human herpesvirus (HHV-6)7 (HHV-7) and to what extent it is influenced by personality traits. It has been observed that cadets with lower psychoaptitude scores (1-2) have a significant higher susceptibility to infectious disease (x2=7.95; p=0.019) compared to subjects with higher scores. A positive relationship between cortisol and antibody titers to HHV-6 (r=0.304; p=0.024) it has been found. It can be interesting to observe that antibody titers on HHV-6 are also related to psychoaptitude profile (r=0.239; p=0.044). The antibody titers to HHV-7 are negatively related to the 5 scales of BFQ and in particular with subdimension Co (cordiality) of BFQ (r=0.401; p=0.002). The survey carried out on over 1,500 cadets of the Military Academy of Modena shows that the susceptibility to infectious diseases during the first six months of admission to the Academy seem to be influenced by the psychoaptitudinal profile. The finding of a positive relationship between serum cortisol and antibody vs HHV-6 suggests that the impairment of the immune system linked to circulatory cortisol levels may induce a reactivation of a latent herpesvirus 6 with related increase of antibody titers.

Prevalence of anti-legionella antibodies among Italian hospital workers.

This study evaluated the prevalence of anti-legionella antibodies in workers at hospitals with a long-term history of legionella contamination. The hospitals are located in Milan and Turin, northern Italy, and in Naples and Bari, southern Italy. Antibody prevalence and titres of healthcare workers, medical and dental students and blood donors were assessed. In total 28.5% of subjects were antibody positive, most frequently to L. pneumophila serogroups 7-14. Major differences were observed in seroprevalence and type of legionella antibody in persons from different geographic areas. Healthcare workers had a significantly higher frequency of antibodies compared with blood donors in Milan (35.4 vs 15.9%, P<0.001), whereas in Naples both groups exhibited high antibody frequency (48.8 vs 44.0%) and had a higher proportion of antibodies to legionella serogroups 1-6. Dental workers had a higher seroprevalence than office staff in Bari, but not in Turin, where daily disinfecting procedures had been adopted to avoid contamination of dental unit water. No association was found between the presence of antibodies and the presence of risk factors for legionellosis, nor with the occurrence of pneumonia and/or flu-like symptoms. In conclusion, the presence of legionella antibodies may be associated with occupational exposure in the hospital environment, but there was no evidence of any association with disease.

Risk factors for particulate and microbial contamination of air in operating theatres.

This study was designed to standardize dust collection in recently built operating theatres equipped with a continuous monitoring system. The objectives were to establish the relationship between microbiological and dust contamination, and then to compare those parameters with the main indicators of surgical activity in order to better define risk factors affecting air quality. The air quality during 23 surgical operations was studied in three conventionally ventilated operating theatres. Microbiological air counts were taken using both passive and active sampling methods. Air dust particles, > or =0.5 and > or =5 microm in size, were measured using a light-scattering particle analyser. The overall dust load was mainly (98%) composed of fine particulate matter, most probably due to its longer suspension time before settlement. These particles positively correlated with operation length, but not with surgical technique, suggesting that fine particles may be a good tracer of operation complexity. In contrast, the surgical technique was the main predictor for the concentration of particles > or =5 microm, with a higher risk from general conventional surgery compared with scope surgery. The frequency of door-opening, taken as an index of staff and visitor movement, was the main negative predictor of over-threshold values of both fine and larger dust particles but, conversely, was a positive predictor of raised bacterial counts.

[Health certification requested for admission to degree courses in Italian university medical schools]. / Certificazioni sanitarie richieste per l'ammissione ai corsi di laurea delle facoltà mediche italiane.

Prior to enrollment in degree courses in Italian university medical schools students are required to undergo health tests and preventive measures. The aim of this study was to census and assess the health certification required by Italian universities. Information was collected from course admission notices published on the university websites. Most universities requested health certificates for the academic year 2005-2006. Requirements usually focused on the risk of tuberculosis and hepatitis B for students enrolled in degree courses in medicine and surgery and in dentistry and dental prosthetics. Additional certification concerning physical and mental well being suited to specific tasks was also required for courses for the health professions of nurses, midwives, rehabilitation, technical and health prevention staff The request of several universities for antituberculosis vaccination clashed with legislation currently in force. Most universities did not notify the subsequent requirement for certification concerning physical and mental wellbeing on the website admissions list. The survey showed that Italian universities adopt different criteria in requesting certifications and different terms and conditions. In addition, requirements were often not updated. Competent university medical staff should be consulted to define what health certification is required from students for admission to different courses in university medical schools.

[Monitoring occupational exposure to volatile anaesthetics in the operating theatre: environmental and biological measurements]. / Monitoraggio dell'esposizione professionale ad anestetici volatili in sala operatoria: misurazioni ambientali e biologiche.

Concentrations of nitrous oxide (N2O) and isoflurane were measured in environmental and urinary samples from subjects occupationally exposed to volatile anaesthetics in operating theatres in a hospital in northern Italy. The aim was to establish whether: an automatic analyzer (Brüel & Kjaer 1302 spectrometer) can be used for fixed position sampling ("anaesthetist zone" and "surgeon/instrument nurse zone"); periodic monitoring of anaesthetics will reduce exposure; exposure to N2O and isoflurane is within legal limits; exposure differs between anaesthetists and surgeons/instrument nurses. Exposure to anaesthetics was monitored twice at six-month intervals. In the first test time spent in the operating theatre was noted and exposure levels were measured automatically. In the second test levels were monitored with passive personal sampling devices. Environmental concentrations of N2O determined by the spectrometer were correlated to urinary levels. Urinary levels of N2O calculated from the regression line were the same as those obtained with the personal samplers. Environmental and urinary levels of N2O decreased significantly from the first to second test. In the second sampling 70% of subjects had levels of exposure to N2O and isoflurane within prescribed environmental limits (50 ppm for N2O and 0.5 ppm for isoflurane). At the first test anaesthetists had significantly higher levels of exposure to N2O than surgeons/instrument nurses. The survey demonstrated that: fixed position sampling data related to time spent in the operating theatre can be used to gauge individual exposure levels; exposure levels decrease after tests following implementation of preventive measures; monitoring needs to be repeated because exposure levels often exceed legal limits; occupational exposure decreases when pollution in the anaesthetic zone is reduced.

[Environmental concentrations of nitrous oxide and isoflurane in the operating theatre]. / Concentrazioni ambientali di protossido di azoto e isofluorano in sala operatoria.

An environmental survey was carried out in the operating theatres of an Emilian hospital (North Italy) to ascertain: if concentrations of nitrous oxide (N2O) and isoflurane were within prescribed limits; if anesthetic pollution decreases when it is periodically controlled; if the degree of pollution from isoflurane can be predicted from N2O measurements. Three controls of anesthetic pollution were carried out at six month intervals using a photoacoustic spectrometry analyser. Mean concentrations of N2O were lower than the limits prescribed for renovated (50 ppm) or not refurbished (100 ppm) operating theatres in 58% of the surgical sessions examined. Mean concentrations of isoflurane were lower than the values proposed for halogenated anesthetics, used together with N2O (0.5 ppm) or alone (2 ppm) in 39% of the cases. Anesthetic pollution decreased only after the second control. Mean concentrations of isoflurane and N2O were correlated with a very good degree of association (r = 0.77). The survey highlights that pollution needs to be controlled in operating room because anesthetic levels often exceed the prescribed limits. Awareness of the problem is important to improve environmental conditions. N2O measurement is indicative of pollution from isoflurane but halogenated anesthetic must also be determined for a thorough evaluation of anesthetic pollution.

Risk of birth defects in a population exposed to environmental lead pollution.

To investigate the relation between environmental lead and risk of birth defects in humans, we examined the prevalence at birth of congenital anomalies in an industrial area of northern Italy heavily polluted with lead. Through a population-based registry of birth defects, we identified anomalies diagnosed during three consecutive periods characterized by decreasing environmental lead exposure, 1982-1986, 1987-1990 and 1991-1995. In the lead-polluted area, we observed an excess risk of cardiovascular defects which decreased from 2.59 [95% confidence interval (CI) 1.68-3.82] in the first period to 1.18 (95% CI 0.62-2.06) and 0.97 (95% CI 0.57-1.54) in the subsequent periods. We also found an excess risk of oral clefts and musculoskeletal anomalies, with decreasing trends over time. We could not identify homogeneous patterns of temporal variation for other congenital anomalies, neither did we detect cases of neural tube defects. These results appear to support an association between severe parental lead exposure and specific birth defects.

Effects of chronic exposure to anaesthetic gases on some immune parameters.

A cross-sectional survey was carried out to evaluate the relation between occupational exposure to low levels of anaesthetic gases (nitrous oxide and isoflurane) and immune parameters. Fifty-one anaesthetists were recruited among different Services of Anaesthesiology and Reanimation. The control group consisted of non-exposed physicians, similar for gender, age, and job grade. Total number of lymphocytes, lymphocyte subpopulations and the natural killer (NK) cytotoxic activity were measured. Information on personal and professional characteristics and on short- and long-term exposure was collected. Percentages of T cells (CD3) decreased significantly in anaesthetists compared to controls, whereas numbers of NK cells (CD16+ CD3-) increased. After correction for confounders, short-term (last 2 weeks) exposure was associated with a decrease in percentages of total T and T helper (CD4) cells. Furthermore, T helper percentages were significantly reduced with increasing individual exposure score evaluated on the basis of working days and levels of anaesthetic gases in operating rooms. A significant X-ray-associated increase of numbers and percentages of NK cells was lastly observed. Despite limited present exposure to anaesthetic gases, a specific derangement in lymphocyte subpopulations, with T lymphocytes more affected than B, has been observed.

Relation between immune variables and burnout in a sample of physicians.

OBJECTIVES: To evaluate in a group of physicians the relation between burnout, demographic or job characteristics, anxiety, and immune variables. METHODS: Seventy one physicians of all grades were recruited among different departments to a cross sectional survey. The Maslach burnout inventory, scales of emotional exhaustion, depersonalisation, and personal accomplishment, the trait scale of anxiety inventory (STAI-Y2), and a questionnaire on personal and professional characteristics were administered. The immune profile included quantitative (number (%) of lymphocytes and subsets) and functional (natural killer cytotoxicity) measures. RESULTS: With a model of stepwise multiple regression analysis, emotional exhaustion was significantly affected by both personal (marital, sex) and job characteristics (qualification, working activity), whereas only patient contact explained a portion of variation in depersonalisation. Furthermore, trait anxiety was found to predict the Maslach burnout inventory scores. After correction for potential confounders, physicians who scored high levels of personal accomplishment showed significantly higher numbers of total lymphocytes, T cells (CD3), T helper cells (CD4), and T suppressor cells (CD8) than those who scored low levels. No other correlation was found between burnout and immune variables. CONCLUSIONS: In our group of relatively young physicians a high degree of personal accomplishment was associated with an increase in the number of peripheral lymphocytes, particularly T subsets. The meaning of this is not clear, although it could be speculated that to evaluate oneself positively, particularly with regard to work with patients in the health services, might help to stimulate the immune system. By contrast, there is no evidence that to work hard, to feel tired from work, and to have a cynical reaction towards patient care is related to immunosuppression.

The epidemiology of selenium and human cancer.

The relation between the trace element selenium and the etiology of cancer in humans remains elusive and intriguing, despite the number of epidemiologic studies published on the topic. We address some methodologic issues, such as misclassification of exposure, particularly to single selenium compounds, effect modification, confounding, and other sources of bias, which may explain the inconsistencies in the literature. We also review the results of cohort studies, which have yielded either inverse or null or direct associations between selenium exposure and subsequent cancer risk. To date, no beneficial effect on cancer incidence at major sites, including prostate cancer, has emerged from the Finnish program begun in 1984 to increase the average selenium intake in its population. Populations exposed to unusually high or low levels of environmental selenium might offer unique opportunities to investigate if selenium exposure is related to the etiology of human cancer.

Emotional stability, anxiety, and natural killer activity under examination stress.

This study was performed to evaluate the relation between a stable personality trait, a mood state and immune response to an examination stress. A self-reported measure of emotional stability (BFQ-ES scale) was obtained in a sample (n = 39) randomly selected from 277 cadets; this personality trait was also investigated by completing a neuroticism scale (Eysenck personality inventory) and a trait-anxiety scale (STAI). Natural killer (NK) cell activity was measured at baseline, long before the examination time and the examination day. The state-anxiety scale evaluated the response to the stressful stimulus. Taking subjects all together, the academic task did not result in significant modification over baseline in NK cell activity. Subjects were then divided into three groups based on emotional stability and state-anxiety scores: high emotional stability/low anxiety, medium, and low emotional stability/high anxiety. Examination stress induced significant increases in NK cell activity in the high emotional stability/low anxiety group, no effect in the medium group, and significant decreases in the low emotional stability/high anxiety group. The repeated-measure ANOVA revealed a significant interaction of group x period (baseline vs. examination) for both lytic units and percent cytolysis. The results did not change after introducing coffee and smoking habits as covariates. Our findings suggest that the state-anxiety acts in concert with a stable personality trait to modulate NK response in healthy subjects exposed to a psychological naturalistic stress. The relation between anxiety and poor immune control has been already described, whereas the ability of emotional stability to associate with an immunoenhancement has not yet reported. The peculiarity of our population, a very homogeneous and healthy group for life style and habits, can have highlighted the role of emotional stability, and may account for the difference with other studies.

Genetic polymorphisms influence variability in benzene metabolism in humans.

The role of genetic polymorphism in modulating urinary excretion of two benzene metabolites, i.e. trans,trans-muconic acid (t,t-MA) and S-phenylmercapturic acid (PMA), has been investigated in 59 non-smoking city bus drivers, professionally exposed to benzene via vehicle exhausts. Exposure to benzene was determined by personal passive samplers (mean +/- SD = 82.2 +/- 25.6 micrograms/m3), while internal dose and metabolic rate were evaluated by measuring urinary excretion of unmodified benzene (mean +/- SD = 361 +/- 246 ng/l), t,t-MA (mean +/- SD = 602 +/- 625 micrograms/g creatinine), and PMA (mean +/- SD = 5.88 +/- 4.76 micrograms/g creatinine). Genetic polymorphism at six loci encoding cytochrome-P450-dependent monooxygenases (CYP2E1 and CYP2D6), glutathione-S-transferases (GSTT1, GSTP1 and GSTM1) and NAD(P)H:quinone oxidoreductase (NQOR) was determined by polymerase chain reaction-based methods. No evidence emerged for a possible role of CYP2E1, GSTM1 and GSTP1 polymorphisms in determining the wide differences observed in the rate of benzene biotransformation. Conversely, a significantly higher t,t-MA urinary excretion was found to be correlated to, GSTT1 null genotype, and a significantly lower PMA excretion was detected in the subjects lacking NQOR activity and in the CYP2D6 extensive-metabolizers. Many biological (i.e. age and body burden) or lifestyle factors (i.e. rural or urban residence, use of paints and solvents, medication, alcohol and coffee intake), also taken into account as potential confounders, did not influence the correlations found. These findings suggest that CYP2D6, GSTT1 and NQOR polymorphisms contribute in explaining the metabolic variability observed in our sample. Therefore, these polymorphisms should be regarded as potential risk factors for benzene-induced adverse health effects.

[Evaluation of the risk of neuropsychological damage from lead exposure in childhood]. / Valutazione del rischio di danno neuropsicologico per esposizione al piombo nell'infanzia.

Potential neurotoxicity of lead in children has been explored in many recent epidemiological studies carried out all over the world. Within a multicentric European study, an investigation was carried out also in Italy on children living in an industrial area and characterised by a non steady-state exposure condition with higher exposure at the early stages of life. This peculiar feature allowed to observe interesting associations between neurobehavioural functions and the levels of Pb measured in teeth, but not in blood. Indeed, Pb in teeth was associated with the results of psychometric tests which evaluate the discriminant ability and the attention. Other associations, like those found between the intelligence quotient (IQ) scores and Pb in teeth disappeared after correction for the socioeconomical status of parents. In general, in children exposed to environmental Pb, more consistent associations were found with visual-motor integration and attention than with IQ measurements. In agreement with literature data from other countries, we suggest that the relevance of neurotoxic effects of Pb is limited, at least at the current exposure levels, but also that a threshold Pb level associated with no effect cannot be identified.

Inter-individual variability of benzene metabolism to trans,trans-muconic acid and its implications in the biological monitoring of occupational exposure.

Unmodified benzene (UBz) and trans,trans-muconic acid (t,t-MA) were measured in urine samples collected at the end of the first half-shift in 80 bus drivers from a large city in Northern Italy. Mean UBz was 1155 ng/l (S.D. = 494), range 85-1980 ng/l; these values roughly correspond to 10-1000 micrograms/m3 of benzene in air. Mean t,t-MA was 297 micrograms/g creatinine; the range was large (20-1295 micrograms/g creatinine), and the distribution of values was bimodal. At further analysis of t,t-MA data, two subgroups of 59 and 18 subjects were identified (3 outliers were excluded): mean values of the index were 108 (S.D. = 65) and 916 (S.D. = 264) micrograms/g creatinine respectively, and the values within each subgroup were normally distributed. The mean ratio between t,t-MA and UBz in the subgroups were 0.15 and 0.85, respectively; the difference was significant. The first subgroup was defined as 'poor t,t-MA metabolizers', the other as 'efficient t,t-MA metabolizers'. No inter-subgroup differences were observed regarding the main characteristics (age, dietary and smoking habits, etc.). As the parent compound of t,t-MA, trans,trans-muconaldehyde is myelotoxic, and its production has been implicated in benzene-induced leukemia. 'efficient' t,t-MA metabolizers may be at higher risk of developing benzene toxicity. If confirmed in further studies, the inter-individual variability rate of metabolizing benzene to t,t-MA may introduce some limitations in the application of this metabolite as an exposure index of low benzene exposure. Nevertheless, the t,t-MA/UBz ratio may be an important index of susceptibility to benzene toxicity.

Lead, cadmium, and selenium in the blood of patients with sporadic amyotrophic lateral sclerosis.

We determined whole blood lead and cadmium levels, and serum selenium levels in patients with sporadic amyotrophic lateral sclerosis and age- and sex-matched controls. Disability due to the disease directly correlated with lead levels, and there was a strong inverse correlation with selenium concentrations. Lead and selenium concentrations tended to be similar in the cases and controls, both in the study population as a whole and after the removal from the analysis of the patients with the highest degree of disability. In the patients with limited disability, cadmium concentrations were higher than in the controls. Our findings lend limited support to a possible involvement of cadmium, but not lead, in the etiology of sporadic amyotrophic lateral sclerosis, and strongly suggest that short-term indicators of exposure are inadequate to investigate the relationship between selenium and the disease.

Zinc and copper status and blood pressure.

In order to elucidate the relationships between Zn and Cu and blood pressure, the present case-control study was carried out. Zn and Cu status was evaluated in 60 subjects, pharmacologically untreated, affected by mild stable hypertension and in 60 normotensives matched for sex, age and smoking habits. Different markers of Zn and Cu status, including serum, erythrocyte and urine levels of the two trace elements and activities of some Zn- or Cu-dependent enzymes (alkaline phosphatase, lactic dehydrogenase, superoxide dismutase and lysyl oxidase) were evaluated. No significant difference between hypertensives and normotensives was observed in the mean levels of Zn and Cu as well as in Zn- or Cu-dependent enzymes, though higher levels of serum copper were associated with increased risk of hypertension. Interesting relationships between the biological parameters investigated were observed in the hypertensive subjects. Inverse correlations between blood pressures and serum Zn were observed. Furthermore, blood pressure was inversely related to lysyl oxidase activity. These findings give further support to the hypothesis that an imbalance of Zn and Cu bioavailability may be associated to hypertensive condition.