Cancer mortality and exposure to nickel and chromium compounds in a cohort of Italian electroplaters.

BACKGROUND: Nickel and chromium-VI compounds are carcinogens for lung cancer, although it is still debated if there is an increased risk at low levels of exposure and for other cancers. METHODS: In a cohort of 2991 Italian electroplaters, a proportion of whom were exposed to low levels of nickel and/or chromium, cumulative exposure to their compounds was obtained by multiplying average concentrations of the metals in each electroplating tank by duration of employment in the company. The association of exposure to compounds with mortality was assessed by multivariable Cox models. RESULTS: No cancer site was associated with chromium exposure controlling for nickel, whereas exposure to nickel significantly increased mortality from lung, rectal, and kidney cancers, even after adjusting for exposure to chromium. CONCLUSIONS: Study results suggest that exposure to nickel compounds may increase the risk of lung cancer even below its occupational exposure limit and indicate possible associations with other cancer sites.

Is the Epworth Sleepiness Scale a useful tool for screening excessive daytime sleepiness in commercial drivers?

The significant social and economic impact of excessive daytime sleepiness makes sleep evaluation a primary medical need in commercial drivers. However, the best screening tool is still matter of debate. In our cohort of 221 commercial drivers, only ten (4.5%) had Epworth Sleepiness Scale scores indicative of excessive daytime sleepiness. These findings and the lack of concordance in estimating excessive daytime sleepiness among commercial drivers in previous studies using the same psychometric measure indicate that the Epworth Sleepiness Scale is not a reliable tool. This may be due to the low internal consistency of the scale in non-clinical samples and the possible intentional underscoring of sleepiness due to a perceived threat of driver's license suspension. Moreover, the reliability of the Epworth Sleepiness Scale results may be strongly influenced by the administration setting. The clinical application of inexpensive less time-consuming new tools like performance tests should be considered for the objective evaluation of excessive daytime sleepiness in commercial drivers.

[Mortality study in a cohort of workers employed in the hot working processing of plastics and rubber]. / Studio di mortalità in una coorte di esposti nella lavorazione a caldo di materie plastiche e gomma.

OBJECTIVES: to study mortality rates among workers in companies manufacturing thermoplastic and rubber articles (excluding tyres). DESIGN: cohort study. SETTING AND PARTICIPANTS: the cohort includes 4,543 workers employed up to 2000 in 131 companies in the Province of Bologna (Emilia-Romagna Region, Northern Italy) exposed to emissions from hot processing of plastics (3,937) and rubber (606). MAIN OUTCOME MEASURES: general- and cause-specific Standardized Mortality Rates (SMR), with 95% confidence intervals; entire reference population resides in the Emilia-Romagna Region. RESULTS: excess mortality for all causes (116 Obs; SMR: 1.20; 95%CI 1.00-1.44) and for lung cancer (18 Obs; SMR: 1.67; 95%CI 1.05-2.65) in men of the rubber factories. Increased mortality rates for oesophageal cancers in women (3 Obs; SMR: 5.41; 95%CI 1.74-16.8) and in men (6 Obs; SMR: 2.16; 95%CI 0.97-4.81), for malignant tumours of pancreas (16 Obs; SMR: 1.65; 95%CI 1.01- 2.70), rectum (11 Obs; SMR: 2.17; 95%CI 1.20-3.92) and kidney (11 Obs; SMR: 1.98; 95%CI 1.10-3.58) in men occupied in plastic processing. CONCLUSION: in this study, we observed an excess of mortality rates for lung cancer in men of rubber factories and for malignant tumours of the digestive tract, pancreas, and kidney in workers employed in the production of plastic articles. Nevertheless, these results must be interpreted with caution, because exposures to non-occupational risk factors, like tobacco smoke or other occupational exposures outside the companies concerned, are not known. The results suggest to continue epidemiological surveillance.

[Mortality study in metal electroplating workers in Bologna (Northern Italy)]. / Studio di mortalità in una coorte di esposti a metalli nel comparto galvanotecnica del territorio di Bologna.

AIM: to investigate general and cause-specific mortality of workers exposed to metals and other chemicals in the electroplating industry in Bologna Province. MATERIALS AND METHODS: factory records of workers employed in 90 electroplating companies present in 1995 were used to build a cohort of subjects potentially exposed to carcinogenic and other substances in this industry, defined as "revised cohort", which was followed-up for mortality from 1960, or since first employment in an electroplating company if later, to 2008. Mortality risk was also examined separately in a subset of the cohort, composed of workers with at least one year of employment in electroplating, denominated "final cohort". Death rates of residents in Emilia-Romagna Region (Northern Italy) were used as a reference. RESULTS: follow-up completeness was 99%. During the observation period, 533 deaths out of 2,983 subjects were observed in the revised cohort and 317 out of 1,739 in the final cohort. Significantly increased Standardized Mortality Ratios were estimated for overall mortality and for mortality from AIDS in the revised cohort and for bladder and rectal cancer in both cohorts. CONCLUSIONS: the present study is, to authors' knowledge, the largest mortality investigation conducted in Italy on electroplating workers, for both size and temporal extension. The presence of excess mortality from causes of death not consistently associated in the literature with exposure to agents in this industry suggests that further research is needed to confirm these associations.