[Alcohol and work: the role of the company physician in the occupational health and safety management systems]. / Alcol e lavoro: ruolo del medico competente nel sistema aziendale di gestione della prevenzione.

The organization of safety in the working places and the increasing attention to behaviours and life styles of workers that may lead to increasing occupational risks are the pick innovative aspects of the recent changes in our country's legislation about occupational safety. In this organization, the role of the company physician is becoming more and more important and his work of evaluation beginning with the knowledge both of the working places and of the workers's lifestyles, is irreplaceable. His role in organizing the managing standards of occupational safety and health cannot be limited to health supervision but must be an essential element in risk assessment in the prevision of workplaces and of safe working conditions, in workers training and information, in organizing the control system of each business. The present paper examines--referring to the current regulation--the duties and functions of a company physician when facing the problems concerning the working risks tied to alcohol assumption.

The undertreatment of alcohol-related liver diseases among people with alcohol use disorder.

Harmful and hazardous alcohol consumption is one of the most significant public health problems in Italy and Europe. Habitual excessive consumption and occasional excessive consumption, known as binge drinking, are the two main risk behaviours related to alcohol. Harmful drinking and alcohol dependence have strong social repercussions in terms of their social and economic impact and contribution to productivity losses. In addition, the terms alcohol abuse and alcohol dependence have been recently substituted by the only term of alcohol use disorder (AUD). The issues presented in this review demonstrate that excessive alcohol consumption is a growing public health concern and an appropriate national action plan is needed to increase the prevention of harmful and hazardous consumption and encourage patients to seek healthcare. To date, the main problem is the under-treatment of the population at risk, manifested as the time-lag between the onset of AUD and the first clinical detection. In order to address this, the Screening, Brief Intervention, and Referral to Treatment (SBIRT) strategy has been shared across countries in Europe and is supported by a Systematic Review of Reviews on SBIRT in primary healthcare. Unfortunately, there are still obstacles in the implementation of this approach. The main problem would appear to be general practitioners' difficulty in carrying out accurate and widespread screening, because they may minimize the problem. A more concerted effort in the training of healthcare professionals could address this by enabling the creation of renewed networks for the early identification of harmful and hazardous drinkers. These networks could prevent the occurrence of avoidable alcohol-related conditions, such as alcohol-related liver disease (ALD), while allowing for the timely implementation of evidence-based brief interventions.

Identification of harmful drinking in subjects who have had their driving license suspended due to alcohol use: a retrospective Italian study.

OBJECTIVE: Early identification of Harmful Drinking (HD) is difficult, and underestimated. The aim of our retrospective study was to investigate the presence of HD in a population of subjects who had their driving license suspended due to driving under the influence of alcohol. MATERIALS AND METHODS: We retrospectively recruited 979 subjects. During the first appointment (T0), clinical and laboratory characteristics of patients were evaluated, and the AUDIT questionnaire was administered. Two groups were then defined: Harmful Drinking (HD) and non-HD, and all subjects underwent a brief interview for 5-10 minutes before being assigned to a group. RESULTS: 95.9% of our sample were identified as non-HD, whereas 4.1% of them were HD; twenty-one (2.1%) of the HD underwent a control appointment (T1), and 17 (1.7%) of them were diagnosed with alcohol use disorder (AUD); there was a statistically significant reduction in mean daily alcohol intake (p<0.009), and in the mean values of the blood markers of HD between T0 and T1 in HD. CONCLUSIONS: The present study shows that 4.1%, and 1.7% of subjects presented a diagnosis of HD and AUD, respectively, and their entry in a protocol of drinking monitoring proved beneficial in reducing alcohol intake. Thus, the implementation of strict surveillance of subjects found driving under the influence of alcohol involving a network of professional figures (from police forces to specialists in alcohol addiction treatment) may help to detect and to treat subjects with HD and AUD, and to monitor their alcohol use over time.

Features of excessive alcohol drinking in older adults distinctively captured by behavioral and biological screening instruments. An epidemiological study.

The entire > or =65-year-old population living in a small Italian town, where alcohol use is almost ubiquitous, was assessed with a frequency-quantity questionnaire for alcohol intake and with two screening instruments for alcohol problems, the CAGE questionnaire and the MCV-gammaGT test. Aim of the study was to assess whether these instruments identify different subsets of subjects with alcohol problems. Of the 649 participants, 19.1% were at-risk drinkers (average intake > 40 g/day in men and > 20 g/day in women). Both the screening instruments were positive in only a minority of participants. Of the 377 drinkers, 53 gave > or =1 affirmative response to the CAGE questionnaire, whereas 24 had a positive MCV-gammaGT test. The concordance between positive CAGE questionnaire and MCV-gammaGT test was limited to seven subjects (kappa = 0.10), and these tests identified subjects who differed for several health and psychosocial characteristics. Participants aged > or =75 years drank less, but had similar prevalence of CAGE and MCV-gammaGT positive markers as compared to younger participants. In conclusion, excessive drinking is common in the elderly. Screening tests based on behavioral and biological markers identify two different sets of subjects with possible alcohol problems. This might indicate the opportunity to use these instruments in conjunction.

Cell-mediated immunity to HBcAg in chronic HBV infection.

The role of hepatitis B core antigen (HBcAg) as a possible target of cell-mediated immune response in chronic hepatitis B virus (HBV) infection has been recently emphasized. Peripheral blood leukocytes (PBLs) from 35 chronic carriers of hepatitis B surface antigen (HBsAg) were studied in vitro for their immune response to a purified preparation of HBcAg isolated from circulating Dane particles. PBLs from all the studied HBsAg-positive patients yielded a stimulation index above 3, with values ranging from 3.1 to 38.1. None of the healthy seronegative subjects, taken as control group, had a stimulation index above 2, with a mean value +/- SD of 1.28 +/- 0.35. Levels of PBL stimulation correlated with the histologic activity of liver disease, and the differences reached statistical significance. These results indicate that lymphocyte response to HBcAg may be relevant in determining liver cell damage.

Serum HBV DNA and intrahepatic hepatitis B core antigen (HBcAg) in chronic hepatitis B virus infection: correlation with infectivity and liver histology.

In this study we investigated the HBeAg/anti HBeAg status, the liver histological features, the intrahepatic localization of HBcAg, and the presence of serum HBV DNA in a group of 79 HBsAg-positive patients. We found a close relationship between the presence of HBV DNA and intrahepatic HBcAg in HBeAg-positive patients. Among the 56 anti-HBeAg-positive patients considered, 13 (23.2%) showed the presence of intrahepatic HBcAg and serum HBV DNA. In this group of patients, active viral replication was associated with a chronic inflammatory liver disease and particularly with CAH. Furthermore, a prevalent cytoplasmic localization of HBcAg was found in 66.6% of patients affected by CAH, showing that this peculiar distribution of HBcAg seems to be associated with a poor prognosis.

Different efficacy of alcohol education tools among trainee nurses.

BACKGROUND/AIMS: The evaluation of the efficacy of two different forms of scientific information concerning alcohol-related problems (ARP), among Italian trainee nurses. METHODOLOGY: A specific questionnaire, investigating the awareness of ARP, was distributed to 193 trainee nurses, 158 enrolled in the Italian Red Cross School for Professional Nurses at S. Orsola-Malpighi Hospital in Bologna and 35 enrolled in the Professional Nursing School at the Social Security Institute in the Republic of San Marino, who had attended a scientific meeting on ARP in the last year. Eighty-one nurses (62 belonging to the Red Cross School of Bologna and 19 to the Professional Nursing School of San Marino), had previously been given an information package on ARP (Group A). One hundred twelve subjects (96 belonging to the Red Cross School of Bologna and 16 to the Professional Nursing School of San Marino) did not read the specialized material (Group B). RESULTS: The results showed a statistically significant difference in the percentage of correct answers between Group A (25.98%) and Group B (21.80%). The percentage of correct answers among the Bologna trainee nurses were always significantly lower than that of the San Marino nurses. CONCLUSIONS: These results suggest a scant awareness and interest in ARP among trainee nurses and show that courses and lectures are more effective than scientific printed material.

[Esthesiometric thresholds in workers exposed to neuropathogenic chemical and physical agents]. / Soglie estesiometriche in esposti ad agenti chimici e fisici neuropatogeni.

Two-point discrimination (TPD) and depth sense perception (DSP) were measured by means of two aesthesiometers in the fingertips of 65 forestry workers exposed to chain saw vibrations and 46 shoe industry workers exposed to neurotoxic solvents (n-hexane). Two control groups, consisting of 31 and 46 healthy subjects, were also examined. The compound means of the TPD and DSP threshold values for the 2nd, 3rd and 4th digits of the right and left hands were significantly higher in the chain saw workers suffering from peripheral sensorineural disorders than in the asymptomatic chain saw workers and the controls (p less than 0.001). Among the forestry workers, a significant relationship was found between loss of tactile perception and vibration dose expressed in terms of four-hour energy-equivalent frequency-weighted acceleration (ISO 5349). The shoe workers, who were asymptomatic, had higher DSP threshold values than the controls (p less than 0.01). No differences in the mean values of TPD thresholds were observed between the exposed and control subjects. These results indicate that DSP is more sensitive than TPD in detecting "sub-clinical neuropathy". On the basis of our previous investigations, the specificity of aesthesiometric threshold testing was high, ranging from 93 to 100%. The sensitivity of the aesthesiometric method was lower than the specificity, varying from 52-56% for TPD to 67-72% for DSP. These findings suggest that aesthesiometry may be considered as a useful testing method to differentiate on a group basis between healthy subjects and workers exposed to physical and chemical agents affecting the peripheral nervous system.(ABSTRACT TRUNCATED AT 250 WORDS)

Allergic manifestations due to castor beans: an undue risk for the dock workers handling green coffee beans.

The main cause of allergic manifestations among workers handling green coffee beans (GCB) is sensitization to castor beans (CB), which are considered a common contaminant of the sacks used to transport coffee beans. The RAST inhibition test was used to evaluate the presence of GCB and CB allergens on the surface of the sacks coming from the major world producers of coffee and to ascertain the presence of the CB allergen in coffee beans. A significant concentration of the two allergens, i.e., GCB and CB, on the sacks was demonstrated, with the highest values found on sacks from Brazil, while the hypothesis of a significant CB contamination in coffee beans was not confirmed. We believe the presence of the CB allergen on the surface of the sacks is due to contamination occurring during stocking and transport and could easily be prevented. Appropriate measures taken during transport could effectively prevent this "undue" risk in dockers and probably also in coffee industry workers.

Storage mites and their role in the onset of asthma and oculorhinitis among cattle farmers in north-east Italy.

The results are reported of an epidemiological study carried out in the province of Treviso in north-east Italy. The research was designed to ascertain the sensitization, through an IgE mechanism, to the main allergens present on cattle farms. Also reported are the results of a mite survey undertaken in ten barns in the same region. Investigations revealed a significantly larger degree of sensitization to storage mites among cattle farmers than in the control subjects. This sensitization was well correlated with mite species to be found in cattle barns. However, the frequent co-sensitization to Dermatophagoides offers a topic for further study.

Sensitization to green coffee bean (GCB) and castor bean (CB) allergens among dock workers.

Dock workers (n = 218) occupationally exposed to green coffee beans (GCB) were studied, using a specific questionnaire for allergic symptoms and skin tests for common and occupational allergens. Thirty-one workers (14.3%) complained of allergic symptoms of the eye, nose and bronchial system at the workplace. The prick tests, using both commercial allergens and specific extracts prepared from the most common types of coffee and their corresponding sacks, confirmed a sensitization in 21 workers (9.6%). A positive skin reaction to castor beans (CB) was found in nearly all these cases; in ten workers there was also a positive reaction to GCB allergens and in 14 cases prick tests were positive to extracts of sacks. There was a good concordance between prick tests and specific IgE for CB (95.0%) and also, but to a lesser extent, for GCB. The authors concluded that there is a significant risk of sensitization to CB and GCB allergens in dock workers occupied in handling green coffee bean, despite the fact that the exposure is not continuous. CB emerged as a common contaminant of GCB from various countries. For effective prevention, a modification of the methods of transport is required to avoid CB contamination to other products. Eliminating environmental dust during shipping operations is the most important preventive measure and it can be achieved by the use of containers, as some exporting countries are already doing.

Lead exposure in the ceramic industry. Evaluation of job exposure in three factories different in size and work organisation.

Air-lead levels (PbA) and biological indices were studied in three ceramic factories (185 workers altogether). A difference in the pattern of lead exposure was found in the largest factory (A) and the other two smaller factories (B and C). PbA never exceeded 67 micrograms/m3 in factory A, but reached values as high as 378 micrograms/m3 in factory B. 19% of PbB values were higher than 40 micrograms/100 ml in factory A, 63% in factory B and 35% in factory C. As was expected, a closer analysis of the jobs confirmed a higher exposure level in people directly in contact with lead glazes (glazers and kiln operators). In factories B and C, however, there was also a significant lead uptake in selection and maintenance staff, who worked in areas at some distance from the glazing lines. This may be due in part to pollution spread over all departments, but also to the lack of hygiene and washing facilities whose importance is stressed for effective prevention. Biological monitoring is suggested as being useful for all workers, whatever the lead-air level, bearing in mind the possibility of lead intake orally through soiling.

Piezoelectric extracorporeal shock wave lithotripsy in 93 patients with gallstones.

Ninety-three patients with gallstones were selected for extracorporeal shock wave lithotripsy (ESWL) with a piezoelectric device (EDAP LT-OI) to verify the efficacy and safety of this technique. Neuroleptoanalgesia with intravenous diazepam and phentanyl was performed in almost all patients. The treatment was combined with adjuvant litholytic therapy using oral ursodeoxycholic acid. Follow-up period was nine months. Piezoelectric ESWL was able to disintegrate radiolucent gallstones in 97.9% of cases. By the ninth month 68 patients (73.1%) were stone-free. Best results were obtained with single stones smaller than 20 mm. After ESWL, surgical cholecystectomy was necessary in 2.1% of cases. This study confirms the efficacy and safety of piezoelectric extracorporeal shock wave lithotripsy combined with ursodeoxycholic acid adjuvant therapy for selected cases of gallstone disease.

[A survey on the use of pesticides in the province of Treviso]. / Indagine conoscitiva sull'utilizzo di presidi sanitari nella provincia di Treviso.

The results of a study on a sample of 301 farms of the province of Treviso are here presented. The aim of our study was the evaluation of the quantity of pesticides, considered as active principle, spread over this territory in 1987. Our data stress that arboreal cultivations need the major quantity of fungicides, insecticides and acaricides while the use of herbicides and soil insecticides is almost exclusive to grassy cultures. The fungicides result the most widely used pesticides followed by herbicides and, to a less degree, the other products. In our case they are used nearly exclusively in vine growing. We underline that, although the consumption of pesticides fell within correct agronomic standards, this quantity could be considerably reduced by modern technology.

Role of hepatitis B virus infection in alcoholic patients.

The aim of this study was to determine the incidence of HBV markers in patients with alcoholic liver disease and to compare the results with those of patients with non-alcoholic liver disease and control subjects. We tried to determine whether the association between alcohol intake and HBV infection increases the risk of developing severe liver disease. The results showed an increased incidence of HBsAg in alcoholic patients when compared with controls as well as an increased incidence of severe chronic liver disease in HBV-positive groups when compared with HBV-negative groups. We conclude that HBV infection is an important additional risk factor for the development of severe liver disease in alcoholic patients.