[Effects of inorganic lead exposure on the autonomic nervous system and on the variability of heart rate among workers at a battery plant]. / Effetti dell'esposizione a piombo inorganico sul sistema nervoso autonomo e sulla variabilità della frequenza cardiaca in lavoratori di una fabbrica di accumulatori.

Inorganic Lead can cause a toxic effect on Central Nervous System, Peripheral Nervous System and Autonomic Nervous System (ANS). A damage of the ANS can determine an heart rate variability (HRV) reduction. In this study 43 battery workers exposed to inorganic lead with mean PbB = 31.63 microg/dl (DS 14.77 microg/dl) and 35 not exposed subjects underwent to an evaluation of heart rate variability by specific tests. Heart rate variability in the exposed group was, for some tests (lying to standing, lying to standing-standing to lying) reduced compared with not exposed subjects and for other tests (Valsalva manouvre, lying to standing-standing to lying) correlated with PbB and Zinc Protoporphyrin (ZPP), but not with BMI, age and smoking habits. This study, like others conducted on similar populations, suggest an effect of occupational inorganic lead exposure on Autonomic Nervous System and heart rate variability

An 11-year longitudinal study of the occupational dust exposure and lung function of polyvinyl chloride, cement and asbestos cement factory workers.

Standardized questionnaires and lung function tests were administered in 1973, 1980, and 1984 to 126 workers occupationally exposed to polyvinyl chloride (PVC) dust, to cement dust, or to asbestos cement dust until 1974-1978 and to PVC thereafter. The workers in the last group were assigned to two asbestos exposure categories (heavy and slight). The decline in forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1.0) was analyzed with regard to the length of time since the data of first employment. After adjustment for age, height, and smoking status at the date of first employment, the decline in FVC and FEV1.0 among the nonsmokers-light smokers was slightly accelerated with length of employment in the PVC and slight asbestos exposure groups and markedly accelerated with time since first employment in the heavy asbestos exposure group. The heavy smokers in all the exposure groups had FVC and FEV1.0 predicted values that were lower than those of the nonsmokers-light smokers; these differences remained constant with length of employment. Cessation of asbestos exposure for about 10 years did not seem to change lung function decline.

Blood cadmium concentrations in the general population of Umbria, central Italy.

The aims of this study were (a) to assess blood cadmium (B-Cd) concentrations and to establish a tentative reference interval; (b) to identify significant determinants of B-Cd, in a population from Umbria, Central Italy, which was not occupationally exposed to cadmium (Cd). Four hundred and thirty-four healthy blood-donors volunteered to answer a questionnaire and provide a blood sample for B-Cd analysis, which was performed by graphite furnace atomic absorption spectrophotometry. Blood Cd concentrations ranged from non-detectable values, i.e. below 0.1 microgram/l up to 3.4 micrograms/l and were not normally distributed. The median values and the 95th percentiles were 0.7 and 2.0 micrograms/l, respectively. Concentrations of B-Cd were more than double in smokers than in non-smokers, median values being 1.1 micrograms/l and 0.5 microgram/l, respectively. In current smokers, B-Cd values correlated with the number of cigarettes smoked daily (rs = 0.40, P = 0.0001) and with the cumulative exposure to cigarette smoke (rs = 0.35, P = 0.0001). Concentrations of B-Cd correlated with age in the non-smokers, but not in the smokers and were significantly higher in women than in men only in the non-smokers. Both in smokers and non-smokers, B-Cd concentrations were similar in subjects living in urban or in rural areas. In the whole study population the lower and the upper tentative reference limit were < 0.1 and 2.2 micrograms/l, respectively, as computed by a non-parametric rank-based method. The upper limit was approximately double in smokers than in non-smokers (3.1 micrograms/l and 1.6 micrograms/l, respectively). Our results show that B-Cd concentrations in a general population from Umbria are in the range reported for general populations in Northern Italy and other European Countries. Smoking was the strongest determinant of B-Cd concentrations and age had a lesser effect.

Blood lead levels in children living in three communities, at different risks of lead pollution.

We carried out a survey on blood lead levels in children living in three different communities in Umbria, Italy: Corciano, a small community (12,500 inhabitants), free of lead-using factories and with light traffic; Perugia, a medium-sized city (146,500 inhabitants); Deruta, a small community (7500 inhabitants) whose economy is based mainly on the production of artistic pottery, mostly in small home-operated factories. The study sample was made up of 539 children (275 boys and 264 girls); 156 of them attended nursery school (aged 3-6) and 383 primary school (aged 6-11). The mean blood lead level was significantly higher in Deruta than in Corciano (9.7 vs 8.3 micrograms/dl); Deruta children whose parents were occupationally exposed to lead had significantly higher blood lead levels than children of lead-unexposed parents (10.7 vs 9.0 micrograms/dl). The mean blood lead level was higher in Perugia than in Corciano children. On the average boys had higher blood lead levels than girls in all of the groups. We conclude that blood lead levels were low in the groups of children studied. Nevertheless children of ceramic workers and children living in a medium-sized city had greater lead absorption than children living in the control area.

High prevalence of sick building syndrome in a new air-conditioned building in Italy.

This study, which was conducted in central Italy, included (a) 525 office workers employed in an air-conditioned building that had fan coil units in every room (building B) and (b) 281 subjects who worked in three naturally ventilated buildings (building A) that were operated by the same public administration. The prevalence of work-related symptoms was assessed by a questionnaire that was administered by an occupational medicine specialist. The most frequent complaints of employees in building B were dry air, strong lighting, and high temperature. Employees who worked in this building experienced a statistically higher prevalence of symptoms that were characteristic of the sick building syndrome. This is the first time that this syndrome has been reported in Italy. Excessive illumination, a low relative humidity, and fiberglass on floors and furniture might have contributed to the symptoms. Inadequate maintenance of the building's air-conditioning plant and the employees' lack of information regarding self-regulation of the fan coil units may also have contributed to the prevalence of symptoms.

Effects of low doses of lead on children's health.

An investigation has been carried out of the blood lead levels of children resident in three different municipalities of Umbria: Corciano, selected as a control area; Perugia, the largest town in Umbria (approx. 150,000 inhabitants), with intense automobile traffic; and Deruta a town in which there is a flourishing ceramic industry. The mean blood lead levels were found to be higher in children in Perugia (96 micrograms/l) and Deruta (97 micrograms/l) with respect to Corciano (83 micrograms/l); in Deruta the mean blood levels were raised in those children whose families are occupationally exposed to lead (107 micrograms/l). The concentration of lead in the air in Deruta was higher than in Corciano (0.19 vs 0.11 microgram/m3, respectively). The lead concentrations in house dust were higher in Deruta (2.8 micrograms/m2) than in Corciano (0.8 microgram/m2) and the difference was greater in the houses were the inhabitants were exposed to lead in factories (2.7 micrograms/m2) or in workshops which were adjacent to the houses (4.7 micrograms/m2). The blood lead levels of children included in this study have been compared with those obtained during a similar investigation in 1978. Over the last eight years primary school children in Corciano and Deruta have shown a marked reduction in blood lead levels (greater than 50%). This improvement should not lead to false optimism: in fact, it is impossible to establish the blood lead level at which no adverse effects are induced, especially in children. Numerous studies suggest that even sub-clinical levels of lead can cause alteration in heme synthesis, peripheral nervous system, kidney, immune system, skeleton and growth. Furthermore, with regard to the central nervous system, low blood lead levels can provoke neuropsychological deficits, which can result above all, in a decreased I.Q., and behavioural alterations.

[Lead absorption in an Umbrian population from 1982 to 1992]. / Assorbimento di piombo nella popolazione umbra nel 1982 e nel 1992.

This report assessed lead absorption in community samples of the general population in Umbria, central Italy, in 1982 and in 1992. Each participant (128 subjects in 1982 and 479 in 1992) answered a questionnaire providing details of personal information and life style. Blood lead levels were determined by atomic absorption spectrophotometry. In 1992 hematocrit and glutamyltranspeptidase (gamma-GT) levels were also measured. In 1982 the mean blood lead level was 226 micrograms/l in males and 167 micrograms/l in females, and in 1992 it was still higher in males than in females (98 micrograms/l vs 61 micrograms/l) as were hematocrit and gamma-GT levels. Multiple regression analysis showed sex and age were the main factors accounting for 42% of the total variation in blood lead levels. They were followed by alcohol consumption, gamma-GT levels and smoking in this order. In conclusion, blood lead levels decreased significantly in central Italy in the decade 1982-92 and persistent lead absorption seems to be due to individual characteristics such as male sex, advanced age and a personal life style which includes alcohol consumption and smoking.

Increased lead absorption in children living in an area with high concentration of ceramic workshops.

Children who live in contaminated areas or whose cohabitants are occupationally exposed to lead are at a higher risk of lead absorption. The present study examined the blood lead levels of 539 nursery and primary school children living in three towns in the Umbria region (central Italy): Deruta, Corciano and Perugia. Deruta is a small town with a high number of ceramic workshops; Corciano is a mainly agricultural centre; Perugia is the largest town in Umbria. The lead concentrations of house dust, soil, air and water ducts of Deruta and Corciano were also examined. The blood lead levels were significantly increased in children in Deruta (9.7 S.D. = 3.6 micrograms/dL, p < 0.05) and Perugia (9.6 S.D. = 4.0 micrograms/dL, p < 0.05) compared to Corciano (8.3 S.D. = 1.9 micrograms/dL). In Deruta the blood lead levels were higher in children whose cohabitants worked in small ceramic factories or workshops near or in the homes (10.7 S.D. = 4.1 vs 9.0 S.D. = 3.0 micrograms/dL, p < 0.05). The mean concentration of lead in the house dust in Deruta was higher than in Corciano (2.8 S.D. = 2.5 vs 0.8 S.D. = 3.8 micrograms/m2, p < 0.01); the highest values were found in the house dust of the homes of children whose cohabitants worked in small ceramic factories either near or in the same building. There was no significant difference between the concentrations of lead in street dust or tap water of Deruta and Corciano. We conclude that the production of handworked ceramics could lead to an increased risk of lead absorption in children, particularly those who live with workers from this sector.

Monitoring of peak expiratory flow rates during occupational asthma treatment.

The purpose of this study was to evaluate the effect of anti-inflammatory drug treatment on respiratory symptoms and lung function in twelve subjects with occupational asthma while at work. PEFR was monitored for four weeks and antiasthmatic drugs (salbutamol, chromolyn sodium and beclomethasone dipropionate) were administered for three weeks, starting after the first week of PEFR monitoring, in an unchanged working environment. After treatment five subjects became asymptomatic, six improved and one continued to have unchanged work-related asthmatic symptoms. There were only minor increases in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and mean forced expiratory flow during the middle half of FVC (FEF25-75). Bronchial reactivity was studied in eleven subjects: six worsened and five improved. PEFR at 0600 h increased by 9.4% in nine responders and decreased by 5.8% in three non-responders. After treatment diurnal variation (DV) in PEFR decreased by 28.4% in responders and 30.8% in non-responders, even if at the fourth week it was 1.75 higher in non-responders compared to responders. In conclusion, in this study a continuous treatment of occupational asthma with anti-inflammatory drugs minimized respiratory symptoms, slightly increased PEFR and greatly reduced DV in PEFR.

Troleandomycin in the treatment of difficult asthma.

BACKGROUND: For difficult asthma, treatment is aimed at improving airway obstruction and minimizing adverse effects of systemic corticosteroids. The combination of troleandomycin (TAO) with methylprednisolone (MP) reportedly has a beneficial steroid-sparing effect on difficult asthma. METHODS: To test the steroid-sparing effect of TAO, 14 subjects with severe corticosteroid-dependent asthma were studied before and during treatment with MP and TAO. RESULTS: Treatment with MP and TAO resulted in a clear reduction in respiratory symptoms, asthmatic attacks, corticosteroid and hospitalization requirements, improvement in pulmonary function tests, and a remarkable decrease in peak expiratory flow rate circadian variability when compared with the period before TAO treatment (with corticosteroids). Treatment with MP and TAO was fairly well tolerated. Only a reduction (-5.2%, p < 0.01) in bone mineral content and an increase in plasma glucose levels (from 81.7 to 94.3 mg/dl, p < 0.05) were found, in comparison with pre-TAO values. One subject discontinued MP-TAO treatment because of a mild but persistent increase in serum alanine aminotransferase. In an evaluation of the clinical and pulmonary function test results, eight of the 14 subjects were responders and six were nonresponders. During follow-up three subjects discontinued TAO and consequently had an asthmatic attack after 4, 7, or 15 days, respectively. CONCLUSIONS: This study confirms that treatment with MP and TAO has a beneficial effect in a subgroup of severely steroid-dependent asthma patients.