Human biomonitoring and personal air monitoring. An integrated approach to assess exposure of stainless-steel welders to metal-oxide nanoparticles.

In welding, there is a potential risk due to metal-oxide nanoparticles (MONPs) exposure of workers. To investigate this possibility, the diameter and number particles concentration of MONPs were evaluated in different biological matrices and in personal air samples collected from 18 stainless-steel welders and 15 unexposed administrative employees engaged in two Italian mechanical engineering Companies. Exhaled breath condensate (EBC) and urine were sampled at pre-shift on 1st day and post-shift on 5th day of the workweek, while plasma and inhalable particulate matter (IPM) at post-shift on 5th day and analysed using the Single Particle Mass Spectrometry (SP-ICP-MS) technique to assess possible exposure to Cr2O3, Mn3O4 and NiO nanoparticles (NPs) in welders. The NPs in IPM at both Companies presented a multi-oxide composition consisting of Cr2O3 (median, 871,574 particles/m3; 70 nm), Mn3O4 (median, 713,481 particles/m3; 92 nm) and NiO (median, 369,324 particles/m3; 55 nm). The EBC of welders at both Companies showed Cr2O3 NPs median concentration significantly higher at post-shift (64,645 particles/mL; 55 nm) than at pre-shift (15,836 particles/mL; 58 nm). Significantly lower Cr2O3 NPs median concentration and size (7762 particles/mL; 44 nm) were observed in plasma compared to EBC of welders. At one Company, NiO NPs median concentration in EBC (22,000 particles/mL; 65 nm) and plasma (8248 particles/mL; 37 nm) were detected only at post-shift. No particles of Cr2O3, Mn3O4 and NiO were detected in urine of welders at both Companies. The combined analyses of biological matrices and air samples were a valid approach to investigate both internal and external exposure of welding workers to MONPs. Overall, results may inform suitable risk assessment and management procedures in welding operations.

The endocrine disrupting effects of nanoplastic exposure: A systematic review.

Good mechanical properties and low costs have led to a global expansion of plastic production and use. Unfortunately, much of this material can be released into the environment as a waste product and cleaved into micro- and nanoplastics (NPs) whose impact on the environment and human health is still largely unknown. Considering the growing worldwide awareness on exposure to chemicals that can act as endocrine disruptors, a systematic review was performed to assess the impact of NPs on the endocrine function of in vitro and in vivo models. Although a limited number of investigations is currently available, retrieved findings showed that NPs may induce changes in endocrine system functionality, with evident alterations in reproductive and thyroid hormones and gene expression patterns, also with a trans-generational impact. Nanoplastic size, concentration, and the co-exposure to other endocrine disrupting pollutants may have an influencing role on these effects. Overall, although it is still too early to draw conclusions regarding the human health risks derived from NPs, these preliminary results support the need for further studies employing a wider range of plastic polymer types, concentrations, and time points as well as species and life stages to address a great variety of endocrine outcomes and to achieve a broader and shared consensus on the role of NPs as endocrine disruptors.

Association between health-related physical fitness indicators and working ability: a systematic review.

OBJECTIVES: Work ability (WA) reflects a balance between work demands and an individual's ability to meet them. It is influenced by several occupational and health-related factors including the individual's physical fitness (PF). Therefore, the aim of the present study was to provide an overview of the possible relationship between PF measures and the individual's WA. METHODS: A systematic review of studies published up to December 1, 2022 and available in PubMed, Scopus, and ISI Web of Science databases, was performed. Results have been summarized according to the specific PF parameter explored. RESULTS: The 14 reviewed studies, enrolling 47 to 1005 workers, all showed a satisfactory methodological quality. Some positive evidence emerged for a possible association between changes in aerobic capacity, walking speed, balance, flexibility, muscle strength, and WA perception. However, the limited number of studies, their cross-sectional design, the different PF performance indicators, populations, and job tasks explored prevented definite conclusions. CONCLUSIONS: Future longitudinal studies should be planned to confirm such positive results and identify PF indicators better predictive for changes in the WA of employees engaged in specific job tasks, particularly in physically demanding activities. This may be helpful to include PF performance tests in occupational health practice as an integrated part of risk assessment and management strategies as well as in health and well-being promotion plans.

Occupational Exposure to Metal Engineered Nanoparticles: A Human Biomonitoring Pilot Study Involving Italian Nanomaterial Workers.

Advances in nanotechnology have led to an increased use of engineered nanoparticles (ENPs) and the likelihood for occupational exposures. However, how to assess such exposure remains a challenge. In this study, a methodology for human biomonitoring, based on Single Particle Inductively Coupled Plasma Mass Spectrometry (SP-ICP-MS), was developed as a tool to assess the ENPs exposure of workers involved in nanomaterial activities in two Italian Companies. The method was validated for size and number concentration determination of Ag, Au, In2O3, Ir, Pd, Pt, and TiO2 NPs in urine and blood samples. The results showed the presence of In2O3 NPs in blood of exposed workers (mean, 38 nm and 10,371 particles/mL), but not in blood of controls. Silver, Au, and TiO2 NPs were found in urine (mean, Ag 29 nm and 16,568 particles/mL) or blood (mean, Au 15 nm and 126,635 particles/mL; TiO2 84 nm and 27,705 particles/mL) of workers, though these NPs were found also in controls. The presence of ENPs in both workers and controls suggested that the extra-professional exposure is a source of ENPs that cannot be disregarded. Iridium, Pd, and Pt NPs were not detected neither in blood nor in urine. Overall, the findings provided a rational basis to evaluate the exposure assessment to ENPs in cohorts of workers as part of risk assessment and risk management processes in workplaces.

The challenges of managing patients with cancer in the workplace: Needs, opportunities and perspectives of occupational physicians.

Cancer is a global major public health problem since it is a leading cause of death, accounting for nearly 10 million deaths in 2020 worldwide and the most recent epidemiological data suggested that its global impact is growing significantly. In this context, cancer survivors have to live for a long time often in a condition of disability due to the long-term consequences, both physical and psychological. These difficulties can seriously impair their working ability, limiting the employability. In this context, the occupational physician plays a key role in the implementation and enforcement of measures to support the workers affected by cancer, to address issues such as the information on health promotion, the analysis of work capacity and the management of disability at work and also promoting a timely and effective return to work and preserving their employability. Therefore, the aim of this study was to gather useful information to support the occupational physicians in the management of workers affected by cancer, through a survey on 157 Italian occupational physicians. Based on the interviewees' opinions, the most useful occupational safety and health professionals in terms of job retention and preservation of workers affected by cancer are the employers and the occupational physicians themselves, whose role is crucial in identifying and applying the most effective reasonable accommodations that should be provided to the workers affected by cancer. The provision of these accommodations take place on the occasion of mandatory health surveillance medical examination to which the worker affected by cancer is subjected when he returns to work. Results on training and information needs showed that the management of the workers affected by cancer is essentially centered on an appropriate fitness for work judgment and on the correct performance of health surveillance. However, an effective and successful management model should be based on a multidisciplinary and integrated approach that, from the earliest stages of the disease, involves the occupational physicians and employers.

Validation of the Global Lung Function Initiative 2012 Spirometry Reference Values in a Healthy Italian Working Population.

BACKGROUND: Several studies showed important differences in the interpretation of spirometry based on different reference values, in particular by comparing European Respiratory Society (ERS) 1993 and Global Lung Function Initiative (GLI) 2012. The validation of new reference values in local populations is essential before they can be used in an appropriate manner. This study aimed to investigate the fit of GLI reference values in a healthy Italian working population. METHODS: Spirometry data were collected in 1355 workers during their health surveillance medical examination conducted for exposure to chemical and biological risk factors. A single portable spirometer that met the ATS/ERS recommendations for occupational testing was used and calibrated daily. RESULTS: Average z-score were -0.13 (with a median of -0.17), -0.25 (with a median of -0.24), and 0.18 (with a median of 0.17) for FEV1, FVC, and FEV1/FVC ratio, respectively. Considering only the normal-weighted workers, the average z-scores were -0.07 (with a median of -0.16), -0.15 (with a median of -0.16), and 0.07 (with a median of 0.02) for FEV1, FVC, and FEV1/FVC ratio, respectively. CONCLUSIONS: GLI 2012 reference values fit the Italian data satisfactorily, resulting as more accurate than ERS 1993, especially in women, normal-weighted subjects, aged 30-50 years, and for height < 165 cm.

Determinants of early working impairments in multiple sclerosis.

Introduction: Unemployment can directly affect social status and identity. Assessing and adjusting determinants of early working impairments in a chronic disease can thus reduce its long-term burden. Hereby, we aim to evaluate differences in occupational history and early working impairments between people with multiple sclerosis (MS) and healthy workers. Methods: This is a cross-sectional study comparing 71 workers with MS [age 41.7 ± 9.4 years; females 59.1%; EDSS 2.0 (1.0-6.0)] and 71 controls (age 42.6 ± 11.9 years; females 33.8%). All participants filled in Work Ability Index (WAI), Work Productivity and Activity Impairment (WPAI), European Questionnaire for Quality of Life (EuroQoL), Beck Depression Inventory II (BDI-II), and Pittsburgh Sleep Quality Index (PSQI). In MS, we further collected expanded disability status scale (EDSS), MS Questionnaire for Job difficulties (MSQ-Job), Fatigue severity scale (FSS), and the Brief International Cognitive Assessment for MS (BICAMS). Results: Workers with MS were more working disabled (p < 0.01), less exposed to workplace risks (p < 0.01), and more limited in fitness to work (p = 0.01), compared with controls. On linear regression models adjusted by age, sex, education, and type of contract, people with MS had worse WAI (Coeff=-5.47; 95% CI = -7.41, -3.53; p < 0.01), EuroQoL (Coeff = -4.24; 95% CI = -17.85, -6.50; p < 0.01), BDI-II (Coeff = 3.99; 95% CI = 2.37, 7.01; p < 0.01), and PSQI (Coeff = 4.74; 95% CI = 3.13, 7.61; p < 0.01), compared with controls, but no differences in WPAI (p = 0.60). EuroQoL, BDI-II, and PSQI were equally associated with both WAI and WPAI in MS and controls (all p< 0.01). In MS, worse MSQJob was associated with higher EDSS (Coeff = 5.22; 95% CI = 2.24, 7.95; p < 0.01), progressive disease (Coeff = 14.62; 95% CI = 5.56, 23.69; p < 0.01), EuroQoL (Coeff = 4.63; 95% CI = 2.92, 6.35; p < 0.01), FSS (Coeff = 0.55; 95% CI = 0.38, 0.72; p < 0.01), and cognitive impairment (Coeff = 4.42; 95% CI = 0.67, 8.22; p = 0.02). Discussion: Early factors associated with working difficulties in MS include disability, fatigue, depression, and cognitive dysfunction. Early identification of clinical features potentially causing working difficulties should be considered to enhance job retention, along with targeted prevention and protection measures.

Impact of Shift Work and Long Working Hours on Worker Cognitive Functions: Current Evidence and Future Research Needs.

Particular working conditions and/or organization of working time may cause important sleep disturbances that have been proposed to be predictive of cognitive decline. In this regard, circadian rhythm misalignment induced by exposure to night work or long working hours would be responsible for cognitive impairment. Nevertheless, evidence supporting this correlation is limited and several issues still need to be elucidated. In this regard, we conducted a systematic review to evaluate the association between shift/night work and cognitive impairment and address its main determinants. Information provided by the reviewed studies suggested that night work might have serious immediate negative effects especially on cognitive domains related to attention, memory and response inhibition. Furthermore, cognitive performance would progressively worsen over consecutive night shifts or following exposure to very long work shifts. Otherwise, conflicting results emerged regarding the possible etiological role that night work chronic exposure would have on cognitive impairment. Therefore, circadian rhythm desynchronization, lack of sleep and fatigue resulting from night work may negatively impact worker's cognitive efficiency. However, in light of the considerable methodological variability of the reviewed studies, we proposed to develop a standardized research and evaluation strategy in order to obtain a better and comprehensive understanding of this topic.

Hormetic dose responses induced by antibiotics in bacteria: A phantom menace to be thoroughly evaluated to address the environmental risk and tackle the antibiotic resistance phenomenon.

The environmental contamination of antibiotics caused by their over or inappropriate use is a major issue for environmental and human health since it can adversely impact the ecosystems and promote the antimicrobial resistance. Indeed, considering that in the environmental matrices these drugs are present at low levels, the possibility that bacteria exhibit a hormetic response to increase their resilience when exposed to antibiotic subinhibitory concentrations might represent a serious threat. Information reported in this review showed that exposure to different types of antibiotics, either administered individually or in mixtures, is capable of exerting hormetic effects on bacteria at environmentally relevant concentrations. These responses have been reported regardless of the type of bacterium or antibiotic, thus suggesting that hormesis would be a generalized adaptive mechanism implemented by bacteria to strengthen their resistance to antibiotics. Hormetic effects included growth, bioluminescence and motility of bacteria, their ability to produce biofilm, but also the frequency of mutation and plasmid conjugative transfer. The evaluation of quantitative features of antibiotic-induced hormesis showed that these responses have both maximum stimulation and dose width characteristics similar to those already reported in the literature for other stressors. Notably, mixtures comprising individual antibiotic inducing stimulatory responses might have distinct combined effects based on antagonistic, synergistic or additive interactions between components. Regarding the molecular mechanisms of action underlying the aforementioned effects, we put forward the hypothesis that the adoption of adaptive/defensive responses would be driven by the ability of antibiotic low doses to modulate the transcriptional activity of bacteria. Overall, our findings suggest that hormesis plays a pivotal role in affecting the bacterial behavior in order to acquire a survival advantage. Therefore, a proactive and effective risk assessment should necessarily take due account of the hormesis concept to adequately evaluate the risks to ecosystems and human health posed by antibiotic environmental contamination.