Vaccination against seasonal influenza and socio-economic and environmental factors as determinants of the geographic variation of COVID-19 incidence and mortality in the Italian elderly.

BACKGROUND: A possible protective effect of seasonal influenza vaccination against the spread of the COVID-19 epidemic has been suggested. METHODS: We used publicly available data bases to explore the hypothesis as well as the effect of multiple social and environmental factors in the 20 Italian regions. RESULTS: Our results suggest that vaccination against seasonal influenza might beneficially impact on incidence and severity of the novel corona virus epidemic. Population density and vehicular traffic were also moderately associated with cumulative incidence of COVID-19. None of the other variables we considered showed an effect on cumulative incidence, case fatality rate or mortality from COVID-19. CONCLUSIONS: Extending influenza vaccination coverage particularly among the elderly, vulnerable individuals with specific chronic medical conditions, health care workers, and workers in other essential services, early in the upcoming 2020 influenza season, might help reduce the health impact of a second epidemic wave of COVID-19.

The preventable burden of work-related ill-health.

Background: The fraction of ill-health overall attributable to occupational conditions has not been extensively evaluated, thus contributing to the perception of a lesser relevance of education and research in occupational health in respect to other fields of medical research and practice. Aims: To assess the relevance of work-related conditions on the aetiology of human ill-health in different health domains. Methods: We extracted the risk estimates associated with heritability and with occupational risk factors for chronic lymphocytic leukaemia (CLL), major depressive disorder (MDD) and long QT syndrome (LQTS) from 13 published international reports. The selection criteria for the eligible studies were: genome-wide studies, or studies of the occupational risk factors associated with one of the three diseases of interest. We calculated and compared the respective population attributable fraction for the combined occupational risk factors, and for heritability. Results: We estimated that occupational risk factors would account for 12% (95% confidence interval (CI) 4-19) of CLL, 11% (95% CI 7-15) of MDD and 10% (95% CI 2-13) of LQTS burden in the general population. The corresponding figures for heritability would be 16% (95% CI 11-22), 28% (95% CI 20-5) and 17% (95% CI 7-27). Conclusions: More efforts in capacity building and research in occupational health are warranted aiming to prevent ill-health and to preserve a productive life for the ageing work population.

[Assessment of congenital malformation risk in the progeny of the military and civilian personnel of the Salto di Quirra military base: preliminary results]. / Valutazione del rischio di malformazioni congenite nella progenie del personale militare e civile del Poligono Interforze del salto di Quirra: risultati preliminari.

INTRODUCTION: We evaluated the congenital malformation rate in the progeny of the personnel of the Salto di Quirra military base in Sardinia. METHODS: During 2011, we gathered questionnaire information on the reproductive history of 389 employees, more then 99% of those eligible for routine health surveillance. RESULTS: the observed congenital malformation rate (20.1 x 10(-3), 95% CI 6.3 - 33.8) was lower than that reported by the Italian Registries of Congenital Malformations, and it did not vary by exposure to radiofrequency, elf electromagnetic fields, and solvents, and by jobs associated with alleged exposure to nanoparticles or alpha radiation. CONCLUSIONS: Our findings suggest that the documented or alleged occupational exposures among the PISQ workforce did not increase the congenital malformation rate in the progeny.

[Retrospective exposure assessment in occupational epidemiology: principles and methods]. / La valutazione retrospettiva delle esposizioni in epidemiologia occupazionale: principi e metodi.

INTRODUCTION: Occupational histories in case-control studies typically include a variety of past exposure circumstances and no monitoring data, posing serious challenges to the retrospective assessment of occupational exposures. METHODS. I will use examples from the EPILYMPH case-control study on lymphoma risk to introduce principles and methods of retrospective assessment of occupational exposures. RESULTS: Exposure assessment consists in several indicators, such as frequency and intensity of exposure, as well as a confidence score, expressing the occupational expert own judgement on the reliability of the assessment itself. Testing the null hypothesis from multiple perspectives allows boosting inference: while trends by the individual exposure indicators were all of borderline statistical significance, testing the association between CLL risk and exposure to ethylene oxide with the Fisher's test for combined testing of multiple probabilities yielded a p-value of 0.003. Using the occupational expert assessment as the gold standard, the specificity of a prior job-exposure matrix for benzene was 93%, and its sensitivity 40%., with a positive and negative predictive values ranging 71-77%. CONCLUSION: Once bias can be excluded, assuming a true association between exposure and disease, retrospective exposure assessment only under estimates the true risk, which size also depends on frequency of the exposure itself.

[Assessment of occupational noise exposure: methodology, measurement error, evaluation criteria]. / La valutazione dell'esposizione professionale al rumore procedure, errore di misura, criterio di decisione.

BACKGROUND: Occupational noise exposure can be monitored directly by personal sampling or indirectly, by area sampling. Personal sampling is performed using an integrating sound level meter, worn by the worker while performing his/her job. When area sampling is used, measurements need to be made in all locations where a typical worker stays while performing his/her tasks; the respective partial lengths of exposure need to be accurately monitored, and the time-weighted average sound level of the measured noise levels must be calculated. OBJECTIVES: Current regulations identify three different thresholds, corresponding to different types of action, but they do not propose any standard criteria to decide whether a threshold has been exceeded. Defining standard procedures to assess occupational noise exposure and identifying such thresholds is crucial. METHODS: Using empirical data collected in the field, the effects are illustrated of the number of sampling locations and of the partial lengths of exposure on area sampling measurements, and the effects of duration of noise exposure on both area and personal samplings. RESULTS: When dealing with area samplings, an accurate definition of both sampling locations and partial lengths of exposure is crucial. When arbitrary decisions are taken in selecting sampling locations and/or establishing partial lengths of exposure, spatial changes in noise level and operator' displacements while performing his/her tasks may affect results. Sampling for less than the duration of noise exposure is the major contributor to measurement error, particularly under conditions of unpredictable variation in noise level. In fact, as noise level in the non-monitored time fraction is unknown, measurement error cannot be determined. We estimate that, even under the most favorable circumstances, sampling should last not less than 40% of the duration of a given noise-generating occurrence, for repeated measurements to be dispersed within a range not wider than that generated by the instrumental error. Inter-daily variability is another important aspect in personal noise exposure evaluation. This is a general occurrence, whose effects cannot be controlled by simply considering weekly instead of daily exposures. Results of an investigation, covering about 60 different jobs within a primary aluminum plant, show an inter-daily variability in noise exposure greater than 5 dBA in about 75% of cases. CONCLUSIONS: Personal sampling, when correctly performed and covering the total duration of exposure, provides the most reliable result as it integrates noise over all locations where the worker actually stays while performing his/her tasks, and over the total length of time spent in each task. We propose extending personal sampling to the total duration of actual noise exposure as the standard procedure for monitoring daily personal noise exposure, and valid for the majority of work places. When the range of daily noise exposure includes one regulatory threshold, corresponding to a given type of action, we propose as a standard decision criterion to refer prudentially to the upper 95% confidence limit of the LEP,d arithmetic mean. Such criterion would allow to standardize procedures and decision methods, with the prospect of further improvements in the assessment of exposure to noise.

[Causal link in the assessment of the relationship between neoplastic diseases and occupational and environmental exposure in the judicial field]. / Il nesso causale nella valutazione del rapporto tra patologie neoplastiche ed esposizioni professionali ed ambientali in ambito giudiziario.

IARC evaluations of the carcinogenic risk to humans, although based on epidemiological and experimental studies, derive their value from the consensus among committee members on a decision based on the current status of knowledge, not from the studies themselves, nor from their summary evaluation. A judiciary setting, based on the opinion of an individual expert, or on the evaluation of the most updated state of the knowledge by a group of experts selected in non scientific settings, or even worse on the evaluation of a specific case with ad hoc epidemiological studies, cannot confute such decisions. Therefore, causal links already defined within the scientific community, such as between exposures in the IARC category 1 and specific cancer sites, should be accepted also in legal trials to establish individual responsibility in case of excess exposures for the general and/or the working population resulting from violation or omission of preventive duties, when those diseases follow such excess exposures. If no violation or omission occurred, a civil responsibility has to be defined when either a disease with established link with the given exposure occurs, or a disease for which no such a level of consensus exists in the scientific community, but for which the legal trial has reached a positive decision. In such instances, if omissions or law violations occurred, the legal trial carries the burden of establishing a causal link between such omissions and violations and the damage for the individual worker or citizen.

Occupational risk factors for cancer of the central nervous system: a case-control study on death certificates from 24 U.S. states.

The risk of cancer of the central nervous system (CNS) by industry and occupation was investigated with a case-control analysis of the death certificates of 28,416 cases and 113,664 controls, selected from over 4.5 million deaths in 24 U.S. states between 1984 and 1992. Industries showing consistent increases in risk by gender and race included textile mills, paper mills, printing and publishing industries, petroleum refining, motor vehicles manufacturing, telephone and electric utilities, department stores, health care services, elementary and secondary schools, and colleges and universities. CNS cancer risk was increased for administrators in education and related fields, secondary school teachers, and other education- and health-related occupations. The application of job-exposure matrices to the industry/occupation combinations revealed a modest increase in risk for potential contact with the public at work and exposure to solvents. Occupational exposure to electromagnetic fields (EMF) was not associated with CNS cancer, although an association was observed with a few EMF-related occupations and industries. Agricultural exposures were associated with significant risk increases among white women and white men. Further work is required to investigate in more detail specific occupational exposures or possible confounders responsible for the observed associations.