[Evaluation and management of pesticide risk in agriculture: the experience of the Region of Lombardy (Italy)]. / Valutazione e gestione del rischio da antiparassitari in agricoltura: l'esperienza della Regione Lombardia.

The evaluation of chemical risk in agriculture is complicated because of difficulties in obtaining measures representative of working conditions. This is the reason why experiences finalized at producing risk estimates are running. In this frame, a Regional working group has developed the project "Pesticide exposure and risk profiles in agriculture". Priority scenarios have been selected and the main variables correlated with pesticide exposure have been pointed out. A value for each variable has been defined. The sum of these values allows the definition of "Exposure Indices" (EI), which can be reduced by multiplication for a coefficient calculated based on use of personal protective devices, training and education and equipment conditions. A Risk Index is calculated as the product of EI per a toxicity index, calculated based on the risk phrases of the substances used ("Risk Profile"). Risk Profiles allow the production of risk estimates and the definition of the appropriate preventive interventions. Next phase will be addressed at the validation of the model, to be carried out through the determination of the levels of concordance between the risk class allocation obtained from the model and the one obtained from environmental and biological measures, in the same groups of workers.

[Noise pathology]. / Patologia da rumore.

After defining noise and describing the physical characteristics that determine its noxious capability, the paper discusses the etiopathogenesis, clinical features and diagnostic criteria (anamnestic, audiometric, exclusion of other causes) of noise-induced damage. In conclusion, the legislative (preventive) and medico-legal issues of noise pathology are presented.

[Research and formal demonstration of evidence of efficiency in occupational medicine]. / Ricerca e dimostrazione formale delle prove di efficacia in medicina del lavoro.

There is an increasing pressure on occupational health professionals to ensure that their practice is based on a quality standard and an evidence of appropriateness. The efficacy-effectiveness of their activity strictly depends on their intellectual and professional integrity, their technical and legal competence, but also on the quality of the relations with the company organisation they are able to establish. We asked to some occupational physician when they considered their interventions in the workplace to be efficacious. Then, accordingto our epexrience, we propose some effectiveness indicators, particular concerning health surveillance and health educttaon, that should be evaluated to verify the health professional agccvity agreement to quality standards.

Application of mathematical modelling for assessing the urinary half-times of nickel in stainless steel welders.

The study regards workers employed in manual metal are welding of stainless steel (MMA/SS). For two weeks they collected their urine during the work shift and the 16 hours following in order to evaluate the kinetics of nickel. Using one-compartment mathematical modelling we calculated the values of the toxicant's urinary half life during the two phases of exposure and postexposure and also during non working weekends. The aim of the study was to find correlations between inhaled doses and excreted quantities and to acquire practical data for use in biological monitoring. In the welders the mean urinary half life in the exposure period was 59.5 hours, in the post exposure it was 95.6 hours, while in weekend it was 95.5 hours. The study showed that exposure to fumes containing nickel could determine the accumulation of the metal in slow elimination speed compartment. As a consequence of the accumulation of nickel in compartments with different elimination speeds, the collection of single urinary portions in biological monitoring seems to give little information about the actual exposure. In our opinion this indicates collecting urine samples throughout the entire work shift and the 16 hours following exposure.

Biological monitoring of human exposure to atrazine.

Atrazine exposure was evaluated in six manufacturing workers by personal and biological monitoring. Total atrazine exposure varied from 10 to 700 mumol per workshift and total urinary atrazine excretion accounted for 1-2% of the external dose. The spectrum of the urinary atrazine metabolites comprises bi-dealkylated (80%), deisopropylated (10%), deethylated (8%) and unmodified atrazine (2%). The metabolites are eliminated in urine in slightly longer than 24 h: 50% of the amount is excreted in the first 8 h following the workshift.

Reference values of urinary ethylenethiourea in four regions of Italy (multicentric study).

The results of a study in which urinary ethylenethiourea (ETU) was assayed in the general population (167 subjects) of four Regions of Italy (Veneto, Lombardy, Piedmont and Trentino Alto Adige) are reported. The results are compared with those in a population of 97 subjects from Rovescala, a hillside wine-producing town a few kilometers from Pavia, where ethylenebisdithiocarbamates are sprayed by helicopter. It was found that an average of 24% of the populations of the four regions, taken together, had urinary ETU levels above detection limits (1.0 microgram 1(-1)) as compared to 37% of the population of Rovescala. The ranges of concentration were 0.8-8.3 micrograms 1(-1) for the four regions and 0.9-61.4 micrograms 1(-1) for Rovescala. Statistically significant variables for urinary ETU levels were smoking and wine drinking.

Urinary excretion of ethylenethiourea in five volunteers on a controlled diet (multicentric study).

Urinary excretion of ethylenethiourea (ETU) was monitored for 8 days in a group of five male non-smoker volunteers on a diet, the items of which were assayed for ETU and carbon sulphide. Urinary excretion of ETU reflected the consumption of wine, fruit and vegetables. Urinary ETU concentrations ranged from 0.6 to 6.7 micrograms/g creatinine. ETU concentrations in the food eaten by the volunteers were generally below the detection limit whereas in wine 8.8 micrograms/l ETU was detected. Evolution of carbon sulphide by food samples ranged from 0.03 to 0.17 mg/kg. Mean (+/- S.D.) daily intake of ETU in wine was 3.5 +/- 0.2% of the acceptable daily intake (ADI): 0.070 +/- 0.004 micrograms/kg body wt. During the 8 days of the study, an average of 48.3% of the ETU ingested in wine was excreted unmodified by the kidneys. Twenty-four hour urinary excretion of ETU was significantly correlated with daily intake of ETU (r = 0.768) and CS2 evolved by the daily food items (r = 0.414).

Reference values of urinary 3,5,6-trichloro-2-pyridinol in the Italian population--validation of analytical method and preliminary results (multicentric study).

The interlaboratory validation of analytical procedures for the assay of urinary 3,5,6-trichloro-2-pyridinol (TCP) in the general Italian population is reported. The determinations were performed by high-resolution gas chromatography (HRGS) with electron capture detection and HRGS with mass spectrometry (MS) in 2 laboratories. The urine samples were from 42 participants from 3 regions of Italy. The results were evaluated by interlaboratory quality control. Urinary TCP concentrations were above the detection limit (1.2 micrograms/L) in 88% of the population, with a mean detectable concentration [GM (GSD)] of 2.8 (1.9) micrograms/g creatinine (creat). (GM, geometric mean; GSD, geometric standard deviation.) The Mann-Whitney U test showed that wine consumption was a statistically significant variable (p < 0.05) for urinary concentrations of TCP. Analysis of variance of the logarithm of urinary TCP versus wine consumption and diet showed a statistically significant fit. The model used explained 30% of the total variance: wine consumption and diet accounted for 37 and 17% respectively of the explained variance.

[Lead automated microdetermination in capillary samples of blood by a flameless atomic absorption spectroscopy (author's transl)]. / Determinazione del piombo in sangue capillare mediante impiego di un microcampionatore automatico per forno di grafite.

A method for lead determination in capillary samples of blood based on flameless atomic absorption spectroscopy in connection with an automated microsampling system is described. For such determinations 50 microliter of heparinized whole blood samples from the fingertip or from the ear lobe are sufficient. Immediately after sampling blood is diluted in ratio 1:5 by an aqueous 0.05% Silicon Antifoam solution. Correlation between lead capillary from the same subjects and venous blood levels sampled from the same subjects and in the same sampling session is highly significant and well suited for routine clinical use.

[Diagnosis and consultation at the Hospital Unit of Occupational Medicine (UOOML)]. / Diagnosi e consulenza nelle Unità Operative Ospedaliere di Medicina del Lavoro (UOOML).

The author describes the operating course of the Occupational Medicine Operating Units (OMOU) in our region. (Lombardia) These Units, born as a second level support to the Basal Occupational Medicine Units, greatly enlarged, as time passed, the limits of their users together with the charge of preventive duties ordered to the employers by the recent laws regarding Occupational Hygiene. (DLgs 277/91-DLgs 626/94) The author also illustrates the variety of the diagnostic demands to the OMOU according to the enlargement of the legal protection of occupational diseases and to the numerous aspects of specific job fitness. He underlines the need of multiple specialistic skillfulnesses achievable by means of a complete integration of OMOU in to the hospital to which they belong. In conclusion the author illustrates the new tasks of the OMOU in the field of the therapy and rehabilitation.

[Responsibility (according to the legislative act "626/1994") in the implementation of preventive measures in the preparation of antiblastic drugs]. / Le responsabilità (ai sensi del d.lgs. "626/1994") nell'attuazione delle misure preventive per la preparazione di farmaci antiblastici.

The 7th title of the legislative act "626/1994" (and the other normative indications) identifies cavcingenic agents in occupational uses, and also the protections of workers in exposure. Among these agents there are any antiblastic drugs. This is a difficult problem for a correct application of normative indications: it's no possible to replace cavcingenic agents with no cavcingenic agents, as so as it's impossible to operate on "closed cycle". The authors put the attention on the other very important normative indications: "preparations in bordered and isolated room", "minimal exposure", "severe procedures and internal normations", formal "identification of the responsibilities" in the hospital organization (also with the strictly identification of managers and foremen).

[Environmental and biological reference values of plant pesticides]. / Valori di riferimento ambientali e biologici dei fitofarmaci.

A wide range of studies concerned with the definition of environmental and biological reference values for plant pesticides is reviewed. All phases of data production are critically assessed, including sampling, sample preparation and analysis, choice of population, statistical analysis and expression of results. The importance of the studies for the definition of reference values useful in the sectors of environmental hygiene and occupational toxicology is also examined. Most of the studies were based on American populations, though work on reference values has also recently been done by Italian authors, particularly the SIVR, which has published data on 3,5,6-trichloro-2-pyridinol and ethylenethiourea in urine. Because the number of the studies is small and more detail about variables is needed, the lists of reference values, given separately for American and Italian populations, also include proposals and attempts at definition of reference values. When available, biological reference values (BRV) are given separately for adults and children, emphasising the greater intake of the infant population due to higher food intake per unit body weight and greater exposure to contaminants present in the domestic environment. BRVs for plant pesticides generally depend on factors such as smoking, wine consumption and diet, major sources of residue intake for the human population.

[Retrospective study of morbidity in a group professionally exposed to chlorotriazine herbicides]. / Studio retrospettivo di morbilità in gruppi di esposti professionalmente ad erbicidi clorotriazinici.

Two different groups of workers involved, during the last 10 years, in the production or formulation of chlorotriazine herbicides have been retrospectively studied in order to verify the occurrence of diseases possibly related to Atrazine, Simazine, Propazine and Terbuthylazine exposure. A control group has been selected between clerical workers of the same plants. Exposure data have been collected during the last five years and some extrapolations have been performed to hypothesize the level of exposure in the preceeding years. Clinical findings and laboratory data obtained from ten year medical surveillance records have been evaluated to highlight possible differences between the investigated groups. A first close examination of the data concerning the anamnesis and clinical, hematochemical and functional reports of the three groups of investigated subjects does not show any pathological situation or symptoms specifically connected to chlorotriazine compounds exposure and/or significant differences between exposed and non exposed. A next series of statistical surveys involving some of the hematochemical indicators (RBC, WBC, Hb%, SGOT, SGPT, gamma GT) has been performed either on internal values of each group or on the average-values of the three groups differently exposed (production, formulation, control). The first survey was a longitudinal study, the second one was a cross sectional one. Both the investigations have excluded significant differences attributable to the occupational exposure.

[VDT and work: descriptive epidemiologic research]. / VDT e lavoro: indagine epidemiologica descrittiva.

We report the statistical elaboration of some data pertinent to a population of workers professionally exposed to VDT. These first data also confirm that the length of the use of VDT doesn't influence the judgement of fitness to work.

[Judgement of fitness to work in a health worker with schizophrenia]. / Giudizio di idoneità lavorativa in un operatore sanitario affetto da schizofrenia.

We show the case of a worker affected with schizophrenia who was declared by the psychiatrist fit to work. The "Medico Competente" on the contrary decides that he is not fit to do that job and his judgement is also confirmed by the "ASL-Collegio Medico" according to the D.Lgs 626/94, item 17, which extends the judgement of the fitness to work given by the "Medico Competente" even to the psychic sphere of the worker.

[Role and significance of information tools in occupational asthma]. / Il ruolo e l'importanza degli strumenti informativi nell'asma professionale.

Role of education in occupational asthma. Subjects' education, i.e. information and training in the specific topic, has a substantial role in several medical fields and is considered to be the challenge to reach the primary, secondary and tertiary preventive goals. In occupational medicine workers information and training is considered particularly relevant and it has been included in a recent governative law regarding prevention and health care at the workplace. The present short review deals with the role of education in occupational asthma, which at present appears the most frequently compensated occupational lung disease.

[Environmental and biologic monitoring of atrazine exposure at a formulating plant]. / Monitoraggio ambientale e biologico dell'esposizione ad atrazina in ambito industriale formulativo.

Atrazine exposure was evaluated in three workers engaged in technical Atrazine dust formulating and bagging processes, by environmental and biological monitoring. We found an Atrazine concentration in breathing area of 31.2 micrograms/m3 (SD +/- 9.9); actual inhalatory absorption was 20.7 micrograms/workshift. Cutaneous amount was 6 mg per workshift and the largest fraction was found on hands. Supposing that only 3.5% of the applied was absorbed, 239.7 micrograms of Atrazine were taken up by skin per workshift. The dealkylated metabolites and parent compound excreted in urine, as a whole, accounted for 71.09% of the presumed total dose absorbed. The spectrum or the urinary Atrazine metabolites comprised bi-dealkylated (58%), deethylated (30.7%), deisopropylated (7.7%) and unmodified Atrazine (3.6%). About 31% of the amount is excreted during the workshift itself. These findings allow to evaluate the magnitude of the real doses absorbed, keeping into account the effect of protective means.

[Judgment on work capacity of a health worker with schizophrenia]. / Giudizio di idoneità lavorativa in un operatore sanitario affetto da schizofrenia.

We show the case of a worker affected with schizophrenia who was declared by the psychiatrist fit to work. The "Medico Competente" on the contrary, on the basis of his studies and in particular on his deep knowledge of the features of the office and the place where that worker works, decides that he is not fit to do that job. This judgement is confirmed by the "ASL-Collegio Medico". The case we described emphasizes in a very strong way what is written in the item 17, paragraph 1, letter a of the D.Lgs 626/94, which extends the judgement of the fitness to work given by the "Medico Competente" even to the psychic sphere of the worker.

[A case of occupational pulmonary siderosis: the pathogenetic and prognostic considerations]. / Un caso di siderosi polmonare professionale: considerazioni patogenetiche e prognostiche.

Pulmonary siderosis is a disease which can be considered with the pneumoconioses of the so-called inert dust (either by deposit or by accumulation) and, from the earliest nosographic descriptions dating back to the thirties and forties, it has been substantially considered a benign form because of the scarce sclerogenic evolution and the preservation of discrete respiratory function. We present a case of pulmonary siderosis characterized on one hand by the importance and clarity of the cytopathological picture and on the other by the presence of changes, although modest, in lung function which confirm the most recent hypotheses in the literature on the potential evolution of pneumosiderotic diseases and their relatively less benign prognosis. From a preventive point of view the case draws attention to the need for greater control of environmental hygiene conditions in small factories. From an insurance and medico-legal point of view siderosis has recently been explicitly added to the occupational diseases which can be declared to the Italian state department dealing with occupational disease and disability payments (I.N.A.I.L.) (DPR of the 13.04.1994, section 47).

[Analysis of occupational allergies reported to the Occupational Medicine and Hygiene Service of the Pavia ASL and to the Hospital Operative Unit of Occupational Medicine in 1993-98]. / Analisi delle allergopatie professionali segnalate ai Servizi di Medicina ed Igiene del Lavoro della ASL di Pavia e alla Unità Operativa Ospedaliera di Medicina del Lavoro nel periodo 1993-98.

In this article the cases of occupational allergic diseases notified to 2 Occupational Health Units in Pavia in the period 1993-1998 are reported. A retrospective study was performed to obtain a descriptive analysis of the diseases. In the studied period 58 cases of occupational allergic diseases were notified. This datum probably underestimates the real occurrence of occupational diseases, because of the low accuracy of the notification system. Allergic skin diseases were more frequent (70.7%) than respiratory diseases.