Simulating real-life exposures to uncover possible risks to human health: A proposed consensus for a novel methodological approach.

In real life, consumers are exposed to complex mixtures of chemicals via food, water and commercial products consumption. Since risk assessment usually focuses on individual compounds, the current regulatory approach doesn't assess the overall risk of chemicals present in a mixture. This study will evaluate the cumulative toxicity of mixtures of different classes of pesticides and mixtures of different classes of pesticides together with food additives (FAs) and common consumer product chemicals using realistic doses after long-term exposure. Groups of Sprague Dawley (CD-SD) rats (20 males and 20 females) will be treated with mixtures of pesticides or mixtures of pesticides together with FAs and common consumer product chemicals in 0.0, 0.25 × acceptable daily intake (ADI)/tolerable daily intake (TDI), ADI/TDI and 5 × ADI/TDI doses for 104 weeks. All animals will be examined every day for signs of morbidity and mortality. Clinical chemistry hematological parameters, serum hormone levels, biomarkers of oxidative stress, cardiotoxicity, genotoxicity, urinalysis and echocardiographic tests will be assessed periodically at 6 month intervals. At 3-month intervals, ophthalmological examination, test for sensory reactivity to different types of stimuli, together with assessment of learning abilities and memory performance of the adult and ageing animals will be conducted. After 24 months, animals will be necropsied, and internal organs will be histopathologically examined. If the hypothesis of an increased risk or a new hazard not currently identified from cumulative exposure to multiple chemicals was observed, this will provide further information to public authorities and research communities supporting the need of replacing current single-compound risk assessment by a more robust cumulative risk assessment paradigm.

Relationship between lead exposure and mild cognitive impairment.

INTRODUCTION: Since it is still controversial whether-low-to moderate long-term lead below current threshold values causes neurobehavioural deficits in adults. METHODS: Forty lead-exposed workers subjects with a mean blood lead (PbB) level of 56.4 µg/dL and 40 non-lead-exposed aged matched subjects (PbB: 15.4 µg/dL) with the same socio-economic background were investigated. Participants were administered a neuropsychological tests consisting of BAMT (Branches Alternate Movements Task), FT (Finger Tapping Speed), DS (Digit Span) POMS (Profile of Mood States). RESULTS: Authors noted a significant relationship between the exposed and the referent groups in tests mainly involving executive functions, short time memory and psycho-emotional variables. In addition, Poisson regression test performed on single psychoemotional factors (POMS), has allowed to evidence a significant influence of Pb e ZPP levels on tension, anxiety and depression. CONCLUSIONS: The present study showed that lead exposure among adults at levels previously considered safe, results in impairment of certain cognitive abilities.

Serum levels of carbonylated and nitrosylated proteins in mobbing victims with workplace adjustment disorders.

AIM: Today the most important problem in the work place is psychological abuse, which may affect the health because of high levels of stress and anxiety. There is evidence that most psychiatric disorders are associated with increased oxidative stress but nothing is reported about the presence of oxidative stress in mobbing victims. METHODS: This study has been carried out in a group of 19 patients affected by workplace mobbing-due adjustment disorders, in comparison with 38 healthy subjects, to evaluate whether oxidative stress may be induced by mobbing. RESULTS: Serum levels of protein carbonyl groups and of nitrosylated proteins, biological markers of oxidative stress conditions, were higher than those measured in healthy subjects. CONCLUSIONS: These findings may contribute to a better understanding of the redox homeostasis dysregulation occurring in victims of workplace mobbing.

[Assessment of occupational stress among shopping centre employees]. / Valutazione dello stress lavoro correlato nei lavoratori di un centro commerciale.

Occupational stress literature emphasizes the importance of assessment and management of work related stress. The recognition of the harmful physical and psychological effects of occupational stress on both individuals and organizations is widely studied in Europe. In Italy such legislation was introduced by Legislative Decree 81/2008. Objective of the present study was to evaluate the occupational stress level of a shopping centre employees. A sample of 50 workers, 54% male (n = 27) and 46% female (n = 23) underwent to the Occupational Stress Index (OSI) questionnaire, used to examine occupational stress level of employees through the evaluation of work organization, individual characteristics, coping strategies, and psychosomatic effects of the stress. The results of OS were compared to the stress levels of a reference population. Results of data analysis provided evidence that the work organization of the examined shopping centre was good and there was no correlation between work characteristics, personality patterns, coping strategies and the psychosomatic effects of the stress. In addition a negative relationship between job satisfaction and length of service was found. Improvements in working conditions as well as early diagnosis are essential for preventing further increases in these disorders among workers. The next step would be multidisciplinary intervention studies aimed at the work environment, with the goal of identifying scientifically-based strategies that are most effective in preventing occupational stress.

Fluoro-edenite fibres induce lung cell apoptosis: an in vivo study.

We previously showed that apoptosis in the lungs of sheep exposed to fluoro-edenite fibres is induced via the receptor pathway. The present study was performed to gain further insights into the mechanisms of activation of programmed cell death induced by the fibres. Fluoro-edenite fibres are similar in size and morphology to some amphibolic asbestos fibres. They have been found in benmoreitic lavas, in the local stone quarry, in building materials and in road paving at Biancavilla, a town in eastern Sicily (Italy), where epidemiological surveys revealed a cluster of mortality from pleural mesothelioma. Inhalation of asbestos fibres can cause chronic inflammation and carcinogenesis. Since fluoro-edenite has been shown to activate the apoptotic process, we set out to characterise the expression of apoptosis-regulating proteins in fluoro-edenite-exposed lung disease and sought to determine if apoptosis results from fluoro-edenite exposure. Lung tissue from apparently healthy sheep habitually grazing near Biancavilla was processed for immunohistochemical localisation of bcl-2 and bax. Results showed epithelial and interstitial bax overexpression, especially in cells directly in contact with the fibres, and negative bcl-2 immunoexpression. TUNEL-positive cells were detected in alveoli and connective tissue. The integrity of alveolar epithelium and alveolar apoptosis are critical determinants in the pathways that initiate fibrogenesis in the lung and fibroblastic foci are usually found close to abnormal or denuded alveolar epithelium. Our results are consistent with the hypothesis that apoptosis is an important mechanism for removing cells with irreparable fluoro-edenite-induced genetic changes that predispose them to a neoplastic evolution.

Meibomian gland dysfunction and ocular discomfort in video display terminal workers.

PURPOSE: Meibomian gland dysfunction (MGD) is one of the most common ocular disorders encountered in clinical practice. The clinical manifestations of MGD are related to the changes in the tear film and ocular surface with symptoms of ocular discomfort. In recent years, many surveys have evaluated symptoms associated with the use of Video Display Terminals (VDT), and VDT use is recognized as a risk factor for eye discomfort. The aim of the present study was to determine if the presence of MGD contributes to the signs and symptoms of ocular discomfort during the use of VDT. METHODS: In course of a routine health surveillance programme, a group of 70 subjects fulfilled the inclusion criteria and responded to a questionnaire about symptoms of ocular discomfort. The following ocular tests were performed: tear break-up time, fluorescein corneal stain, and basal tear secretion test. RESULTS: A total of 52 subjects out of 70 (74.3%) had MGD. A statistically significant correlation between the symptoms of ocular discomfort and hours spent on VDT work was observed in the total population (r=0.358; P=0.002; 95% CI 0.13-0.54) and in the group of subjects with MGD (r=0.365; P=0.009; 95% CI 0.103-0.58). Such correlation was not shown in subjects without MGD. CONCLUSIONS: The high prevalence of MGD among the subjects with symptoms of ocular discomfort suggests that this diagnosis should be considered when occupational health practitioners encounter ocular complaints among VDT operators. It appears that MGD can contribute to the development of ocular discomfort in VDT operators.

[Prevalence of Staphylococcus aureus methicillin-resistant (MRSA) among health care workers]. / Prevalenza di Staphylococcus aureus meticillino-resistente (MRSA) tra gli operatori sanitari.

Methicillin-resistant Staphylococcus Aureus (MRSA) is a type of Staphylococcus that is resistant to certain antibiotics. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. Staphylococcus infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities. The present study was performed to investigate the in vitro activity of oxacillin and other antimicrobial agents against S. aureus strains obtained from nursing personnel. The study included 56 hospital personnel of Universitary Policlinic of Messina. S. aureus strain was isolated in 14 samples (25%); resistent patterns have been studied and results have demonstrated: none methicillin resistant, while 14% oxacillin and tetraciclin resistant. The incidence of methicillin sensitive was 100%, while 86% proved to be sensitive to oxacillin and tetraciclin. In conclusion, the usually hygienic methods (disposable gowns, hygienic hand disinfection after each patients contact, masks use when is a risk of aerosolization of MRSA) are indicate for significantly reducing of these strains. Continuing education programmes can help to increase awareness among hospital staff.

[Asthenopia in VDT users: our experience]. / Astenopia e lavoro al VDT: nostra esperienza.

The aim of this study was to investigate the relationship between asthenopia and work with video display terminals (VDT). 62 office workers (29 males and 33 females), that use VDT for more than 20 hours each week, were investigated by means of standardized questionnaires (elaborated by the Italian Society of Occupational Medicine and Industrial Hygiene). The authors analyzed the prevalence of occupational asthenopia and its correlation with the duration of weekly VDT use and the presence of refractive alterations. It was demonstrated a prevalence of asthenopia of 51% and a statistically significant correlation between the entity of asthenopic symptoms and number of weekly hours and years of work at VDT, in particular in subjects with presbyopia.

[Work related low-back pain: prevention and strategies of rehabilitation]. / Lombalgia lavoro correlata: prevenzione e strategie riabilitative.

Back disorders are a major health problem in many occupations. Physical loads at work, such as manual materials handling frequent bending and twisting, lifting, and forceful movements, have been identified as possible risk factors for low back pain (LBP). Aim of the present study was to evaluate the rehabilitative treatment in the chronic lumbago.

[Hand-arm vibration syndrome and upper limbs diseases in the forest workers of Italia meridionale]. / Sindrome da vibrazioni mano-braccio e patologie degli arti superiori in lavoratori forestali dell'Italia meridionale.

Vibration exposure of the hand-arm system is associated with an increased risk of upper-limb vascular, neurological and musculoskeletal lesions, or hand-arm vibration syndrome (HAVS). The prevalence of occupational HAVS and upper-limb disorders was studied among 278 Forestry Service workers in Sicily and Calabria. Subjects who used chain-saws (18 weeks/year) had a greater prevalence of peripheral sensory-neural disturbances (28%), upper-limb musculoskeletal disorders (33%) and carpal tunnel syndrome (19%) compared with 260 manual workers from the same Corps not exposed to hand-transmitted vibration. Raynaud's phenomenon was comparable in exposed and control subjects (5.3% vs. 4.7%.) Upper-limb neuropathies were significantly associated with energy-equivalent frequency-weighted acceleration; exposure duration; and cumulative vibration dose (m2/s4h). The variable "years of work with vibrating tools" was strongly associated with peripheral neuropathies; carpal tunnel syndrome; and upper-limb musculotendinous syndromes. Data suggest that in Sicily and Calabria, where the climate is milder than in other areas of Italy, forestry work with hand-held vibrating tools does not entail a greater prevalence of peripheral vascular disorders (Raynaud's phenomenon), while the prevalence of occupational upper-limb neurological and musculoskeletal disorders, in which combined ergonomic and mechanical risk factors have a large pathogenic role, is significantly increased.

[Screen dermatitis and visual display units]. / Screen dermatitis e videoterminali.

Over the last fifteen years, the increasing prevalence of screens and electromagnetic devices used in a number of activities has determined the occurrence of new emerging clinical problems. Hence the need to evaluate the ergonomic aspects of the professions using such equipment to study the effects of electromagnetic fields on human health. The objective difficulties to standardize the studies on this field makes controversial the debate on the evidences in support of these nosographical entities and on the possible causative factors. One interesting area is that of dermatological diseases. The authors present the results of a study on the incidence of dermatological diseases of the face and of the neck in a population of screen workers. To achieve this goal subjects underwent dermatological counselling during the periodic of monitoring visits. Subjects were then identified in two groups: screen workers and as a control group, subjects not exposed to electronic equipments. Members of the first group when compared with those of the second, suffered more frequently from skin diseases, although there was just a statistical trend. However skin diseases were distributed with different frequency in the two groups and seborrheic dermatitis was much more represented among screen workers.

[Air pollution in urban areas as a risk factor for health in the general population and in workers. Environmental and biologic monitoring of 1-3 butadiene]. / L'inquinamento atmosferico delle aree urbane come fattore di rischio per la salute della popolazione generale e lavorativa. monitoraggio ambientale biologico dell'1-3 butadiene.

Exposure to 1,3-butadiene (BD), a probable carcinogen to humans, was investigated in two groups of subjects working in a refinery plant: 28 occupationally exposed workers and 21 subjects non-occupationally exposed controls. BD in blood was higher in the exposed workers than in controls. Excretion of urinary mercapturic acids N-acetyl-S-(3,4-hydroxybutyl)-l-cysteine (MI), was not influenced by occupational exposure. The present study shows that unmetabolised BD in biological fluids, represents the biomarker of choice for assessing occupational exposure to low airborne concentrations of BD.

[Column and upper limb muscoloskeletal disorders in drivers helpers]. / Valutazione dei disturbi e delle patologie muscolo- scheletriche del rachide e degli arti superiori in autisti soccorritori.

The past two decades have witnessed a sharp rise in the incidence of work-related musculoskeletal disorders (WMSD) off the upper extremities and low back pain. The high frequency of these Pathologies and the estimated costs induced a large number of searcher to indentify causes etiological and preventive measure. Epidemiological surveys have inquired people mainly devoted to health clinic, where nurses and health assistants partner; are few data on the rescuers drivers and operators of emergencies. In the sample considered the 3.9% presented abnormalities in at least one section of the column, the 3.8% presented borne disorders of the cervical spine and backbone for the past 12 months. No major disturbances emerged dependents of the upper limbs, pain in the wrist, paraesthesia day and night; No subject also reported disturbances hands as evidenced from examination goal. The 2.3% reported having had an accident at work with prognosis of less than 30 days and 06% over 30 days. The results showed that, through prevention program it is possible to reduce musculoskeletal disorders in specific occupations such as drivers and operators of emergencies.

[Occupational brucellosis in slaughtering of sheep and goats: study of five cases from a municipal abattoir in south-eastern Sicily]. / Brucellosi professionale nella macellazione degli ovi-caprini: studio di 5 casi di un mattatoio comunale della Sicilia orientale.

BACKGROUND: Brucellosis is a world-wild zoonosis of bacterial origin. In Italy, where reporting of the disease is mandatory, the incidence is 2.1 cases every 100,000 inhabitants, but tends to be higher in southern regions. However, the incidence decreased from 1999 to 2002. CASES: Five cases of occupational brucellosis, four slaughter-house operators and one veterinary surgeon, were reported in a slaughter-house in south-eastern Sicily employing 15 people. RESULTS: A study of the slaughtering process for sheep and goats led to identification of 23 different operations, some of which involved greater probability of infection: animal consignment; unloading and leading animals from the stable to the trap; strangling and bleeding; skinning and removal of mammary glands; removal and processing of abdominal viscera; post-mortem examination; mobile equipment and facility maintenance, and washing/disinfection. All affected workers had participated in one or more of these operations. CONCLUSION: Eradication of brucellosis in stock-farms should lead to the disappearance of the human disease, since the two are closely related. Despite legislation aimed at eradicating brucellosis in cattle, which has been in force since 1992, the prevalence of the human disease has risen in Italy, especially in Sicily. Within the framework of prevention, occupational physicians should exercise specific surveillance of brucellosis risk by carefully examining the plasma antibody content of workers involved in the slaughtering process. Occupational health physicians should also provide ad hoc information regarding the infectious agent and modes of transmission during slaughtering operations as well as specific training in the use of protective equipment, which is the only way of providing protecting from contagion by infected animals.

[Influence of microclimate factors on ocular discomfort in video display terminal workers]. / Influenza dei fattori microclimatici sul discomfort oculare in lavoratori addetti al VDT.

The objective of the present research was to evaluate the effect of environmental parameters (temperature, air velocity, relative humidity, illumination level, cubature) on ocular symptoms (tiredness, tearing, redness, blinking, itching, burning, photophobia, foreign body sensation, and heaviness) in a group of 54 male Video Display Terminal (VDT) workers. The subjects were employed in a public office placed in Messina and naturally ventilated; the investigation was performed in Spring time. Information about the ocular symptoms, occurring during the workshift, were gathered through a questionnaire; environmental measurements were performed by a data collector LSI. The results showed that 43 subjects out of 54 (79%) reported a lack of eye comfort; in addition the illumination level, temperature and air velocity were not consistent with those suggested by the Italian Regulatory Authority. A significant correlation between illumination level, temperature, air velocity and eye discomfort (tearing, heaviness, blinking, photophobia itching, respectively) was found. The Authors conclude that the inadequate environmental condition, possibility in interaction with the indoor chemical contaminants and the workload at VDT, may be responsible for the irritative eye symptoms complained by VDT-workers at workplace.

[Noise-related occupational risk aboard fishing vessels: considerations on prevention and the protection of exposed workers]. / Il rischio rumore a bordo dei pescherecci: alcune considerazioni sulla prevenzione e protezione degli esposti.

Recent legislation regarding the safety of workers aboard fishing vessels requires the appointment by ship owners of a Reference Physician in charge of health surveillance, preventive inspections and related tasks. As maritime workers, especially fishermen, have always been excluded from legal protection of occupational health, there are no exhaustive data on the incidence of their occupational disease. Several epidemiological studies of fishermen have evidenced a high prevalence and incidence of occupational conditions, among which noise-related hypoacousia. We report data of a phonometric survey conducted aboard six fishing vessels carrying a crew of less than six fishing in the mid-Adriatic. Measurements were performed during fishing and navigation aboard five vessels fitted with a fixed-pitch propeller and during fishing only aboard one vessel fitted with an controllable pitch propeller. Measurements were conducted: 1) in the engine rooms; 2) in the work area on deck; 3) at the winch; 4) in the wheelhouse; 5) in the mess-room and kitchen; 6) in the sleeping quarters. Results show that the equivalent sound pressure level in the engine rooms consistently exceeded 90 dBA on all vessels. The speed of the vessels fitted with the fixed-pitch propeller is 3-4 knots in the fishing phase and around 10 knots during navigation to and from the fishing grounds; noise emission is lower with the former regimen because of the smaller number of engine revolutions per minute. Our survey demonstrated considerably different noise levels in the various areas of vessels. One key element in workers' exposure, the tasks assigned and the environmental working conditions is of course the type of fishing in which the vessel is engaged. Further phonometric studies are required to assess the daily level of exposure per crew member, which represents the reference for the noise-related risk of each subject. Knowledge of the sound pressure levels in the work environment and the length of daily exposure of each crew member will allow to assess the level of occupational exposure and consequently enact the proper prevention and protection measures by the Reference Physician.

Stressful life events and fibrinogen level in middle-aged teachers.

BACKGROUND: Strong evidence has been reported that a high plasmatic level of fibrinogen plays a central role in the development of coronary heart disease. Many researches showed that stressful life events lead to an increase in plasmatic fibrinogen. The present investigation examined the relationship between plasmatic fibrinogen level and stressful life events. SAMPLING AND METHODS: A sample of 40 middle-aged women employed as teachers underwent a general objective examination, a venous puncture for plasma fibrinogen level evaluation, and completed a questionnaire regarding health behaviours, at baseline and 1-year follow-up. The stressful life events were recorded using the Paykel's interview for recent life events. RESULTS: At the baseline assessment, the distribution of teachers in the two stress exposure groups was 16 women for the non-exposed group of teachers, and 24 for the exposed teachers, while at the 1-year follow-up assessment, it was 10 for the non-exposed and 30 for the exposed group. The number of teachers exposed to stress was significantly higher at the 1-year follow-up than at the baseline assessment (30 and 24, respectively; p < 0.05). Average levels of plasmatic fibrinogen were significantly higher in stress-exposed women than in non-exposed women both at baseline assessment (p < 0.01) and at 1-year follow-up (p < 0.002). Moreover, the mean value of fibrinogen at the follow-up assessment showed a higher increase in stressed women compared with non-stressed women with an annual increase of 10.71 and 5.40%, respectively. CONCLUSIONS: Stress may trigger the hypercoagulable state evidenced by an increased plasmatic fibrinogen level. This mechanism may help explain the adverse impact of stress on the cardiovascular system.

[Reference values of urinary mercury in the Italian population]. / Valori di riferimento del mercurio urinario nella popolazione Italiana.

This paper shows the results of a polycentric study performed to assess the reference values of urinary mercury (U-Hg) in Italian population. 374 subjects from four Italian cities (Bari, Brescia, Genova e Siena) have been examined. A questionnaire on life style, dietary habits, occupational or environmental exposure to Hg and clinical history has been administered to every participant and number and surface of dental amalgams have been verified for all subjects. The determination of U-Hg has been performed on urinary extemporary samples by hydride generation atomic absorption method (HG-AAS); urinary creatinine has been determinated to reduce the intraindividual variability. U-Hg reference values were: 0.21-3.20 micrograms/g creat (5 degrees and 95 degrees percentile) and 0.12-6.04 micrograms/g creat (range). Moreover study results have shown that number and surface of dental amalgams, dietary fish intake and body mass index (BMI) influenced significatively U-Hg excretion. U-Hg reference values from this polycentric study resulted comparable to those assessed in other European countries, whereas the mean U-Hg observed in the referent Italian population was lower.

The veterinary surgeon in natural disasters: Italian legislation in force.

Law No. 225/1992 established a National Service of Civil Protection, with the important role of 'safeguarding life, goods, settlements and the environment from damage deriving from natural disasters, catastrophes and calamities' (art. 1). This law arranges civil protection as a co-ordinated system of responsibilities administrated by the state, local and public authorities, the world of science, charitable organisations, the professional orders and other institutions, and the private sector (art. 6). The President of the Republic's Decree No. 66/1981 'Regulation for the application of Law No. 996/1970, containing norms for relief and assistance to populations hit by natural disasters--Civil Protection' mentions veterinary surgeons among the people that are called upon to intervene. In fact, in natural disasters the intervention of the veterinary surgeon is of great importance. The authors examine these laws and other legislation relating to the National Service of Civil Protection.

[Work and video terminals: eye discomfort and blepharitis. Preliminary data]. / Lavoro al videoterminale: discomfort oculare e blefariti. Dati preliminari.

Blefaritis is one of the most common ocular disorders encountered in clinical practice. The clinical manifestation primarily occurs along the lid margin, and the predominant symptoms are itching and burning. In addition, the inflammation could cause a dysfunction of meibomian gland; this condition leads to ocular surface abnormalities. Objective of the present study was to determine if the Visual Display Terminals (VDT) work get worse the signs and symptoms of blefaritis in a group of 35 VDT operators. Results showed a correlation between burning, itching and corneal fluorescein staining and hour number a day of VDT work in the workers affected by blefaritis. The Authors concluded that VDT work can get worse the signs and symptoms of blefaritis.