[Urinary MTBE as biological marker of exposure to traffic exhaust fumes]. / Valutazione di MTBE urinario come indicatore biologico di esposizione a traffico autoveicolare.

Methyl tert-butyl ether (MTBE) is an oxygenated compound added to Italian fuel in quantity of about 3% v/v. In the present study the excretion of urinary MTBE (U-MTBE) was evaluated as biomarker of exposure to traffic exhaust fumes. With this aim 127 Milan urban policemen, working as traffic wardens, were investigated. Spot urine samples were obtained prior to and at the end of the work shift, in different seasons. Median U-MTBE varied from 74 to 164 ng/L (range 60-657 ng/L). Comparing the pre-shift and end-shift samples an increase of about 14% in the U-MTBE level during the workshift was observed. An influence of the different seasons was observed, with lower values in spring and higher values in winter. Smoking did not affect the excretion of U-MTBE. The results of this study suggest that U-MTBE is a sensitive and specific marker for the assessment of exposure to traffic exhaust fumes.

[New biomarkers of exposure]. / Nuovi indicatori di esposizione.

In this paper we have defined the new biomarkers of exposure (NBE) as those biomarkers discovered in the last five years and, among previously validated biomarkers, also those applied in different ranges of doses or those determined in biological matrices which differ from matrices originally considered. We examined the results from the surveys carried out by the main Italian research units involved in biological monitoring, i.e. those from the Universities of Brescia, Milan, Naples, Padua, Parma, Pavia, Turin and Verona. The data were collected using a standardized model and included the following: type of element or organic compound, type of biomarker, analytical technique and method, their relationship with environmental monitoring data, their relationship with effect indicators or effects in general, improvement with respect to old biomarkers, reference values. Twenty two NBEs were identified: 14 elements and chemical compounds as such or as metabolites, 4 examples of mixtures, 3 of new matrices, one of speciation. Among the others, aspects such as interest in requiring NBE, quality assurance, availability, cost-benefit ratio were discussed. We conclude that development of this specific field of research appears to be a crucial point for future improvement in risk assessment and health surveillance procedures.

NJHA and continuing education.

Founded in 1918, the New Jersey Hospital Association (NJHA) has, as its mission, the advocacy for health care services provided by New Jersey hospitals, nursing homes, and other health care institutions. Through its current membership of 126 institutions, the Association seeks to provide guidance in shaping policy and in improving the organization and delivery of quality health care. Along with other affiliated organizations, based at its Center for Health Affairs in Princeton, NJHA offers a variety of services. For example, NJHA: represents member institutions on legislative and regulatory problems before the Health Care Administration Board, Hospital Rate-Setting Commission, and other regulatory and legislative bodies; assists member hospitals in assessing and providing solutions to manpower needs; communicates common problems and accomplishments among member institutions through several publications and other media; and joins with MSNJ in conducting continuing medical education programs for physicians and hospital administrators, jointly working to develop position papers on health care issues. The following article presents an opinion piece by the president of NJHA, in which he addresses a current major concern of his organization, that is, how quality CME can be maintained given the severe economic constraints imposed by today's health care economy.

Join hospitals in working toward a common reimbursement goal.

In light of growing public concern about rising health care costs, government is seeking ways to reduce expenditures while maintaining the accessibility and quality of health care for Americans. Prospective payment and competition are two proposed mechanisms for achieving reduced costs; both impact on hospitals and pathologists. Hospitals and pathologists share a number of common interests including the same market, patients, physicians as colleagues, and the desire to provide quality care and have less government intervention. They clearly must work together to assure the survival of the health care system as it is today. This article, first presented at the American Pathology Foundation last year, describes, from a hospital administrator's perspective, an experimental reimbursement system used in New Jersey.