Occupational exposure to styrene in the fibreglass reinforced plastic industry: comparison between two different manufacturing processes.

BACKGROUND: Styrene is used in manufacturing fiberglass reinforced plastics: and occupational exposure was related to neurotoxicology and genotoxicity. The sum of the metabolites mandelic and phenylglyoxylic acids is the ACGIH biomarker for occupational exposure with a BEI of 400 mg/g of creatinine in end shift urine corresponding to a airborne styrene concentration of 85 mg/m3. There are two main molding processes, open and closed, the last more effective at controlling worker's styrene exposure. OBJECTIVES: To compare the open molding process to the compression of fiber reinforced resin foils, a kind of closed molding, monitoring the styrene exposure of workers in two production sites (A and B). METHODS: Environmental Monitoring was carried out by Radiello samplers and Biological Monitoring by means of the determination of MA and PGA with HPLC/MS/MS in 10 workers at Site A and 14 at Site B. RESULTS: The median values for styrene exposure resulted 31.1 mg/m3 for Site A and 24.4 mg/m for Site B, while the medians for the sum of the two metabolites in the end shift urine were 86.7 e 33.8 mg/g creatinine respectively. There is a significant linear correlation between personal styrene exposure and the excretion of styrene metabolites (R = 0.74). CONCLUSIONS: As expected the exposure markers of the workers of the two production sites resulted higher in the open process. The analytical results of both environmental and biological monitoring were all below the occupational exposure limits, confirming the efficacy of the protective devices.

[First aid and defibrillation in the workplace: a helpful decision for the public]. / O soccorso e defibrillazione precoce nei luoghi di lavoro: scelta di pubblica utilità.

Immediate activation of the chain of survival and the CPR training of the lay population, including prompt use of a semiautomatic defibrillator (AED), has been amply shown to reduce mortality due to cardiac arrest, which causes 60,000 deaths per year in Italy alone. This paper proposes a revision of the Italian regulation D.M. 388/03 on First Aid (FA), starting from the assumption that action in the workplace significantly improves the safety not only of workers but of citizens as a whole, especially in places attended by large numbers of people. The proposals, reflecting the recent regulation on early defibrillation, are based on field work done by the ISPESL Training Center (actually merged in INAIL), in cooperation with other institutions, and on a review of the literature and international guidelines. New training models have been tested and introduced in company FA systems, with fresh course content for FA workers and instructors.

[Synergistic exposure to noise and styrene and cochlear functionality in a sample of exposed workers: preliminary results]. / Esposizione sinergica a rumore e stirene e funzionalità cocleare in un campione di lavoratori esposti: risultati preliminari.

This study is aimed at testing the cochlear functionality using otoacoustic emissions, analyzing the synergistic effects of simultaneous exposure to noise and organic solvents EBTx on workers of a glass-reinforced plastic products factory. Exposure to organic solvents was assessed using ambiental measurements and evaluation of the salivary concentration. Biological monitoring was performed evaluating the urinary concentration of the styrene metabolites. Statistical analysis shows that otoacoustic tests can discriminate between different exposure groups. Significant differences were found between controls and subjects exposed to high styrene and low noise levels, showing the ototoxic effect (at sub-clinical level) of the styrene exposure.

[Psycho-physical fatigue in hospital personnel and intervention of the occupational physician]. / L'affaticamento psico-fisico nelle lavoratrici ospedaliere e l'intervento del medico del lavoro.

Fatigue is a topical subject that slips an univocal classification. That is because it involves the whole organism with its physiological components (Autonomous Nervous System, biochemical parameters...), as well as the affective, cognitive, and behaviour components. The Authors investigate fatigue as an emotion. Emotion is a research object that unifies all these different aspects. Throughout a qualitative research, over a sample of female hospital workers, they try to explain the complexity of this emotion. Trigger factors and, at the same time, inhibition factors are, on the one hand, the traditional ones such as shiftwork or number of years in office. On the other hand, important factors emerged: the satisfaction at work; the lack of control over some aspects of work (management and organization); the health work itself( experience of illness and death, relationship with patients and their relatives); the fatigue of "keeping in mind" the worker's own family and sons. The elaboration of these topics, done by the same workers as well as managers and occupational health and safety services, could allow to treat in a more efficient way "fatigue at work" and its effects in individuals, groups and organizations.

[Chemical risk in health environment: contribution to the evaluation and management of the risk to health]. / Il rischio chimico in ambiente sanitario: contributo per la valutazione e la gestione del rischio per la salute.

Among the many workplaces where there is a chemical risk, hospitals are surely one of the most complex when it comes to risk assessment. Numerous highly toxic substances are routinely used; clinical decisions often mean health workers come into contact with latest-generation drugs whose secondary effects are not yet fully known; they may have to execute procedures using different chemicals at the same time, as often happens in therapy or surgery. We studied two provincial hospitals in order to make a preliminary risk assessment, using an algorithm model. The chemical risk in the environments analyzed was mainly moderate, though some specific settings call for closer attention. Certain at-risk conditions can be solved by simple procedural changes, but others need to be tackled with a view to residual risk management. Some critical points came to light, linked to the algorithm employed, which need further examination to fit the model better to this particular context.

[Salivary analyses for biologic monitoring: possibility and perspectives]. / La saliva come matrice di analisi per il monitoraggio biologico: possibilità e prospettive.

The use of saliva for biological monitoring offers several interesting advantages, in terms of cost, non-invasive sampling, no risk of infection and little likelihood of the sample being polluted. Tests for measuring chemicals in saliva are available for many endogenous analytes, and xenobiotics. Saliva tests for inorganic compounds have so far not given satisfactory results, even using highly sensitive methods such as ICP/MS or atomic absorption. However, testing saliva for pesticides holds promise: the close correlation between the plasma compartment and saliva for some of these compounds has led to proposals for assaying diazinon, trichloropyridinol, atrazine, and paraquat, for instance, in saliva as biological indicators of occupational exposure. In industrial settings too significant correlations have been found between blood, urine and saliva assays. Investigations of exposure, for example, to plastifiers (phthalates), methanol, isopropanol and m-xylene have given comparable, equally reliable data, although highly sensitive instrumentation is needed. This approach appears to offer a wide range of applications, and certainly merits further study.

[Occupational medicine and new risks]. / La medicina del lavoro e i nuovi rischi.

Technological and socio-economic changes in the world of work are having a strong impact on the life of individuals and organizations. Individuals expect security, a feeling of belonging, and recognition; organizations constantly demand more flexibility, participation and productivity. Inside this growing gap we find today's new risks: they reflect at-risk work settings, where organizational "discomfort" is most likely to develop. Against this backdrop, dominated by a feeling of precariousness, workers have to re-visualize their jobs. This is a complicated and tiring process, as they have to demolish the old models they already have in their minds, so they can replace them with new, more appropriate ones. Occupational medicine has a role on two levels in this process. The first, close to the workers themselves, calls for the ability to understand the new risks, interpreting them in relation to the organizational settings. The second involves a path within the discipline, crossing over the first role but in the opposite direction to the usual one: from the dominant model of medicine by classification to reinstatement of the clinical dimension. This attributes importance to a research approach to problems, and calls for the construction of networks both within occupational medicine and between disciplines.

Prevalence and incidence of antibodies to Borrelia burgdorferi and to tick-borne encephalitis virus in agricultural and forestry workers from Tuscany, Italy.

The ticks Ixodes persulcatus and Ixodes ricinus are the main vectors of both Borrelia burgdorferi sensu lato and tick-borne encephalitis (TBE) virus in Eurasia. Borrelia burgdorferi is the cause of Lyme borreliosis, and TBE is a biphasic meningoencephalitis induced by an arbovirus belonging to the flavivirus family. The principal aims of the current investigation were (i) to determine the frequency of serological evidence of Borrelia burgdorferi sensu lato and TBE infections in healthy agricultural and forestry workers, (ii) to determine the incidence of seroconversion for antibodies against Borrelia burgdorferi sensu lato and TBE virus in Tuscan workers during a 1-year survey; and (iii) to assess the occupational risk for agricultural and forestry activities in a defined area (Tuscany, Italy). A total of 412 blood samples were taken from agricultural and forestry workers, and information on age, duration of employment, and history of tick bites was collected in a questionnaire to establish the risk factors for the diseases. Three hundred sixty-five blood donors from the same region served as controls. To estimate the rate of seroconversion, 176 of the agricultural and forestry workers were tested 1 year later. IgG and IgM antibodies against Borrelia burgdorferi sensu lato and TBE virus were detected in serum by an enzyme-linked immunosorbent assay and confirmed by Western blot analysis for Borrelia burgdorferi and by a test for inhibition of hemagglutination for TBE. Antibodies against Borrelia burgdorferi were more frequent among the workers than in the control group (7.8% vs. 4.9% in the IgG-IgM enzyme-linked immunosorbent assay and 7.03% vs. 3.56% in the confirmatory test). No seropositivity was observed for TBE virus. Eighteen of 176 subjects who underwent a second blood test developed specific antibodies against Borrelia burgdorferi within 1 year.

[Occupational exposure to endocrine disruptors: state of the art]. / Esposizione professionale a distruttori endocrini: stato dell'arte.

Research into how exposure to "endocrine disrupters chemicals" affects human health is attracting increasing attention among European and international scientists since these contaminants are so widespread in the home and work environment and can have far-reaching effects on mental and physical health. Here we draw a general picture of studies to date on specific occupational exposures to single chemicals such as bisphenol A, styrene, etc., or homogeneous groups such as pesticides, metals, dioxins, phthalates and others. Although the exposure occurs in different ways, the toxic mechanisms of action vary widely, and it is hard to establish precisely the conditions of occupational exposure, significant correlations are nevertheless evident between the potential dose and its effects and further studies are certainly needed. There is still much debate on the epidemiological methods employed, which may overestimate exposure. The "measure" or at least an accurate description of exposure conditions is critical to the whole question and attempts to ensure this involve standardized procedures and statistical tests as the basis for a protocol for assessing the risk of occupational exposure. Investigations to date have focused on the effects on the reproductive system, in males in particular. However, considering the broad range of equilibria and systems on which endocrine destructive compounds can act, the international scientific community needs to persist in its efforts to develop methods for checking the effects on other endocrine organs--particularly the thyroid gland--and on the immune and neurological systems.

[Health risk caused by exposure to low-dose chemical agents at research laboratories]. / Rischio per la salute da esposizione ad agenti chimici a basse dosi nei laboratori di ricerca.

In literature there are many works on the exposure to organic solvents and its risk. In research laboratories the risk valuation is really problematic due to different variables such as low dose, multiple exposure to substances with different characteristic of hazardous. We analyzed the blood exams of workers of seven biomedical research laboratories for finding a correlation between exposition and the variability of some parameters.

[Vaccine prophylaxis: contribution for the control of biologic risk in exposed workers]. / La profilassi vaccinale: contributo per il controllo del rischio biologico nei lavoratori esposti.

Working activities with exposure to biological agents have become a matter of discussion especially after the introduction in Italy of the Law 626/94, in conformity with the EU directive 90/679/EEC. There are many important biological agents that can have infectious, allergic, toxic or carcinogenic effects on the working population. Large occupational groups are exposed to these biohazards, both in agriculture and industry. Vaccination is one of the most beneficial medical practices, which has led to the eradication of such a devastating human disease as smallpox and the almost total elimination of poliomyelitis. Vaccination is also one of the most cost effective prevention measures applicable in this respect. This paper describes the possible vaccinations that employers should make available to employees exposed to biological risk, according to article 86 of Law 626/94.

[Chronic noise exposure and the cardiovascular system in aircraft pilots]. / Esposizione cronica a rumore e apparato cardiovascolare in piloti di aeromobili.

The aim of this study was to assess whether pilots are exposed to any risk of effects on the cardiovascular apparatus, whether chronic exposure to noise can be a risk factor for this occupation, the importance of intensity, length and type of exposure to noise, and if any relationship exists between audiometric deficits and cardiovascular effects. The study comprised 416 pilots subdivided into two groups according to the different levels of chronic exposure to noise, and a group of 150 control subjects not exposed to noise. The results showed: a) a higher prevalence of hypertension, nearly always diastolic, and of ECG abnormalities in the group of pilots of turboprop aircraft compared to jet plane pilots and to controls (p < 0.005 and p < 0.01 respectively); b) a higher prevalence of orthostatic hypotension in the two groups of pilots than in the controls (p < 0.05); c) a higher prevalence of hypertension with audiometric deficit compared to hypertension without audiometric deficit both in the more heavily and in the less heavily exposed to noise (p < 0.05), and a higher prevalence of hypertension with audiometric deficit in subjects exposed to higher levels of noise compared to hypertension with deficit but in subjects with lower levels of exposure (p < 0.05); d) a higher prevalence of abnormalities of basal, maximum effort and recovery ECG in pilots exposed to higher noise intensity (p < 0.05); e) improved hypertensive response to ergometric test in pilots with basal hypertension; f) subjects with a maximal load up to 120 W belonged prevalently to the group exposed to more intense noise (p < 0.001), while those with maximal load up to 210 W (p < 0.001) belonged to the group exposed to less intense noise. Considering that pilots are comparable for traditional cardiovascular risk factors, including age, both within the group and with the controls, the results confirm 1) that pilots could be exposed to the risk of effects on the cardiovascular apparatus, 2) that noise could be one of the risk factors and that cardiovascular effects could be related to intensity, type and length of exposure, age being the same, 3) that vascular damage is often accompanied by hearing loss even if the response of the auditory apparatus is different from the response of the cardiovascular apparatus, 4) that the postural diminution of arterial blood pressure might be a sign of a cardiovascular effect of noise. Lastly, a higher hypertensive response in hypertensive pilots suggests that basal hypertension is not reversible. Also a longer exposure to noise seems to influence the cardiovascular apparatus, causing a decrease in the response to work loads due to a lower sympathetic adaptability. The altered response of sympathetic activity to the postural modifications in the more exposed subjects and the response to lower work loads in pilots exposed to more intense noise, suggests a hypothesis of catecholamine depletion and alteration of baroceptor sensitivity as a consequence of chronic sympathetic activation due to chronic exposure to noise.

Vascular effects of occupational exposure to low-dose ionizing radiation.

Damage to the microcirculation caused by high-dose ionizing radiation is well known but data concerning low-dose exposure are scant and contrasting. We employed capillary microscopy to study dermal microcirculation damage resulting from occupational exposure to ionizing radiation doses lower than 5 rem/year (maximum permissible dose in Italy). We studied 145 physicians (60.7% radiologists, 33.8% orthopedic specialists, 5.5% cardiologists) occupationally exposed to ionizing radiation and a control group of 106 subjects in comparable but different occupations not exposed to ionizing radiation or to other skin hazards. All subjects were administered a clinical protocol and underwent capillary microscopy of the fingernail-fold. Capillary microscopy alterations were classified as absent, mild, moderate, marked and severe. Our data confirm that occupational exposure to low-dose ionizing radiation can lead to morphological and functional alterations of the dermal microcirculation, which can be identified early by capillary microscopy.

Liver damage in pharmaceutical industry workers.

A group of workers who were employed at a pharmaceutical manufacturing company and who participated in the entire production cycle were studied. Numerous substances, including iodo-chloro-oxyquinoline, erythromycin, disinfectants, small amounts of cortisones, and preserving agents (prevan and parabenzoates), were used in the manufacturing processes. A control group comprised individuals who were not exposed to hepatotoxic substances. This investigation was designed to determine the risk of hepatotoxicity in the pharmaceutical industry, and a protocol was used that allowed for ease of screening. In the presence of a physician, all subjects completed a clinical history questionnaire. They all underwent a general clinical examination, and specific blood chemistry tests were performed. Certain liver indices that were correlated with cytotoxicity were significantly higher in the pharmaceutical workers than among the controls. The findings confirmed that there was a problem of hepatic involvement among workers in this sector, indicating that the clinical-biohumoral screening protocol used in this study was valid for identifying subjects at risk of hepatotoxicity.

Noise and gastric secretion.

In view of the increasing incidence of diseases such as gastritis and ulcers in workers exposed to noise, we assessed whether noise does in fact affect gastric secretion. Then, considering the conflicting findings published on the effects of noise on gastric secretion, we also investigated whether the response was related to differences in baseline secretion, and whether it was further modified by a hydroalcoholic meal. We studied 50 dyspeptic subjects engaged in various types of work but not occupationally exposed to noise. They were exposed to a "pink noise" stimulus of 95 dB administered through earphones, lasting 15 minutes. Gastric secretion sometimes remained unchanged, sometimes increased, or sometimes even decreased in relation to the baseline hydrochloric acid secretion. The hydroalcoholic meal did not generally modify the effects of noise. These findings might help explain the differences in previous reports on this question.

Vascular effects of noise.

The possible vascular effects of noise were studied. A study of the carotid vessels was made with Doppler ultrasonography in two groups of subjects exposed to various intensity of noise. The following data were studied: age, blood pressure, serum cholesterol, blood glucose, smoking habits, excess weight, electrocardiographic anomalies, family history of vascular disease, connection with duration of exposure and the type of noise and with audiometric deficits, and cerebrovascular modifications after postural changes and after a stress test. The control group comprised subjects not exposed to noise. The findings confirm that noise does play a role in causing vascular modifications that can be detected early by use of Doppler ultrasonography. This technique is predictive and could be useful in screening campaigns, following the method suggested here.

Study of some cardiovascular parameters after chronic exposure to noise.

Research has focussed lately on noise as a risk factor for cardiovascular diseases. Recent findings, which have not been well confirmed, indicate that it does appear to affect heart rate, blood pressure and the electrocardiogram. This study involved two groups of subjects (with 75 and 225 in each, respectively) classified on the basis of different intensity of exposure to noise. Non-occupational risk factors studied (cholesterol, blood glucose, smoking, body mass index, family history of cardiovascular problems) revealed no significant differences between the two groups. Audiometric deficits and time exposure to noise were also studied. Blood pressure was measured at rest, an electrocardiogram was taken, and a cycloergometric stress test was made. The prevalence of hypertension and electrocardiographic modifications in basal conditions and under the stress test differed to a significant extent in relation to the different exposures to noise.