[Italian Program for Surveillance of Acute Pesticide-Related Illnesses: cases identified in 2005]. / Sistema di Sorveglianza delle Intossicazioni Acute da Fitosanitari: la casistica rilevata nel 2005.

In 2005, the Italian System for Surveillance of Acute Pesticide-Related Illnesses (SIAF) identified 625 cases, among which 520 unintentionally exposed. The majority of these subjects were men (75%) and aged 26-65 years (65%). About 63% of all exposures occurred at work. Severity for these illnesses was low for 94% and moderate for 5%. Four cases were classified as illnesses of high severity. Some 70% of all the reported exposures occurred between May and September. The active ingredients responsible for the largest number of cases were: glyphosate (n. 56), copper sulphate (n. 55), methomyl (n. = 52), metam-sodium (n. 24). Three episodes of collective environmental exposure to soil fumigants involving 23 subjects were also detected.

[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.

[Cluster of malignant mesothelioma cases in a thermostat manufacturing industry]. / Cluster di casi di mesotelioma maligno in una azienda produttrice di termostati.

BACKGROUND: Malignant mesothelioma is a rare disease and the identification of a cluster of cases suggests a possible presence of an asbestos contamination source. OBJECTIVES: To describe 3 cases of malignant mesothelioma (2 pleural and 1 peritoneal) that occurred in workers employed in the same thermostat factory. METHODS: Since this occupational sector is not traditionally known for asbestos exposure the Lombardy Mesothelioma Registry proposed to Local Occupational Health Unit to investigate this industry. RESULTS: From the first inspection of the plant, an environmental asbestos contamination (ropes covering oven handle and gasket) was found. But the greatest source of exposure was identified in the melamine resin reinforced with asbestos that constituted some internal parts of thermostats and that were sheared and perforated by the workers. So the 3 cases were defined as occupational diseases and legal procedures were initiated. CONCLUSION: The results underline the importance of a close cooperation within Local Occupational Health Units and Mesothelioma Registry in the identification and evaluation of asbestos occupational exposure otherwise not recognized, determining thus the loss of precious information.

Pesticide exposure assessment: a crop exposure matrix. The Working Group on Pesticide Exposure Assessment.

A crop exposure matrix (CEM) was developed in the context of two Italian case-control studies. The CEM relates agricultural practices to pesticide exposures taking into account change over time and the use of chemicals by geographical area for farming. The matrix is specific to 14 areas and to 10 major crops. The exposure axis is made up of 440 chemicals used in the last 40 years in the areas of interest. In the matrix the association between crop growing and pesticides is expressed in terms of presence or absence of exposure. Accuracy of the matrix was initially evaluated using 26 occupational histories collected within the two case-control studies. Sensitivity and specificity of CEM for some compounds were estimated versus assessment of exposure by experts. Sensitivity ranges from 83.3% to 100%, specificity from 66.2% to 95.8% depending on the chemicals.

Effects of 2,5-hexanedione on the ovary and fertility. An experimental study in mice.

Sixty-day-old virgin female Swiss CD1 mice were treated with 1.5% 2,5-hexanedione in their drinking water; control mice received tap water; duration of treatment was either 4 or 6 weeks. Under these conditions the treated mice did not show any clinical symptoms although electromyography revealed some signs of polyneuropathy. Protein and DNA content per mg of ovarian tissue in treated mice were not significantly different from controls. Histological examination of ovarian sections at the light microscope level showed no significant alterations after exposure. A morphometric study revealed a statistically significant reduction in the number of growing oocytes after 6 weeks of treatment. For fertility studies three groups of 15 female mice each were treated for 0, 4 or 6 weeks as above and then permanently housed with untreated proven breeder male mice (one male per female); cages were checked daily for newly born mice. All litters appeared normal by gross examination. During the first 14 weeks of continuous mating the mean litter size (number of newborns per litter) remained about 11.4 in all groups; this number subsequently began to decrease. Control and 4-week treatment regression curves did not differ statistically, while the slope of the 6-week line was significantly steeper, indicating a faster decrease in litter size over time and a shortening of fertile life in the latter group of treated females.

Effects of extended peroral borate ingestion on rat liver and brain.

2-Month-old male Wistar rats were given sodium tetraborate in drinking water (3 g/l). Cerebral succinate dehydrogenase activity increased after 10 and 14 weeks of exposure. Increased RNA concentration and increased acid proteinase activity in brain occurred after 14 weeks. NADPH-cytochrome c reductase activity and cytochrome b5 content decreased in the liver microsomal fraction after 10 and 14 weeks. A reduction in the cytochrome P-450 concentration was detected at 14 weeks. The results support the hypothesis that borate anion exerts its toxic action by interfering with flavin metabolism in flavoprotein-dependent pathways.

Cancer among farmers in central Italy.

This case-referent study evaluated cancer risks among farmers in central Italy. Cancer cases (N = 1674, 17 sites) were selected from all deceased men aged 35-80 years; a random sample of 480 decedents formed the reference series. Farmers had a decreased risk of lung and bladder cancer and melanoma and nonsignificant excess risks for stomach, rectal, kidney, and nonmelanoma skin cancer. Stomach and kidney cancer were significantly increased among the farmers with > 10 years' experience, and stomach, rectal, and pancreatic cancer were increased among licensed pesticide users with > 10 years' experience. Possible relationships emerged between specific crops and cancer: fruit and colon and bladder cancer, wheat and prostate cancer, olives and kidney cancer, and potato and kidney cancer. The results regarding stomach, pancreatic, lung, bladder, and prostate cancer and melanoma congrue with earlier results. The kidney cancer excess, the association of colon and bladder cancer with orchard farming, and the excess of rectal cancer among licensed farmers are new and unexpected findings.

Mortality study on a cohort of Italian licensed pesticide users.

This study describes the mortality experience in a cohort of 23,401 farmers, residing in southern Piedmont, Italy, and licensed to use pesticides. From 1970 to 1986 the cohort included 340,794 person-years and 2683 deaths were observed. A strong attenuation of the death risk was found due to the healthy worker effect (seen as an active role in the application for the license by the members of the cohort) and due to the limited comparability of the cohort with respect to the reference population. The standardized mortality ratios (SMRs) were remarkably < 100 for all causes (SMR = 59; 95% confidence interval = 57-61) and for all tumors (SMR = 60; 95% CI 55-64), but they increased with the increasing duration of the follow-up. A risk increase was observed with respect to melanomas and eye tumors in the entire cohort and lymphoma and tumors of the connective tissue in the subcohort of subjects living in villages with mainly arable land.

Cancer risk among male farmers: a multi-site case-control study.

Farmers may experience exposure to several hazardous substances, and cancer risk in this occupational group is considered an important public health issue. In order to examine the association between cancer and farming among male agricultural workers, a hospital-based case-control study was conducted in five Italian rural areas. The cancer sites selected for the study were: lip, oral cavity and oropharynx, oesophagus, stomach, colon, rectum, lung, skin melanoma, skin non-melanoma, prostate, bladder, kidney, and non-Hodgkin's lymphoma. In all, 1525 newly diagnosed cases, aged 20-75 years, were ascertained in hospital records, covering the period between March 1990 and September 1992, and for 1279 of them, a detailed exposure information was collected by a standard questionnaire. Data analyses were performed comparing each cancer site to a control group, including a subset of the other cancer sites in the study. Unconditional logistic regression models were used in the statistical analyses. Increased risks of cancer associated with agricultural work were found for stomach (OR = 1.4, 95%CI:0.9-2.0), rectum (OR = 1.5, 95%CI:0.8-2.7), larynx (OR = 1.4, 95%CI:0.8-2.5), and prostate (OR = 1.4, 95%CI:1.0-2.1). The excess of prostate cancer was specifically related to application of pesticides (OR = 1.7, 95%CI:1.2-2.6).

[Pesticide poisonings compensated by the INAIL in 1995-98]. / Infortuni da antiparassitari indennizzati dall'INAIL nel periodo 1995-98.

The present paper describes agricultural pesticide-related accidents compensated by the Italian national institute for insurance of occupational accidents (INAIL) from January 1995 to December 1998. During the period under study, 643 accidents claims were examined by INAIL and 549 received compensation. The Italian regions with the highest number of compensation during the period under study were Puglia (no. 102), Sicily (no. 66), Emilia-Romagna (no. 61), and Veneto (no. 55). The national annual rate of pesticide-related accidents, estimated by dividing the number of cases receiving compensation by the number of insured agricultural workers was 12 per 100,000 per year. The regions with the highest rates were Puglia and Marche (27 per 100,000 per year), Liguria (22 per 100,000 per year), and Sicily (18 per 100,000 per year). Most of the cases (70%) occurred among male workers. The agents most frequently reported to have caused the accidents were fungicides (32.2%). For a relevant number of cases (34.2%) the exposure was not specified.

[Acute poisoning with methomyl and other pesticides in the province of Ragusa, Sicily]. / Intossicazioni acute da methomyl ed altri antiparassitari in provincia di Ragusa, Sicilia.

In 1995-96, the Occupational Medicine Service of the province of Ragusa, Sicily, examined all cases of pesticide poisonings among persons seen in two local emergency departments, identifying 86 cases due to unintentional pesticide exposure. Methomyl, a highly toxic carbamate, was indicated for 51% of all cases. The most frequently reported symptoms included nausea and vomiting (48%), excessive perspiration (33%), and dyspnea (16%). Fifty-nine cases (69%) were hospitalized, 5 in intensive care. The methomyl cases occurred more frequently during summer months while the cases from all other pesticides showed no seasonal patterns. These observations point out the relevance of identifying acute pesticide poisonings in the province of Ragusa and suggest that ongoing registration of these events should be a public health priority.

[Consultations at the Poison Center of Rome on pesticide poisoning referrals]. / Consulenze prestate dai Centri Antiveleni di Roma in riferimento a prodotti antiparassitari.

From 1 January 1998 to 31 October 1999 the two Poison Control Centres active in Rome provided 923 telephone consultations for individuals and health care providers on suspected poisonings involving pesticides. Exposures more frequently reported in association with suspected cases were insecticides (n. 636), including organophosphates (n. 300), carbamates (n. 155), pyrethroids (n. 102), and organochlorines (n. 79). Children aged 1-4 years accounted for 22% of all suspected poisonings (n. 200). Each case was classified as to the likelihood of a relationship between the reported pesticide exposure and the occurrence of health effects. Around 18% of suspected pesticide poisonings (n. 168) were subsequently classified as definite, around 43% (n. 390) as possible, and around 37% were considered unlikely (n. 344).

[Pesticide poisoning referred to the Poison Center of Milan in 1995-1998]. / Intossicazioni da prodotti antiparassitari rilevate dal Centro Antiveleni di Milano nel periodo 1995-1998.

From 1995 through 1998 the Poison Control Centre of Milan identified 7594 cases of suspected or confirmed cases of acute pesticide poisoning. Domestic use products accounted for 4483 (59%) of the cases. Of these, 84% occurred at home and 48% in children under five. The most frequently reported domestic use products were pyrethrins/pyrethroids (26%), fertilizers (19%) and camphor/naphthalene (12%). Of 3111 cases (41%) due to agricultural products, 10% were children under five and 69% were males. Half of the poisonings from agricultural products occurred at home, the remainder at workplace. The products most frequently reported were organophosphates (26%), pyrethrins/pyrethroids (9%), and carbamates (9%). These preliminary data indicate the importance of implementing prevention programs to reduce pesticide poisonings with particular reference to young children.

[National surveillance system for acute poisoning caused by pesticides]. / Piano di sorveglianza nazionale per la rilevazione delle intossicazioni acute da antiparassitari.

In the present paper is presented the surveillance system for pesticide-related illnesses proposed by the Istituto Superiore di Sanità, in collaboration with the Ministry of Health. Through the collaboration of local or regional poison control centres and local health departments with public hospitals and emergency departments, cases of acute pesticide-related illnesses among persons seeking health care will be registered according to standard procedures. Data collected locally will be transmitted to the Istituto Superiore di Sanità for registration and evaluation of the association between symptoms and type of exposure and for severity of illnesses related to pesticide exposure. These data will be analysed at regular intervals in order to estimate the magnitude of the problem of acute pesticide-related illnesses in Italy and to identify priority areas for implementing public health prevention and intervention programs.

[New aspects in the evaluation of risk factors for fetal development]. / Nuovi aspetti nella valutazione di fattori di rischio per lo sviluppo embrionale.

Much knowledge concerning the effects of xenobiotics on prenatal development derive from experimental studies, which are generally performed on laboratory animals according to standardized protocols. Conventional in vivo studies should be integrated by other models within a scientifically-based risk assessment strategy. The paper reviews a few in vitro and/or in vivo approaches: identification of critical effects through the characterization of the pathogenesis as well as the use of dose-response relationships; alternative models to identify reproductive risks from single substances and/or mixtures present in the environment; interactions between in vitro and in vivo studies in the risk assessment of solvents: embryonic metabolism in teratogenicity; interactions between experimental and epidemiological studies to understand the pathogenesis of embryolethality; risk assessment of the effects of prenatal exposure to ionizing radiations.

[Safety assurance for occupational tumors in agriculture]. / La tutela assicurativa dei tumori professionali in agricoltura.

Cancer risk in farming is characterized by:-multiple exposure varying in time, space and between crops;-poor knowledge of agrochemical used by workers;-interset of both sellers and users mainly or acute toxicity of pesticides;-availibility of sufficient evidence of carcinogenicity in humans only for arsenical insecticides and for benzene used as solvent. The frequency of both claims for compensation and recognized cased is extremely low. Referral to exper agronomists operations in the area of interest can turn out to be of great value in assessing exposures. In case of exposure to carcinogenic agents defined as possible or probable, the following criteria may be adopted:-duration of exposure and latency time in agreement with findings from scientific literature;-biological plausibility of the association of interest;-evaluation of the interaction in the frame of multiple exposure, with special reference to the role of brief and/or low exposures. The above mentioned items are discussed by examining practical cases.

[Application of article 35 of the DPR 303/56: experience of the operators of the Public Occupational Services and competent physicians. Sample survey]. / Applicazione dell'art. 35 del DPR 303/56 in Lombardia: esperienze degli operatori delle ASL e dei medici competenti. Indagine campionaria.

In the last three years 450 requests of derogation to the article 35 of legislative decree 303/56 reached one third of the Public Occupational Services, with a clear progressive increase of their number. The working risks derogation is most frequently requested for are: solvents, welding fumes and metallic dusts. The operators of the Public occupational Services employed these criteria to grant the derogation: the effectiveness of the prevention, the low concentrations of the harmful agents, the occasionality of the unhealthy working, the risk lack or scarcity. In the 80% of the cases the operators of the Public Occupational Services made an inspection in only two cases they notified breaches of the law. 350 (70%) of the requested derogation were granted, 10 (20%) are now under evaluation, 90% (20%) were not allowed. In conclusion we point out that the use of the article 35 in industries with an adequate safety organization, by means of the dilution of the periodical clinical examinations, allows to better fit the health surveillance programs to the real working risks.

[Health surveillance: from risk presumption to risk assessment]. / La sorveglianza sanitaria: dalla presunzione del rischio alla valutazione del rischio.

A working group of the Occupational Medicine and Industrial Hygiene Association of Lombardy, the National Association of Occupational Health Physicians the National Society of Prevention Operators made a paper in order to rationalize the sanitary surveillance, observing the laws in force and following the European Directives. The authors, thinking that everyday experience not very useful health examinations are carried out and that the sanitary surveillance should be planned according to the real working risks, give methodological directives about the way to make the mandatory clinical examinations less frequent, to the firms, to the occupational health physician and to the public occupational health operators of the local health units that must supervise the sanitary surveillance.

[Lombardy regional project: prevention of occupational tumors]. / Progetto regione lombardia: prevenzione dei tumori professionali.

In Lombardy, the regional project "Prevention of occupational cancers" is ongoing. The main objectives of this project are to identify work environments in which there might be a possible exposure to carcinogenic substances and to elaborate preventive measures. A casual sample of 250 working settings representing the different economic activities has been selected and evaluated. The 10% of the examined workplaces showed a possible exposure to chemical carcinogens. The most common carcinogens were trichloroethylene, preparation of plastics materials containing acrylonitrile-butadiene-stirene, formaldehyde, wood dust, hexavalent chromium, silica and polycyclic aromatic hydrocarbons. Galvanic industries, Bitumen production and placing companies and Plastics processing plants will be studied for environmental and biological monitoring and for the development of preventive measures.

Epidemiologic study for the evaluation of the cancerogenic risk associated with pesticides.

A begun started Italian multicentric hospital-based case-control study aimed at detecting carcinogenic risk associated with pesticides exposure is presented. During a 2 year period, incident cases of cancer of various sites in adults of both sexes will be identified in five hospitals used by residents of five Italian rural areas (Asti, Imola, Pescia, Pistoia, Grosseto). Selected sites include the following: lip, oral cavity and oropharynx, oesophagus, stomach, colon-rectum, liver, biliary ducts, pancreas, larynx, lung, soft tissue, skin melanoma, skin other than melanoma, breast, uterus, ovary, prostate, bladder, kidney, thyroid, and lymphoid tissue. Trained personnel will interview patients about their total work experience, with special emphasis on activities in agriculture. Other relevant information to be collected includes pathological anamnesis and smoking habits. A team of coders will analyse the occupational histories using an a priori job-exposures matrix (JEM). The JEM will be specific with respect to type of agricultural production, calendar years, geographic location and pesticides. Each cancer site will be compared with a selected pool of the other sites. This investigation is expected to provide information on a range of associations between cancer of various sites and individual pesticides or mixed exposures. The study can be seen as a pilot study which could be replicated in other areas.