Occupational risk factors for sinonasal inverted papilloma: a case-control study.

OBJECTIVES: Sinonasal inverted papilloma (IP) is an uncommon benign tumour characterised by frequent recurrence and, in approximately 10% of cases, by neoplastic transformation. IP aetiology is unknown but human papillomavirus is detectable in about one quarter of tumours. As some occupational hazards have been reported to be possible risk factors for IP, the aim of this study was to assess risk for sinonasal IP associated with prior exposure to suspected occupational risk factors for sinonasal malignancies. METHODS: Between 1996 and 2007, data on incident cases were collected from hospitals throughout the Piedmont region of Italy by the regional sinonasal cancer registry. A questionnaire on occupational history, completed by 127 cases and 337 hospital controls, was used to assign previous exposure to a list of 17 occupational hazards. The relationship between IP and cumulative exposure to these hazards was explored using unconditional logistic regression to statistically adjust for age, sex, area of residence, smoking and co-exposures. RESULTS: The risk of IP was significantly increased for ever exposure to welding fumes (OR 2.14) and organic solvents (OR 2.11) after controlling for potential confounders. For organic solvents only, a significant association with continuous cumulative exposure and a significant trend in risk across ordered cumulative exposure categories was found. CONCLUSIONS: The present study revealed a significant association and a significant dose-response relationship between occupational exposure to organic solvents and IP. The lack of a dose-response relationship for welding fumes suggests that the observed association with ever exposure should be interpreted with caution.

High hydrostatic pressure activity on the disinfection of clams artificially contaminated with feline calicivirus.

BACKGROUND: The contamination of shellfish with gastroenteric viruses may cause outbreaks because they are often eaten raw or under-cooked. High-hydrostatic pressure treatments have already proven to be effective in reducing high viral load in shellfish samples. The objectives are the assessment of the viral load reduction of contaminated clams using HHP treatments at different pressures and times and the study of the changes caused by these treatments in some food physical parameters. METHODS: Clams were contaminated with a solution containing Feline Calicivirus; they were closed in envelopes and treated with 300, 400, 500, 600 MPa for 1, 3, 5, 7 min for every pressure value. After the treatment the residual viral titre was calculated. The texture parameters were obtained after treating clams samples at the same pressure values but only for 3 and 7 min and analysing them with a TPA test. RESULTS: HHP treatments of 500 and 600 MPa were sufficient to cause a total inactivation at every timelength considered while with 300 and 400 MPa after 1 min, concentrations of 1.13 and 0.55 respectively were found. In general hardness and gumminess tend to increase after the treatment whereas springiness and cohesiveness decrease a bit. CONCLUSIONS: HHP treatments showed good sterilization ability against FCV but it's necessary to consider that FCV has a lower resistance to disinfection than Human norovirus. Texture changes are in line with what is reported in literature.

[Hospital admission of subjects with chronic obstructive bronchopulmonary disease (COPD) and air pollution in the city of Parma (Italy). A preliminary analysis]. / Funzionalità respiratoria in soggetti con Broncopneumopatia Cronica Ostruttiva (BPCO) e inquinamento atmosferico nella città di Parma Analisi preliminare.

A study was conducted in subjects admitted to hospital for chronic obstructive bronchopulmonary disease (COPD) in the city of Parma (Italy). The aim was to evaluate changes in patients' percent vital capacity (VC), forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), as a function of changing degrees of atmospheric pollution as measured by PM10, NO2 and O3 concentrations in the outside air. Study results revealed an association between PM10 concentrations and hospital admissions for COPD. Statistically significant differences were found between PM10 concentrations measured three-four days before admission and in days not followed by admission to hospital. Regression analysis between PM10 concentrations at 24, 48, 72, and 96 hours before admission and respiratory function showed a significant association between FVC% and FEV1% and PM10 concentrations at 96 hours. The relative risk was calculated to be 1.016 (95% confidence intervals: 1.001-1.032), which corresponds to a 1.6% increased risk of admission to hospital for COPD for each unit increase in PM10 concentration in the outside air.

A case-control study on occupational risk factors for sino-nasal cancer.

OBJECTIVES: Sino-nasal cancer has been consistently associated with exposure to wood dust, leather dust, nickel and chromium compounds; for other occupational hazards, the findings are somewhat mixed. The aim of this study was to investigate the risk of sino-nasal epithelial cancer (SNEC) by histological type with prior exposure to suspected occupational risk factors and, in particular, those in metalworking. METHODS: Between 1996 and 2000, incident cases were collected on a monthly basis from hospitals throughout the Piedmont region of Italy by the regional Sino-nasal Cancer Registry. A questionnaire on occupational history, completed by 113 cases and 336 hospital controls, was used to assign exposure to occupational hazards. The relationship between SNEC and cumulative exposure to these hazards was explored using unconditional logistic regression to statistically adjust for age, sex, smoking and co-exposures, allowing for a 10-year latency period. RESULTS: The risk of adenocarcinoma was significantly increased with ever-exposure to wood dust (odds ratio; OR = 58.6), and to leather dust (OR = 32.8) and organic solvents (OR = 4.3) after controlling for wood dust, whereas ever-exposure to welding fumes (OR = 3.7) and arsenic (OR = 4.4) significantly increased the risk for squamous cell carcinoma. For each of these hazards, a significant increasing trend in risk across ordered cumulative exposure categories was found and, except for arsenic, a significantly increased risk with ever-exposure at low intensity. Treating cumulative exposure on a continuous scale, a significant effect of textile dusts was also observed for adenocarcinoma. For a mixed group of other histological types, a significant association was found with wood dust and organic solvents. CONCLUSIONS: Some occupational risk factors for SNEC were confirmed, and dose-response relationships were observed for other hazards that merit further investigation. The high risk for adenocarcinoma with low-intensity exposure to wood dust lends support for a reduction in the occupational threshold value.

[Peculiarities and aims of first aid training in the road haulage sector]. / Peculiarità e obiettivi della formazione degli addetti al primo soccorso nel settore dell'autotrasporto.

BACKGROUND: Four years after the law concerning first aid in the workplace was passed in Italy (inter-ministerial decree 388/2003), which is a useful tool in improving safety at work, it is necessary to organize first aid courses specifically for those working in the road haulage sector which would also be effective in case of traffic accidents. In view of the characteristics of the working environment in this sector (the road) and of the working conditions (generally workers are isolated and far from the company's headquarters), it would be necessary to organize ad hoc first aid courses at the workplace for the category of professional drivers. OBJECTIVES AND METHODS: The aim of this article is to discuss some possible organizational aspects of first aid in the road haulage sector, such as: number of workers responsible for first aid, how to train workers for specific risks of traffic accidents, the requirements for teachers responsible for first aid and course targets that must be achieved. RESULTS AND CONCLUSIONS: A good level of training, achieved during the first aid course at the workplace, might therefore be useful to improve road safety and increase the quality of basic and advanced first aid in road traffic injuries.

[Microbiological aspects of pool water]. / L'acqua delle piscine: aspetti microbiologici.

It is well known that there is an elevated risk of diffusion of pathogenic micro-organisms in swimming pools. Preventive measures aimed at protecting the health of swimmers are complex because of the variety of micro-organisms involved, the different ways in which these can be transmitted and the involvement of both aquatic and environmental factors. In industrialised countries, the circulation of many pathogens which were common in the past has progressively decreased in recent years; in contrast, infections caused by emerging pathogens such as Pseudomonas, atypical mycobacteria, Aeromonas, Legionella, Cryptosporidium, Norwalk virus, adenovirus and rotavirus have increased in frequency. Such infections affect not only the gastrointestinal tract but also other body sites, in particular the skin, conjunctiva, respiratory tract and auditory apparatus. Opportunistic pathogens capable of causing potentially serious infections in debilitated and immunocompromised subjects may also be involved. It is clearly necessary, therefore, that preventive interventions and effective monitoring programs, regarding both pool water and environmental quality, be implemented in all swimming facilities.

[Professional driving and safety, a target for occupational medicine]. / Guida professionale e sicurezza, un approccio obiettivo che coinvolge anche la medicina del lavoro.

BACKGROUND: Road traffic injuries constitute one of the main causes of death and disability in Italy and in the European Union. Occupational medicine should pay special attention to the field of road transport because every year a large number of road accidents occur with fatal outcomes. Via health surveillance the occupational physician can play an important role in the prevention of such events. OBJECTIVES: The aim of the article is to summarize the results of the most recent studies on the main risk factors for road transport safety and discuss possible strategies of health surveillance, according to the recent indications of the European Agency for Safety and Health at Work, Bilbao. METHODS: A review of the literature was made. RESULTS AND CONCLUSIONS: The scientific literature provides a large amount of interesting information on the most important risk factors for road accidents, such as drinking and drug abuse, sleepiness and other medical conditions, or excessive speed. The presence of numerous and varied hazards for road transport safety requires, as suggested by the Bilbao Agency, the adoption of occupational health measures, including risk assessment, health education, technical and environmental prevention, health surveillance and clinical interventions (diagnosis and rehabilitation of occupational accidents). Moreover, the paper stresses the need to strengthen collaboration between occupational health physicians and other medical specialists.

[Syncope and professional driving: the role of the occupational physician]. / Sincope e guida professionale, il ruolo del medico del lavoro.

BACKGROUND: Road traffic injuries constitute one of the main causes of death and disability in Italy and in the European Union. Although much scientific evidence exists on the important role of complete loss of consciousness in the dynamics of motor vehicle accidents, at present there is no specific legislation in Italy. Occupational medicine should take particular care in this field, because every year a large number of accidents with fatal outcomes occur among truck drivers. Via health surveillance, the occupational physician can play an important role in the prevention of such events. OBJECTIVES AND METHODS: The aim of this article is to discuss some possible strategies of health surveillance, comparing the current Italian regulations with the recent guidelines of the European Society of Cardiology (ESC) Task Force regarding the association of syncope and road transport. RESULTS AND CONCLUSION: Current Italian legislation does not include specific prescriptions in case of syncope in truck drivers. This deficiency leads to a lack of information for occupational physicians in order to define unanimous judgements of work fitness. The authors attempted to apply the ESC guidelines on syncope and truck driving to the Italian situation. Four cases of syncope were described, in which the judgement of work fitness for truck drivers proved to be especially complex and stressed the need for cooperation between occupational health physicians and cardiologists.

[Prevention of road accidents in the road haulage field]. / Prevenzione degli infortuni da incidente stradale nel settore dell'autotrasporto.

UNLABELLED: Every year many traffic accidents with fatal outcomes occur in our Country. According to the recent indications of the European Agency for Safety and Health at Work, the Piedmont region has financed the plan: Prevention of road accidents in the road haulage field. OBJECTIVES: The aims of the plan are to stimulate transport companies to the target of road safety and to improve and enforce sanitary surveillance, in order to improve the safety on road haulage and to prevent traffic injuries. METHODS: the plan foresees, over a period of two years, a few encounters with all the interested parties (companies, police forces, labour unions etc). During those encounters we have to give a questionnaire for evaluating the companies' knowledge about the problem and we have to choose a common plan with the aim of improving road safety. RESULTS AND CONCLUSIONS: The Piedmont regional plan recalls the need to increase the attention to numerous and diversified hazards for safety on road haulage. It also imposes the choice of measures that include: risk assessment, health education, technical and environmental prevention, sanitary surveillance and clinical interventions (diagnosis and rehabilitation of occupational accidents).

Investigation on virucidal activity of chlorine dioxide. experimental data on feline calicivirus, HAV and Coxsackie B5.

INTRODUCTION: The aim of this study was to evaluate the efficacy of ClO2 with regard to viruses which show a particular resistance to oxidizing agent such as HAV and Norwalk and Norwalk-like viruses, and which play an important role in the epidemiology of viral foodborne diseases. In the food industry, disinfection of processing systems and equipment is a very important instrument to prevent secondary contamination and to guarantee food safety. Among disinfectants, chlorine dioxide (ClO2) presents a good efficacy at wide range of pH values, its action is rapid and generates few reaction byproducts if compared to hypoclorite. Experimental studies have highlighted that ClO2 shows a good bactericidal activity and it is also active towards viruses. Furthermore, the low concentrations and low contact times required to obtain microbial load reduction are favourable elements for the application of this compound in the industrial sanitizing practices. METHODS: As it is impossible to cultivate the Norwalk virus in vitro, we tested the resistance of Feline calicivirus (F9 strain) vs. ClO2, in comparison with HAV (strain HM-175) and Coxsackie B5. Chlorine dioxide was used at concentrations ranging from 0.2 to 0.8 mg/l in water solution, at pH 7 and at +20 degrees C. Viral suspensions were added to disinfecting solution and, at pre-set times, were sampled to undergo to titration after blocking the disinfectant action with thiosulphate 0.05 M. On the basis of the data obtained, for each virus and in relation to different concentrations, mean reduction times were calculated for 99%, 99.9% and 99.99% using the regression analysis model. RESULTS: As regards Feline calicivirus, at a concentration of 0.8 mg/l of ClO2, we obtained the complete elimination of the viral titre in 2 min while 30 min were required at concentrations of 0.2 mg/l. Coxsackie B5 showed a similar behaviour, being completely inactivated in 4 min with 0.4 mg/l of ClO2 and after 30 min at a concentration of 0.2 mg/l. Inactivation was quicker for HAV, which was eliminated after only 30 sec at a concentration of 0.8 mg/l and after 5 min at 0.4 mg/l. CONCLUSION: Our data show that for complete inactivation of HAV and Feline calicivirus, concentrations > or = 0.6 mg/l are required. This observation is true for Coxsackie B5 too, but this virus has shown a good sensitivity at all concentration tested according to regression analysis results. For Feline calicivirus and HAV, at low concentrations of disinfectant, prolonged contact times were needed to obtain a 99.99% reduction of viral titres (about 16 and 20 minutes respectively).

Bronchoalveolar lavage and its role in diagnosing cobalt lung disease.

The bronchoalveolar lavage (BAL) of two groups of hard metal workers (11 subjects) were examined and compared with BALs of 14 unexposed individuals as controls. The first group of workers included five asymptomatic subjects (2 females and 3 males) with normal lung function tests and chest X-rays. All the workers had been exposed daily to hard metal dust for 5 years before fiberoptic bronchoscopy. The second group of workers included six individuals (1 female and 5 males) with cobalt lung disease at biopsy. The BAL's cytology at the deep lung level is in agreement with a possible immunologic pathogenesis of the lung disease, similar to hypersensitivity pneumonitis (lymphocytosis with helper-suppressor ratio reduction). In order to identify diagnostic key-parameters, the data presented here are compared with data reported in literature for workers with a history of hard metal or cobalt (alone) exposure. Although the BAL can be useful, for a better definition of the reaction at the deep lung level, it seems insufficient per se for the diagnosis of hard metal lung disease.

Uncommon evolution of fibrosing alveolitis in a hard metal grinder exposed to cobalt dusts.

This study reports a case of fibrosing alveolitis with uncommon evolution in a 27-year-old male non-smoker, working as a hard metal grinder for 10 years. Personal and occupational history, routine clinical and laboratory check-up, chest X-rays, lung function tests, fiberoptic bronchoscopy with bronchoalveolar lavage and open lung biopsy returned a diagnosis of hard metal lung fibrosis. The patient felt greatly improved after removal from the workplace, without any therapy. At present, he is complaining of only mild exertional dyspnea and shows an attenuation of his ventilatory defect. The radiological picture has clearly improved and the cellular pattern of bronchoalveolar lavage was normal.

Cutaneous metastases from breast carcinoma: a report of 18 cases.

In this study, the authors report 18 patients with metastatic breast carcinoma affecting the skin, observed since 1988 in Forli, Italy. The results are compared with those already published in the literature.

Study of lung reactions in six asymptomatic workers occupationally exposed to hard metal dusts.

The description of one case of pulmonary fibrosis in a group of workers occupationally exposed to hard metal dusts with high concentrations of cobalt (50-90%), followed for five years, prompted us to perform a cytological examination on the bronchoalveolar lavage fluid plus determination of the lymphocytic subpopulations in six asymptomatic workers with the longest exposure. Bronchoalveolar lavage performed 16 hours (3 cases) or 48 hours (3 cases) after the end of the workshift showed a lymphocytosis with inversion of the helper/suppressor ratio in 3 cases. This demonstrates an immune response at deep lung level. No difference was observed between a subject with ascertained interstitial fibrosis and the other subjects. Furthermore, bronchoscopy revealed marked inflammatory reaction of the tracheobronchial mucosa.