Basic Occupational Health Services for Agricultural Workers in the South of Iran.

The agricultural sector has by far the world's largest labour force, there are more than one billion workers in this industry worldwide, which contains half of the total world labour force. On the other hand, agriculture is one of the most hazardous occupations, and many workers suffer occupational accidents and ill health each year. Farming and animal breeding are associated with exposure to a wide variety of risk factors, including zoonotic agents, dust, elements of the thermal environment, noise, vibration and chemicals. Although half of the world's population are economically active and spend at least one third of their time in the workplace, only 15% of the workers have access to basic occupational health services. According to a WHO report, Iran has a well-structured health care system through which basic health care services are available to the entire population, and health indicators in Iran have consistently improved. The agricultural health program in Iran is being carried out in the cities and rural areas, and occupational health services are mainly integrated into the health network. This paper aims to describe the health care system and basic occupational health services (BOHs) available to 5,300 agricultural enterprises with 8,380 employees in the cities of Abadan, Khorramshahr and Shadegan in the Abadan region (Abadan, Khoramshahr and Shadegan districts), in the south of Iran.

Differences between peritoneal and pleural mesothelioma in Lombardy, Italy.

BACKGROUND: We examined characteristics of peritoneal (PEM) and pleural (PLM) mesothelioma in Lombardy, Italy. METHODS: From the Lombardy Mesothelioma Registry we selected PEM (N=300) and PLM (N=5011) cases diagnosed in 2000-2014. We investigated asbestos exposure and presence of asbestosis or pleural plaques. RESULTS: Incidence rates (per 1,000,000 person-years, world standardized) of PEM were 1.2 (men) and 0.9 (women), compared with 22.6 and 8.4 for PLM. Asbestosis (both genders) and pleural plaques (men) were more frequent among PEM cases. Occupational asbestos exposure was similar in PEM and PLM cases. We found higher proportions of PEMs employed in the asbestos cement production. CONCLUSION: The higher frequency of pleural plaques in PEM cases confirm the association between asbestos and peritoneal mesothelioma. The higher proportions of asbestosis and of past employment in the asbestos-cement sector among PEM cases suggest a possible role of high exposures to asbestos in the peritoneal mesothelioma genesis.

Occupational Health Services Integrated in Primary Health Care in Iran.

INTRODUCTION: A healthy workforce is vital for maintaining social and economic development on a global, national and local level. Around half of the world's people are economically active and spend at least one third of their time in their place of work while only 15% of workers have access to basic occupational health services. According to WHO report, since the early 1980s, health indicators in Iran have consistently improved, to the extent that it is comparable with those in developed countries. In this paper it was tried to briefly describe about Health care system and occupational Health Services as part of Primary Health care in Iran. METHODS: To describe the health care system in the country and the status of occupational health services to the workers and employers, its integration into Primary Health Care (PHC) and outlining the challenges in provision of occupational health services to the all working population. FINDINGS: Iran has fairly good health indicators. More than 85 percent of the population in rural and deprived regions, for instance, have access to primary healthcare services. The PHC centers provide essential healthcare and public-health services for the community. Providing, maintaining and improving of the workers' health are the main goals of occupational health services in Iran that are presented by different approaches and mostly through Workers' Houses in the PHC system. CONCLUSIONS: Iran has developed an extensive network of PHC facilities with good coverage in most rural areas, but there are still few remote areas that might suffer from inadequate services. It seems that there is still no transparent policy to collaborate with the private sector, train managers or provide a sustainable mechanism for improving the quality of services. Finally, strengthening national policies for health at work, promotion of healthy work and work environment, sharing healthy work practices, developing updated training curricula to improve human resource knowledge including occupational health professionals are recommended.

Occupational exposure to zoonotic agents among agricultural workers in Lombardy Region, northern Italy.

OBJECTIVES: This study was conducted in Northern Italy with the aim of defining the risk of agricultural workers' contact with biological agents through the determination of serum antibodies against selected zoonotic agents. Immunity against tetanus was also investigated. METHODS: Two groups of agricultural workers consisting of 153 animal breeders (exposed) and 46 non- breeders (controls) were included in the study. In a first group of 103 workers (89 exposed and 14 controls) the serum concentrations of antibodies against Hepatitis E Virus (HEV) were measured, whereas in the second group of 96 workers (64 exposed and 32 controls) the serum concentrations of antibodies against Leptospira spp., Coxiella burnetii, Borrelia burgdorferi, Brucella spp. and Salmonella spp. were addressed. Imunization against tretanus was also studied in this group. RESULTS: Animal breeders showed higher rates of IgG antibodies against Coxiella burnetii (50% vs. 31.2%), and Leptospira spp. (59.4% vs. 43.7%). Results of logistic regression analysis revealed that breeder workers showed a tendency to have higher prevalence of positivity for antibodies to Leptospira spp.and Coxiella burnetii than non-breeders (ORs ~ 3). Only one exposed subject showed antibodies against hepatitis E (none in controls), but when tested with another commercially available kit the percentage of anti HEV IgG positive subjects increased to 22.3% in the exposed, while none of the controls showed positive. None of the subjects showed antibodies against Salmonella spp. and Brucella spp. Italians and other European workers have better protection against tetanus (91%) compared to non-EU workers (81%). CONCLUSIONS: The higher frequency of the presence of serum antibodies to zoonotic agents (e.g. Leptospira spp. and Coxiella burnetii) in animal breeders suggests that they are more exposed to biological agents than workers not involved in animal breeding activities. The risk of contact with HEV deserves further studies because the adoption of different assays can result in significantly different results. The promotion of immunization of agricultural workers might be a priority, in particular for migrants.

Emerging zoonoses: the "one health approach".

Zoonoses represent a public health risk recently pointed out by the spreading of previously unknown human infectious diseases emerging from animal reservoirs such as severe acute respiratory syndrome and avian influenza caused by H5N1-virus. These outbreaks have shown that animal breeding activities can pose a significant public health risk. Until now, the risk of zoonoses has probably been underestimated, particularly in occupational settings. The emergence or re-emergence of bacterial (Mycobacterium bovis and Brucella spp) or viral (hepatitis E virus) infections shows that zoonoses should be considered as emerging risks in agricultural and animal breeding and should be addressed by specific preventive interventions. Close cooperation and interaction between veterinarians, occupational health physicians and public health operators is necessary, for a worldwide strategy to expand interdisciplinary collaborations and communications in all aspects of health care for humans, animals and the environment. This is what the One Health Approach was intended to be.

Immune changes in animal breeders: a pilot study conducted in northern Italy.

OBJECTIVE: Farming is associated with exposure to a wide variety of risk factors including organic dusts, endotoxins, allergens and other chemicals. The ability of some of these agents to interact with the immune system is demonstrated in the presented study which was undertaken to evaluate the relationship between pig and cow breeding, and the immune system early changes. Particular attention is paid to selected serum cytokines. METHODS: Sixty four animal breeders (36 cattle and 28 pig breeders) were selected as the exposed group, and 32 rural workers not engaged in animal breeding were utilised as the controls. Personal data were collected through a questionnaire, and selected serum parameters measured, including cytokines IL-6, IL-8, IL-10, IFNγ and TNFα, immunoglobulins and proteins, and total and differential white blood cell counts. RESULTS: The study stresses the significant increase of TNF-α, IL-8, and IL-10 in animal breeders, with the highest values in pig breeders, and a slight but statistically significant increase in albumin and total serum proteins. CONCLUSIONS: The findings of the presented study suggest a condition of immune system activation in animal breeders, with the highest levels observed in pig breeders. These changes may be attributable to exposure to organic dusts, endotoxins, or to the different biological agents present in the rural environment. The prognostic significance of these findings, however, remains unclear, but the observed changes might be indicative of a risk of developing respiratory toxic and allergic diseases, which need to be further investigated.