Immunogenicity of meningococcal polysaccharide ACWY vaccine in primary immunized or revaccinated adults.

Meningococcal polysaccharide (Men-Ps) vaccine immunogenicity following either primary immunization or revaccination in adults was evaluated. The study population consisted of subjects who have received tetravalent Men-Ps vaccine once (group 1) or at least twice, with a 2-6 dose range (group 2). Human leucocyte antigen (HLA)-typing was performed by polymerase chain reaction and specific immunoglobulin (Ig)G was measured by enzyme-linked immunosorbent assay. Nine months post-immunization, the percentages of individuals with levels of anti-Men-Ps IgG ≥ 2 µg/ml were comparable in both groups, with the exception of anti-Men-PsW135 IgG, which were significantly higher in group 2. The percentage of subjects doubling IgG levels at 9 months was significantly higher in group 1. The high baseline anti-Men-Ps antibody levels negatively influenced the response to revaccination, suggesting a feedback control of specific IgG. The calculated durability of anti-Men-Ps IgG was 2·5-4·5 years, depending on the Men-Ps, following a single vaccine dose. No interference by other vaccinations nor HLA alleles association with immune response were observed. This study confirms that Men-Ps vaccine in adults is immunogenic, even when administered repeatedly, and underlines the vaccine suitability for large-scale adult immunization programmes that the higher costs of conjugate vaccines may limit in developing countries.

Functional changes cardiovascular: normobaric activity and microgravity in young healthy human subjects.

BACKGROUND: The cardiovascular system works to maintain homeostasis through a series of adaptive responses to physiological requirements. Different self-regulatory mechanism prevent the effects induced by hydrostatic pressure changes on oncotic pressure caused by postural changes. Gravity exerts a strong influence on the postural changes with implications on the cardiovascular system. In orbit, gravity (+Gz) is responsible of mass redistribution of circulating blood flow. The aim of this study was the evaluation of the adaptive responses of cardiovascular system to postural changes with and without the use of the Lower Body Negative Pressure (LBNP). We considered that pressure changes that occur in human body in orbit can be simulated experimentally with use of Tilt-Test (Clino/ortho; Clino/head-down; head-down/ortho). This investigation could be useful for studying the influence on astronauts of long flights. SUBJECTS AND METHODS: We studied in 12 months, 30 young healthy volunteers (20 males, 10 female) during postural change tests. In the first evaluation they were submitted to tilt-test for 40 minutes, remaining in head-up +60 degrees (this state corresponds to a kind of gravitational stress +Gz) and in head-down to -30 degrees (-Gz) for 20 minutes. During the second assessment (after 5 +/- 1 days) all volunteers wear a device that simulate a state of LBNP at -20 mmHg. Afterwards, they were processed to 20 minutes in Head Down -8 degrees and after 2 hours of rest to 20 minutes at -15 degrees. Volunteers were monitored measuring blood pressure, heart rate and by Transthoracic Echocardiogram (TTE). RESULTS: Collected data were elaborated by a statistical analysis. We observed during orthostatic position for 40 min (+60 degrees) without LBNP, lower diameters and volumes of left and right ventricular (p < 0.05) and an increase in heart rate in comparison with the baseline conditions in clinostatism. Despite the reduction of preload volume, the mean value of cardiac output does not vary significantly. In Trendelemburg (-15 degrees) data show a non-significant variation (p > 0.05) of left and right ventricular diameters and volumes, while cardiac output and systolic blood pressure varies significantly (p < 0.05) compared to clinostatic and orthostatic position. With LBNP in head down to -8 degrees and -15 degrees, systolic and diastolic arterial pressure, ventricular volumes and cardiac output were unchanged if compared to values obtained in clinostatism with and without LBNP. If compared to -30 degrees in Trendelemburg without LBNP, data reached statistical significance (p < 0.05). CONCLUSIONS: The cardiovascular system and the autonomic nervous system, respond to postural changes and to volemia alterations, maintaining the physiological cardiac output, in order to preserve the metabolic requirements of body.

[Protection of working woman's health]. / Tutela della salute della donna lavoratrice.

INTRODUCTION: In the past the role of women was mainly that of wife and mother, over the centuries, this role has changed: women assert themselves in every social field and workplace. OBJECTIVES: Analyze the history of women's work, from prehistory to the present day highlighting the evolution of women's role over the centuries. Identify which may be the different occupational stressors, in particular the organizational and psycho-social ones, to which is submitted a working woman. MATERIALS AND METHODS: The authors have analyzed the most relevant data from literature, in particular on the issue of mental health. RESULTS: Provide the main forms of prevention that have to be implemented. DISCUSSION: The main challenge for women today, is to balance work outside the home and housework. This added to job stressors, may interfere with the psychological and physical wellbeing of the worker.

Elasticity/distensibility of the ascending aorta: basal conditions and simulated conditions from space flights.

INTRODUCTION: The hysto-morfological composition of the ascending aorta wall gives to the vessel its characteristic elasticity/distensibility, which is deteriorated due to both physiological (age) and pathological events (hypertension, diabetes, dyslipidemia). This contributes to reduce the wall elasticity and to occurrence of cardiovascular events. MATERIALS AND METHODS: Thirty young healthy subjects (20 males, 10 females, age <30 yr), were subjected to different postural conditions with and without Lower Body Negative Pressure (LBNP) with conventional procedures, to simulate the microgravity conditions in space flight. During this procedure the cardiovascular parameters and the aorta elasticity were assessed with ecocardiography. RESULTS: The observation of results and statistical comparison showed that despite different hemodynamic conditions and with significant variation of blood pressure related to posture, elasticity/distensibility did not change significantly. DISCUSSION: The elasticity/distensibility of arterial vessels is the result of two interdependent variables such as blood pressure and systolic and diastolic diameters. While blood pressure and heart rate vary physiologically in relation to posture, the compensation of the vessel diameters modifications maintains the aortic compliance invariate. Therefore, in young healthy people, despite the significant postural and the sudden pressure changes (equivalent to parietal stress) aortic compliance does not alter. This behavior might be related to the low rate of cardiovascular events that are present in healthy people aged under 30 yrs.

Occupational exposure to noise and the cardiovascular system: a meta-analysis.

The aim of our meta-analysis is to evaluate the association between the modifications of the cardiovascular system and chronic exposure to noise in occupationally exposed subjects. We considered the articles published from 1950 to May 2008. Only 15 papers were conforming to the inclusion criteria identified for this meta-analysis. A total of 18,658 workers were divided in three groups according to the level of noise exposure as measured in the original studies (High Exposure, HE, Intermediate Exposure, IE, Low Exposure, LE). A preliminary evaluation of the type of data allowed for a classification of the type of performed measurements. Two classes of variables were identified: Class I, composed by continuous variables (systolic blood pressure, SBP, diastolic blood pressure, DBP, and heart rate, HR) and Class II, composed by not continuous variables (prevalence of hypertension and prevalence of ECG abnormalities). For each variable the calculation of heterogeneity was performed. For continuous variables the calculation of ES and its significance were performed while Odds Ratio (OR) and its significance were calculated for not continuous variables. The results show a statistically significant increase of SBP and DBP in HE workers compared to LE and IE workers while HR is statistically higher in HE participants compared to LE participants. The prevalence of both hypertension and ECG abnormalities is statistically higher in HE workers compared to LE and IE workers. Taking into account both the extremely high heterogeneity among studies and the ES/OR values we suggest a particular attention to the measurement and evaluation of SBP, DBP and HR in workers with chronic exposure to noise. Also ECG for workers with chronic exposure to noise is suggested in order to identify and evaluate possible abnormalities noise could be a concurrent cause of.

Follicle-stimulating hormone levels in male workers exposed to urban chemical, physical, and psychosocial stressors.

The aim of this study is to evaluate whether occupational exposure to urban stressors could cause alterations in the follicle-stimulating hormone (FSH) levels in traffic policemen compared to a control group. After excluding the subjects with main confounding factors, traffic policemen and male controls were matched by age, working life, body mass index (BMI), drinking habit, cigarette smoking history, and daily consumption of Italian coffee, 166 traffic policemen and 166 controls were included into the study. FSH levels were significantly higher in traffic policemen compared to male controls (P < 0.05). The distribution of FSH values in traffic policemen and controls was significant (P < 0.05). Our results suggest that occupational exposure to low doses of chemical and psychosocial stressors may alter plasma levels of FSH in traffic policemen more than in the control group. If the results obtained are confirmed by further research, the plasma levels of FSH may be used as early biological markers, valuable for the group, used in occupational set even before the appearance of disorders of male fertility.

[Night workers and plasmatic cortisol]. / Lavoratori notturni e cortisolo plasmatico.

The aim of the study is to evaluate whether occupational exposure to night work could cause alterations in the levels of plasmatic cortisol. The interest toward this argument arises form several studies in scientific literature referring the presence of an alteration in the synthesis and release of cortisol in workers exposed to night work. We studied a population of workers employed in night security service and monitoring service of alarm systems in different museums compared to a control group not performing shift-work and/or night work. The exposed and control subjects were compared by age, length of service, smoking habit (n. cigarettes per day), habitual consumption of alcoholic drinks (n. glass of wine/beer per day). We evaluated the levels of plasmatic cortisol on 50 workers exposed to night work, all males of whom 30 smokers and 20 non-smokers and on 50 controls of whom 30 smokers and 20 non-smokers.

Plasma 17-alpha-OH-progesterone in female workers exposed to urban pollutants.

The aim of this study is to evaluate whether occupational exposure to urban pollutants could cause alteration in plasma 17-alpha-OH-P levels in female workers. After excluding the subjects with the principal confounding factors, traffic police and controls were matched by age, working life, age of menarche, menstrual cycle day, BMI, drinking habits, habitual consumption of soy and Italian coffee. 68 traffic police and 82 controls (7th day; follicular phase of the ovarian cycle), 37 traffic police and 20 controls (21st day; lutheal phase of the ovarian cycle) were included in the study and matched for the above mentioned variables. In follicular and lutheal phase of ovarian cycle, 17-alpha-OH-P mean levels and the distribution of 17-alpha-OH-P values were significantly higher in traffic police vs. controls. A higher instance of mental health disorders in traffic police vs. controls was found, although the difference was not significant. Considering that the potential confounding effect of extraneous factors was controlled by restricting the study population and by matching traffic police vs. controls on the above mentioned variables, our results suggest that occupational exposure to urban pollutants may alter plasma 17-alpha-OH-P concentrations. 17-alpha-OH-P could be used in an occupational setting as an early biomarker of exposure to urban pollutants, valuable for a group, even before the onset of related pathologies.

Respiratory and cardiovascular function at rest and during exercise testing in a healthy working population: effects of outdoor traffic air pollution.

BACKGROUND: There is controversy regarding long-term adverse effects of urban pollutants in urban workers. AIM: The aim of this study was to evaluate the effects of urban pollutants on respiratory and cardiovascular function in exposed traffic policemen compared to a control group. METHODS: Sixty-eight traffic policemen and 62 controls (all male) were investigated at rest and during symptom-limited incremental exercise test (performed with a cycle ergometer). The data were statistically evaluated. RESULTS: There were no significant differences in the mean values of resting ventilatory capacity, the forced spirometric test, or in blood gas parameters between the groups. The traffic exposed group demonstrated a number of significant changes in cardiorespiratory measures on exercise testing. Twenty-six traffic policemen and none of the controls experienced exercise-induced ECG abnormalities, hypertension or oxyhaemoglobin desaturation; 80% of the 26 had resting PaO(2) values <80 mmHg. CONCLUSION: The findings suggest that chronic occupational exposure to urban pollutants reduces resistance to physical effort and increases the risk of cardiovascular and respiratory changes including slight hypoxemia.

[Agricultural work: noise exposure and cardiovascular effects]. / Lavoro agricolo: esposizione a rumore ed effetti cardiovascolari.

Aim of the study was to assess cardiovascular effects in the farmers exposed to noise. We assessed two samples of 143 farmers using tactor (mean age 51.0 +/- 10.5 years, length of service 33.0 +/- 10.5 years) and 193 farmers not exposed to noise (controls) (mean age 48.3 +/- 13.7 years, length of service 30.6 +/- 14.7 years). After the phonometric measurements all farmers were undergone to a medical examination, measurements of blood pressure, a audiometric test and a electrocardiogram. The collected data show an increased prevalence of hypertension and electrocardiographic anomalies in farmers exposed to noise (systolic hypertension n. 53, 37.1%; diastolic hypertension n. 60, 42.0%; electrocardiographic anomalies n. 44; 30.8%) compared to the control group (systolic hypertension n. 23, 16.1%; diastolic hypertension n. 26, 18.2%; electrocardiographic anomalies n. 5; 3.5%) (systolic hypertension p = 0.002; diastolic hypertension p = 0.003; electrocardiographic anomalies p = 0.030). Our results could be taken to mean that there are effects of chronic exposure to noise on cardiovascular apparatus; this would stimulate the screening programmes for farmers.

Harm to the liver among employees of the Municipal Police Force.

The purpose of the study is to assess whether employees of the Municipal Police Force of a big city exposed to urban pollution are at risk of hepatotoxicity. The usual clinical practice tests like AST, ALT, gamma-GT, AP, conjugated and total bilirubin were carried out, accompanied by a questionnaire designed to identify the possible risk factors and the principal non-professional confounding factors for hepatotoxicity. The study covered 118 male Municipal Police employees performing traffic duties and 118 male blood donors engaged in office work. There were significant differences between exposed and controls with regard to the average AST and ALT values and values above the normal laboratory range; this was also the case for the distribution. The results suggest that there may be the possibility of liver damage among asymptomatic members of the Municipal Police Force and that periodic hepatic screening, with the above-mentioned tests, could be useful. It is presumed that chemical agents present in urban air in big cities may cause damage to the liver, even at exposure levels that fluctuate around the admissible environmental concentrations.

Environmental and biological monitoring of traffic wardens from the city of Rome.

A molecular epidemiological study on Roman policemen is ongoing. The results of a first assessment of the occupational exposure to aromatic compounds of 66 subjects engaged in traffic control and of 33 office workers are presented in this paper. Passive personal samplers and urinary biomarkers were used to assess exposure to benzene and polycyclic hydrocarbons during work shifts. The results obtained indicate that benzene exposure in outdoor workers is about twice as high as in office workers (geometric mean 7.5 and 3.4 micrograms/m3, respectively). The distribution of individual exposure values was asymmetrical and skewed toward higher values, especially among traffic wardens. Environmental benzene levels recorded by municipal monitoring stations during work shifts (geometric mean 11.2 micrograms/m3) were in the first instance comparable to or greater than individual exposure values. However, several outlier values were observed among personal data that greatly exceeded average environmental benzene concentrations. Among the exposure biomarkers investigated, only blood benzene correlated to some extent with previous exposure to benzene, while a seasonal variation in the excretion of 1-hydroxypyrene and trans-muconic acid was observed in both study groups. In conclusion, these results suggest that outdoor work gives a greater contribution than indoor activities to benzene exposure of Roman citizens. Moreover, relatively high-level exposures can be experienced by outdoor workers, even in the absence of large-scale pollution episodes.

Hypertension and chronic exposure to noise.

The effects of noise on various cardiovascular parameters are conflicting and uncertain. In the current study, the authors studied 52 workers who were employed in a bedframe factory who were chronically exposed to noise and who had poor hearing. An additional group of 65 workers who had jobs in the light-metal sector and another group of 64 office workers served as two control groups; none of the controls were exposed to noise, and none had hearing defects. Blood pressure was measured for each person in the supine and standing positions, and an electrocardiogram was also performed. Sound-level measurements were taken in the workplaces. Mean systolic and diastolic blood pressures and diastolic blood pressure distributions were significantly higher in the noise-exposed group than in both control groups. Among the three groups, there were significantly different frequencies of hypertension, drops in blood pressure, and electrocardiogram anomalies. Within the group of bedframe workers, those exposed to a personal daily level of exposure (i.e., equivalent continuous noise level for exposure to noise for each individual workers in an 8-hr shift) that exceeded 90 dBA had a higher mean diastolic blood pressure and a higher frequency of diastolic hypertension than workers exposed to a personal daily level of exposure of < 90 dBA. The findings suggested that (a) work performed by the bedframe group had some effects on the cardiovascular system, (b) noise is a cardiovascular risk factor, and (c) cardiovascular effects are relative to intensity and type of exposure. Vascular damage often accompanies auditory damage, but--depending on individual susceptibility--the cardiovascular system can respond in various ways.

Chronic venous disorders and occupation.

BACKGROUND: Chronic venous disorders in the general population are a significant socio-medical pathology. The importance and role of venous pathologies in the occupational field are underestimated and the data in the literature are incomplete and contradictory. METHODS: A study was made of 336 male workers: 112 industry workers, 120 stoneworkers, and 104 office workers. A targeted questionnaire was administered to all workers regarding occupational and extraoccupational risk factors for venous pathologies. The same workers were clinically examined, and a venous check-up and specific tests were done in clinostatic and orthostatic postures. RESULTS: The prevalence of chronic venous disorders, including major and minor pathology, was significantly higher among industrial workers (39.28%) than among stoneworkers (24.16%, P=.019) and office workers (22.11%, P=.010). Only for major pathology was the mean age higher in phlebopathic workers than in non-phlebopathic; furthermore, the proportion of workers standing for >/=50% of the work shift was higher in phlebopathic than in non-phlebopathic. These differences were significant in all working groups. The results showed a positive relationship between the prevalence of phlebopathy and increased age and number of hours spent standing. Considering workers of the same age classes, a higher prevalence of phlebopathy was found between those who stood for >/=50% of their shift and those who stood for <50% of the time. CONCLUSIONS: The results suggest that professions involving standing, particularly for those standing for >/=50% of the shift, can influence the development of chronic venous disorders and a diagnostic clinical protocol to be used by occupational physicians in screening working populations for the prevention of venous disease is suggested.

Liver damage among shoe repairers.

BACKGROUND: The risk of hepatotoxicity in the shoe industry has already been suggested, however, there has been no investigation among the craftsmen who repair shoes. METHODS: A group of 33 shoe repairers who work in supermarkets, and who use the same glues which contain mixtures of potentially hepatotoxic solvents were identified. A control group of 61 workers not exposed to hepatotoxic substances was also examined. All participants completed a questionnaire designed to identify potential risk factors and the main non-occupational confounding factors for hepatotoxicity. Laboratory tests, commonly used in clinical practice, were done to check whether they were useful markers of hepatotoxicity due to exposure to solvent mixtures, and to investigate which tests should be used in the screening campaigns. RESULTS: The exposed workers had a higher prevalence of elevated mean alanine aminotransferase (ALT), aspartate aminotransferase (AST), conjugated bilirubin (P=0.0001), and alkaline phosphatase (AP) (P=0.004) than controls did. The number of workers who had values outside the upper limit of normal for our laboratory was significantly higher (ALT P=0.034, AST P=0. 037, conjugated bilirubin P=0.014). Exposed workers all had a ratio of ALT to AST greater than 1, with a mean of 1.5; it was > 1.6 in more than half the exposed workers. CONCLUSIONS: The findings suggest that there is the possibility of liver involvement among even asymptomatic shoe repairers, and that periodic liver screening may be useful; furthermore, use of these tests (especially the ratio of ALT to AST) for craftsmen who repair shoes, and are exposed to solvent mixtures, is advisable even when environmental monitoring indicates levels below the threshold limit values (TLVs).

[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 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.