Cause specific mortality in an Italian pool of asbestos workers cohorts.

BACKGROUND: Asbestos is a known human carcinogen and is causally associated with malignant mesothelioma, lung, larynx and ovarian cancers. METHODS: Cancer risk was studied among a pool of formerly asbestos-exposed workers in Italy. Fifty-two Italian asbestos cohorts (asbestos-cement, rolling-stock, shipbuilding, and other) were pooled and their mortality follow-up was updated to 2018. Standardized mortality ratios (SMRs) were computed for major causes of death considering duration of exposure and time since first exposure (TSFE), using reference rates by region, age and calendar period. RESULTS: The study included 63,502 subjects (57,156 men and 6346 women): 40% who were alive, 58% who died (cause known for 92%), and 2% lost to follow-up. Mortality was increased for all causes (SMR: men = 1.04, 95% confidence interval [CI] 1.03-1.05; women = 1.15, 95% CI 1.11-1.18), all malignancies (SMR: men = 1.21, 95% CI 1.18-1.23; women = 1.29, 95% CI 1.22-1.37), pleural and peritoneal malignancies (men: SMR = 10.46, 95% CI 9.86-11.09 and 4.29, 95% CI 3.66-5.00; women: SMR = 27.13, 95% CI 23.29-31.42 and 7.51, 95% CI 5.52-9.98), lung (SMR: men = 1.28, 95% CI 1.24-1.32; women = 1.26, 95% CI 1.02-1.53), and ovarian cancer (SMR = 1.42, 95% CI 1.08-1.84). Pleural cancer mortality increased during the first 40 years of TSFE (latency), reaching a plateau thereafter. CONCLUSIONS: Analyses by time-dependent variables showed that the risk for pleural neoplasms increased with latency and no longer increases at long TSFE, consistent with with asbestos clearance from the lungs. Peritoneal neoplasm risk increased over all observation time.

Relation of the work ability index to fitness for work in healthcare and public employees in a region of Northeastern Italy.

PURPOSE: Work ability indicates an individual's capacity to match job demands according to his/her physical and mental conditions and work circumstances. Occupational physicians should take into consideration the global health status of a worker in order to correctly assess if he/she is fit for the job. The aim of this study was to verify the association between fitness for work evaluation and Work Ability Index scores, as well as individual factors (age, gender, and anthropometric characteristics) and work-related variables (job type, years of working duration). METHODS: A cross-sectional study was conducted within the occupational health surveillance of health and public employers in the Friuli-Venezia Giulia region (2018-2022). The participants voluntarily agreed to answer the standard Work Ability Index questionnaire. Data were investigated by univariable as well as multivariable regression analysis. RESULTS: The Work Ability Index of the workers included in the study (N = 6893) resulted negatively associated with age, female sex, and body mass index. It was averagely lower in nurses and assistive personnel, and the highest in medical doctors and public employers. The fitness for work assessments was also statistically related to WAI scores. The results obtained from the univariable and the multivariable analysis were consistent. CONCLUSIONS: The Work Ability Index is an efficient tool to measure an individual's capability to sustain job demands, and can be taken into account to produce a correct fitness for work evaluation and consequently preserve workers' health status.

Combined Effects of Noise and Hand-transmitted Vibration on Workers' Muscle and Mental Fatigues in a Simulated Construction Operation.

BACKGROUND: The frequent use of hand-held vibrating tools by construction workers exposes them to hand-transmitted vibration (HTV) and noise. This study investigated the effect of combined exposure to HTV and noise on workers' fatigues under simulated work with a typical building destruction tool. METHODS: The repeated measures study was conducted on 40 construction workers exposed to HTV (5 m/s2 rms with frequencies of 31.5, 63, and 125 Hz), HTV (10 m/s2 rms- 31.5 Hz), noise (90 dBA), and concurrent exposure (noise (90 dBA) + HTV (10 m/s2 rms- 31.5 Hz)) with the typical vibrating hand-held tool for 30 minutes. Electromyography signals determined each worker's fatigue level in the Flexor digitorum superficialis (FDS) muscle in two pre- and post-exposure periods. The subjects also filled out the visual analog scale to evaluate mental fatigue severity subjectively. RESULTS: The mean difference of muscle fatigue parameters was significant in all scenarios except for the two scenarios of alone exposure to HTV (5 m/s2 -125 Hz and noise exposure (p-value < 0.05). The mean difference of mental fatigue in all scenarios except for the two scenarios of exposure to HTV (5 m/s2 -125 Hz) and exposure to HTV (5 m/s2 -63 Hz) was significant (p-value < 0.05). The most differences in muscle fatigue parameters (Amplitude = 8.16±5.63, Mean frequency=-4.69±3.78) and mental fatigue (4.97±2.38) were observed in the simultaneous exposure to noise and HTV. CONCLUSION: Noise exposure alone cannot produce remarkable effects on muscle fatigue but can aggravate the effects of vibrations as a consequence of synergistic interaction. However, the role of noise on perceived mental fatigue was more dominant than the HTV. These findings should be considered to adapt the existing exposure limits to actual work conditions.

Occupational contact dermatitis in a gender perspective: North East Italian data 1996-2016.

BACKGROUND: Occupational contact dermatitis (OCD) ranks high among occupational diseases in Europe, but little is known as regards OCD and jobs in a gender perspective. OBJECTIVES: To evaluate sex prevalence of OCD according to occupational sectors and agents involved. 27381 patients (1996-2016) with suspected irritant/allergic contact dermatitis (ICD-ACD) were evaluated in North-Eastern Italy. Each patient underwent: a standardized questionnaire, a dermatologist/occupational physician evaluation and a patch test. RESULTS: Females were younger at diagnosis (35.2 ± 11.6 years vs 37.7 ± 12.6 in males, p< 0.001) and had a lower ICD prevalence (OR 0.58, C.I. 95% 0.51 - 0.66, p < 0.001). Job categories most involved differed between sexes, with highest rank for healthcare professionals in females and machinery mechanics and filters for males. In females ACD percentage was higher in all job categories. CONCLUSIONS: OCD characteristics differ between sexes, according to intrinsic and extrinsic factors. Use of personal care products, housekeeping products and outdoor work activities may account for different sensitization profiles.

Low sensitivity of rapid tests detecting anti-CoV-2 IgG and IgM in health care workers' serum for COVID-19 screening.

BACKGROUND: the sensitivity and specificity of a rapid antibody test were investigated for the screening of healthcare workers. METHODS: the serum of 389 health care workers exposed to COVID-19 patients or with symptoms, were analysed. All workers underwent monthly the screening for SARS-CoV-2 with detection of viral RNA in nasopharyngeal swabs by RT-PCR. IgG antibody detection in serum was performed by Chemiluminescence Immunoassay (CLIA) and by the Rapid test (KHB diagnostic kit for SARS CoV-2 IgM/IgG antibody after a median of 7.6 weeks (25°-75° percentiles 6.6-11.5). RESULTS: the rapid test resulted positive in 31/132 (23.5%), 16/135 (11.8%) and 0/122 cases in COVID-19 positive individuals, in those with only SARS-CoV-2 IgG antibodies and in those negative for both tests, respectively. Sensitivity was 17.6% (CI95% 13.2-22.7) and 23.5% (CI95% 16.5-31.6), and specificity was 100% (CI95% 97-100) and 100% (CI95% 97-100) considering Rapid test vs CLIA IgG or Rapid test vs SARS-CoV-2 positive RNA detection, respectively. CONCLUSION: the KHB Rapid test is not suitable for the screening of workers with previous COVID-19 infection.

Photobiomodulation modulates inflammation and oral microbiome: a pilot study.

INTRODUCTION: Oral mucositis (OM) is a severe side effect in patients undergoing anticancer therapies, which negatively impacts on their quality of life often leading to either the interruption of the therapy. Photobiomodulation (PBM) is emerging as an effective strategy allowing a faster wound healing. OBJECTIVES: This pilot study aims at verifying whether PBM modulates the inflammatory response in patients and its effect on the oral microbiome composition. MATERIALS AND METHODS: Buccal swabs were collected from four patients affected by OM, both on ulcerated and clinically healthy areas, before and on the last day of PBM therapy, as well as on the first day after treatment discontinuation. The concentration of 38 cytokines and the composition of oral microbiome were measured. RESULTS: Most of the pro-inflammatory cytokines were reduced, whereas anti-inflammatory cytokines resulted up-regulated by PBM. In addition, PBM influenced the composition of oral microbiome, by decreasing the amount of pathogenic species and promoting the growth of commensal bacteria. These changes were even more evident when separately analysing patients who clinically responded to PBM and the only patient who did not respond. CONCLUSIONS: PBM reduces inflammatory burden in patients affected by OM and positively influences the composition of the oral microbiome.

Acoustic comfort depends on the psychological state of the individual.

Recent studies have shown that comfort can be influenced more by psychological processes than from the characteristics of environmental stimulation. This is relevant for different industrial sectors, where comfort is defined only as a function of the intensity of external stimuli. In the present study, we measured physiological and psychological comfort during the exposure to four levels of acoustic noise [from 45 to 55 dB(A)] corresponding to different comfort classes inside a full-scale mock-up of a cruise ship cabin. We found an increase of psychological and physiological discomfort for higher noise intensities, but not for all the intensities defining the comfort classes. Furthermore, we found that negative psychological states determine a lower physiological sensitivity to acoustic noise variations compared to positive states. Our results show that, at normal/low intensities, psychological processes have a greater role in determining acoustic comfort when compared to the stimulus intensity. Practitioner Summary: This study shows that psychological factors can be more relevant in determining acoustic comfort inside a ship cabin than the intensity of acoustic stimulus itself. This finding suggests that the cruise industry should consider not only the engineering measurements when evaluating comfort on board, but also the passenger' psychological state. Abbreviations: AIC: akaike information criterion; CCT: colour correlated temperature; cd/m2: candela/square meters; df: degrees of freedom; F-test: Fisher's test; HF: high frequency; HR: heart rate; HRV: heart rate variability; HSV: hue saturation value; K: kelvin; LF: low frequency; LF/HF: low frequency to high frequency ratio; lme: linear mixed effects; ms: milliseconds; nu: normalized unit; p: p value; pNN50: percentage of adjacent pairs of normal to normal RR intervals differing by more than 50 milliseconds; r2: coefficient of determination; rc: concordance correlation coefficient; RMSSD: square root of the mean normal to normal RR interval; SD: standard deviation; SDNN: standard deviation of normal to normal RR intervals; SEM: standard error of the mean; t-test: student's tests; χ2: chi-square test.

Risk assessment of vascular disorders by a supplementary hand-arm vascular weighting of hand-transmitted vibration.

PURPOSE: To provide an updated epidemiological validation for a supplementary method for assessing the risk of vascular disorders from hand-transmitted vibration. METHODS: The occurrence of vibration-induced white finger (VWF) in the vibration-exposed workers of the Italian cohort of the EU VIBRISKS study was related to measures of daily vibration exposure expressed in terms of r.m.s. acceleration magnitude normalised to an 8-h day, frequency weighted according to either the frequency weighting Wh defined in international standard ISO 5349-1:2001 [Ah(8) in ms- 2] or the hand-arm vascular frequency weighting Wp proposed in the ISO technical report (TR) 18570:2017 [Ap(8) in ms- 2]. To estimate a threshold value for vascular hand-arm vibration risk, the Wp-weighted vibration exposure value Ep,d (in ms- 1.5) was calculated according to the ISO/TR document. The difference in the predictions of VWF between the exposure measures calculated with the frequency weightings Wh or Wp was investigated by means of logistic modelling. RESULTS: Measures of daily vibration exposure constructed with the frequency weighting Wp [Ap(8) and Ep,d], which gives more importance to intermediate- and high-frequency vibration, were better predictors of the occurrence of VWF in the vibration-exposed workers than the metric derived from the conventional ISO frequency weighting Wh [Ah(8)]. There was some epidemiological evidence for a threshold value of Ep,d for the onset of VWF in the vibration-exposed workers. CONCLUSIONS: Measures of daily vibration exposure evaluated with the vascular weighting Wp performed better for the predictions of VWF than those obtained with the frequency weighting Wh recommended in ISO 5349-1.

Cerium Oxide Nanoparticles Absorption through Intact and Damaged Human Skin.

Cerium oxide (CeO2) nanoparticles (NPs) are used in polishing products and absorbents, as promoters in wound healing, and as organopesticide decontaminants. While systemic bioaccumulation and organ toxicity has been described after inhalation, data on CeO2 NPs' transdermal permeation are lacking. Our study was an in vitro investigation of the permeation of 17-nm CeO2 NPs dispersed in synthetic sweat (1 g L-1) using excised human skin on Franz cells. Experiments were performed using intact and needle-abraded skin, separately. The average amount of Ce into intact and damaged skin samples was 3.64 ± 0.15 and 7.07 ± 0.78 µg cm-2, respectively (mean ± SD, p = 0.04). Ce concentration in the receiving solution was 2.0 ± 0.4 and 3.3 ± 0.7 ng cm-2 after 24 h (p = 0.008). The Ce content was higher in dermal layers of damaged skin compared to intact skin (2.93 ± 0.71 µg cm-2 and 0.39 ± 0.16 µg cm-2, respectively; p = 0.004). Our data showed a very low dermal absorption and transdermal permeation of cerium, providing a first indication of Ce skin uptake due to contact with CeO2.

Occupational status and hospitalisation for mental disorders: findings from Friuli Venezia Giulia region, Italy, 2008-2017.

Purpose: To investigate to which extent occupational status, and job titles, were associated with types of hospitalisations and psychiatric diagnoses among inpatients of Friuli Venezia Giulia Region, Italy.Methods: Cross-sectional study based on 10 years register data (2008-2017) on 2929 subjects hospitalised in General Hospital Psychiatric Units. Odds ratios (OR) of hospitalisations and psychiatric diagnoses for occupational status and job titles were calculated by logistic regression analysis.Results: Employed were at lower risk of urgent and involuntary hospitalisation. The risk of urgent hospitalisation was higher for affective, organic or other disorders, while all psychiatric diagnoses were at lower risk of involuntary hospitalisation than psychosis. Using white collars as reference category, army showed a higher risk for urgent hospitalisation (OR = 2.3) and affective disorders (OR = 1.9). A higher risk for affective disorders was found in managers (OR = 2.0). Blue collars were at higher risk for alcohol and substance abuse (OR = 1.7).Conclusions: Employment was protective for urgent and involuntary hospitalisations and severe diagnoses. Hospitalisation for affective disorders was more likely in managers, army, and for substances abuse in blue collars. More research is needed to assess the association between specific occupational groups and involuntary hospitalisation.KeypointsEmployment was shown to be a protective factor for both urgent and involuntary hospitalisations and diagnosis of severe mental disorder.Managers, police and military forces were at higher risk of being hospitalised for affective disorders, while blue collars were at higher risk of hospitalisation for alcohol and substances abuse.Future research would benefit from a better analysis on the association between more specific occupational groups and hospitalisation for psychiatric disorders, with a particular focus on involuntary treatment.Further research is needed to compare the risk of hospitalisation for mental disorders in temporary or permanent position, according to recent international changes in labour market and its impact on mental health.

[New international criteria for evaluating vascular hand-arm vibration risk and staging and-arm vibration syndrome]. / Nuovi criteri internazionali per la valutazione del rischio vascolare e la stadiazione clinica della sindrome da vibrazioni mano-braccio.

SUMMARY: Recently, a supplementary methodology to improve the assessment of occupational exposures to hand-transmitted vibration (HTV) and a revision of the clinical staging of the hand-arm vibration syndrome (HAVS) have been proposed. The Technical Report ISO/TR 18570:2017 provides guidance on a supplementary method to that defined in ISO 5349-1:2001 for measuring and reporting HTV exposures; the method provides an improved assessment methodology for evaluating vascular hand-arm vibration risks (vibration induced white finger). On using a Delphi procedure, an international panel of experts has achieved consensus to develop an updated staging system for the vascular and neurological disorders of the HAVS, previously defined in the Stockholm Workshop Scale (1986); a new classification has been proposed with three stages for vibration related vascular and neurological effects. This paper provides details on the new international criteria for the assessment of vibration induced vascular risk and for the clinical staging of the vascular and neurological components of the HAVS.

Position Paper on Asbestos of the Italian Society of Occupational Medicine.

The Position Paper (PP) on asbestos of the Italian Society of Occupational Medicine (SIML) aims at providing a tool to the occupational physician to address current diagnostic criteria and results of epidemiological studies, and their consequences in terms of preventive and evaluation actions for insurance, compensation and litigation. The PP was based on an extensive review of the scientific literature and was compiled by a Working Group comprising researchers who have contributed to the international literature on asbestos-related diseases, as well as occupational physicians with extensive experience in the evaluation of risks and the medical surveillance of workers currently and formerly exposed to asbestos. The PP was drafted and reviewed between 2017 and 2018; its final version was prepared according to the guidelines of AGREE Reporting Checklist. All the members of the Working Group subscribed to the document, which was eventually approved by SIML's Executive Committee. The first section addresses industrial hygiene issues, such as methods for environmental monitoring, advantages and limitations of different microscopy techniques, the potential role of microfibers and approaches for retrospective assessment of exposure, in particular in epidemiological studies. The second section reviews the biological effects of asbestos with particular attention to the diagnostic aspects of asbestosis, pleural changes, mesothelioma and lung cancer. In the following section the criteria of causal attribution are discussed, together with different hypotheses on the form of the risk functions, with a comparison of the opinions prevalent in the literature. In particular, the models of the risk function for mesothelioma were examined, in the light of the hypothesis of an acceleration or anticipation of the events in relation to the dose. The last section discusses topics of immediate relevance for the occupational physician, such as health surveillance of former exposed and of workers currently exposed in remediation activities.

MiR-126 in intestinal-type sinonasal adenocarcinomas: exosomal transfer of MiR-126 promotes anti-tumour responses.

BACKGROUND: Intestinal-type sinonasal adenocarcinomas (ITACs) are aggressive malignancies related to wood dust and leather exposure. ITACs are generally associated with advanced stage at presentation due to the insidious growth pattern and non-specific symptoms. Therefore, biomarkers that can detect the switch from the benign disease to malignancy are needed. Essential for tumour growth, angiogenesis is an important step in tumour development and progression. This process is strictly regulated, and MiR-126 considered its master modulator. METHODS: We have investigated MiR-126 levels in ITACs and compared them to benign sinonasal lesions, such as sinonasal-inverted papillomas (SIPs) and inflammatory polyps (NIPs). The tumour-suppressive functions of MiR-126 were also evaluated. RESULTS: We found that MiR-126 can significantly distinguish malignancy from benign nasal forms. The low levels of MiR-126 in ITACs point to its role in tumour progression. In this context, restoration of MiR-126 induced metabolic changes, and inhibited cell growth and the tumorigenic potential of MNSC cells. CONCLUSIONS: We report that MiR-126 delivered via exosomes from endothelial cells promotes anti-tumour responses. This paracrine transfer of MiRs may represent a new approach towards MiR-based therapy.

Cancer incidence in a cohort of asbestos-exposed workers undergoing health surveillance.

OBJECTIVES: To compare a local cohort of 2488 men occupationally exposed to asbestos and enrolled in a public health surveillance program with the 1995-2009 cancer incidence of the general population of Friuli Venezia Giulia (FVG) region, Northeast Italy, we conducted a historical cohort study. METHODS: Standardized incidence ratios (SIRs), with 95% confidence interval (95% CI), for specific cancer sites were estimated in the cohort and in subgroups of workers employed in shipbuilding between 1974 and 1994. For internal comparisons, we calculated incidence rate ratios (IRRs) for all cancers, lung cancer and mesothelioma, by level of exposure to asbestos and sector of employment adjusted for smoking habits and age at start of follow-up. RESULTS: Among cohort members the SIR was 8.82 (95% CI 5.95-12.61) for mesothelioma and 1.61 (95% CI 1.26-2.04) for lung cancer. In subgroup analyses, the SIR for lung cancer in subjects hired in shipbuilding between 1974 and 1984 was 2.09 (95% CI 1.32-3.13). In the overall cohort, a borderline increased incidence was also found for stomach cancer (SIR = 1.53 95% CI 0.96-2.31). Internal comparisons within the cohort show that among men with high asbestos exposure level the relative risk was almost threefold for lung cancer (IRR = 2.94 95% CI 1.01-8.57). CONCLUSIONS: This cohort experienced an excess in the incidence of both mesothelioma and lung cancer, showing increasing incidence rates at higher level of asbestos exposure. For lung cancer, the relative incidence was highest among workers hired in shipbuilding between 1974 and 1984.

Sensitization to, and allergic contact dermatitis caused by, colophonium in north-eastern Italy in 1996 to 2016 with a focus on occupational exposures.

BACKGROUND: Colophonium is a natural substance derived from Pineaceae trees. It is used in a wide range of consumer and occupational products because of its tackiness, and is a known sensitizer. OBJECTIVES: To analyse the temporal trend of contact allergy to colophonium in north-eastern Italy, and to evaluate the associations with occupations in our geographical area. METHODOLOGY: From 1996 to 2016, 27 381 patients with suspected allergic contact dermatitis were patch tested in north-eastern Italy. Individual characteristics were documented by use of a standardized questionnaire in 6 departments of dermatology or occupational medicine. RESULTS: The overall prevalence of colophonium sensitization was 1.67%; the prevalence was significantly higher in women (1.75%) than in men (1.49%). No significant differences among departments were observed. We found significant associations between colophonium sensitization and being a student (odds ratio [OR] 4.64; 95% confidence interval [CI]: 1.04-20.6), being a farmer or fishermen (OR 3.63; 95%CI: 1.21-10.84), being a housekeeper (OR 2.02; 95%CI: 1.08-3.77), and being retired (OR 2.06; 95%CI: 1.08-3.92). CONCLUSION: Our study showed that contact allergy to colophonium is still relevant in north-eastern Italy. The frequency of sensitization has dropped significantly over a period of 10 years, but students and farmers/fishermen still have sensitization prevalences above 3.5%. Our results are in line with European data.

Mortality in a cohort of asbestos-exposed workers undergoing health surveillance.

BACKGROUND: The coastal area of Friuli Venezia Giulia (FVG) region, north-eastern Italy, was characterized by work activities in which asbestos was used until the early 1990s, particularly in shipbuilding. A public health surveillance program (PHSP) for asbestos-exposed workers was established, although limited evidence exists about the efficacy of such programs in reducing disease occurrence and mortality. OBJECTIVES: To compare mortality in a cohort of 2,488 men occupationally exposed to asbestos, enrolled in a PHSP in FVG between the early 1990s and 2008, with that of the general population of FVG and Italy. METHODS: Standardized Mortality Ratios (SMR), with 95% Confidence Interval (95% CI), for all causes, all cancers, lung (LC) and pleural cancer (PC) were estimated in the cohort and in subgroups of workers with the first hire in shipbuilding that caused asbestos exposure (<1974, 1974-1984, 1985-1994). RESULTS: A strong excess in mortality for PC with reference to FVG (SMR=6.87, 95% CI 4.45-10.17) and Italian population (SMR=13.95, 95% CI 9.02-20.64) was observed. For LC, the FVG-based SMR was 1.49 (95% CI 1.17-1.89) and the Italy-based 1.43 (95% CI 1.12-1.81). Mortality among workers with the first hire in shipbuilding before 1974 was high for PC (FVG-based SMR=8.98, 95% CI 5.56-13.75; Italy-based SMR=18.41, 95% CI 11.40-28.17) and for LC (FVG-based SMR =1.60, 95% CI 1.18-2.11; Italy-based SMR=1.54, 95% CI 1.14-2.03). Further, for LC between 1974 and 1984, the FVG-based SMR was 2.45 (95% CI 1.06-4.82), and the Italy-based SMR was 2.33 (95% CI 1.01-4.60). CONCLUSIONS: This cohort experienced an excess mortality for pleural and lung cancer, compared with regional and national populations. For lung cancer, the excess was stronger in workers with the first hire in shipbuilding before 1985, suggesting a key role of asbestos exposure.

[Guidelines for occupational exposures to mechanical vibration.] / I valori guida nella valutazione del rischio da vibrazioni meccaniche.

OBJECTIVES: In this study, the daily exposure action values (EAV) and the daily exposure limit values (ELV) for hand-transmitted vibration (HTV) and whole-body vibration (WBV), established by the EU Directive 2002/44/EC and the Italian Decree 81/2008, and expressed in terms of 8-hr frequency weighted r.m.s. acceleration magnitude, are discussed upon consideration of the findings of experimental and epidemiological studies. METHODS: There is some epidemiological support for the EAV A(8) of 2.5 ms-2 r.m.s. and the ELV A(8) of 5 ms-2 r.m.s. for HTV, at least for the vascular component (secondary Raynaud's phenomenon) of the hand-arm vibration syndrome. RESULTS: There is some experimental evidence for the EAV A(8) of 0.5 ms-2 r.m.s. for WBV, while there is neither biodynamic nor epidemiological validation for the ELV A(8) of 1.15 ms-2 r.m.s. for WBV, this latter lowered to 1 ms-2 r.m.s. in the Italian legislation.

An overview of low back pain and occupational exposures to whole-body vibration and mechanical shocks.

This paper offers an overview of the relation of low back pain (LBP) to occupational exposures to whole-body vibration (WBV) and mechanical shocks. LBP is a condition of multifactorial origin and is a very common health problem in the general population. Among occupational risk factors, epidemiological studies of driving occupations have provided evidence for strong associations between LBP and occupational exposures to WBV and mechanical shocks. Since it is hard to separate the contribution of WBV exposure to disorders in the lower back from that of other individual, ergonomic or psychosocial risk factors, a quantitative exposure-response relationship for WBV cannot be outlined precisely. Experimental research has provided biodynamic support to the findings of epidemiological studies, showing that in controlled laboratory conditions exposure to WBV can cause mechanical overload to the human spine. The EU Directive on mechanical vibration has established daily exposure action and limit values to protect the workers against the risk from WBV. There is some evidence that the EU exposure limit values are excessive, so much so that an elevated risk of LBP has been found for WBV exposures beneath the EU limit values. In the Italian arm of the EU VIBRISKS prospective cohort study of professional drivers, measures of internal lumbar load (compressive and shear peak forces), calculated by means of anatomy-based finite-element models, were found better predictors of the occurrence over time of low back disorders than the metrics of external exposure suggested by the EU Directive on mechanical vibration. Further biodynamic and epidemiological studies are needed to validate the findings of the VIBRISKS study.

A longitudinal study of neck and upper limb musculoskeletal disorders and alternative measures of vibration exposure.

OBJECTIVE: To investigate the exposure-response relationships between alternative frequency weightings of hand-transmitted vibration (HTV) and neck and upper limb musculoskeletal disorders (MSDs) in a cohort of HTV workers. METHODS: In a three-year longitudinal study, the occurrence of neck and upper limb MSDs was investigated in 249 HTV workers and 138 control men. In the HTV workers, MSDs were related to measures of daily vibration exposure expressed in terms of 8-h energy-equivalent frequency-weighted acceleration magnitude [A(8)]. To calculate A(8), the acceleration magnitudes of vibration were weighted by means of four alternative frequency weightings of HTV. The associations between MSDs, individual characteristics, physical work load other than vibration, and psychological strain were also investigated. RESULTS: The occurrence of upper limb MSDs was greater in the HTV workers than in the controls. After adjustment for potential confounders, the occurrence of elbow/forearm and wrist/hand MSDs increased with the increase in vibration exposure. A measure of model selection did not reveal any substantial difference in the performance of the alternative frequency weightings of HTV for the prediction of neck and upper limb MSDs. In the study population, age, hard physical work load, and poor psychological well-being were associated with both neck and upper limb MSDs. CONCLUSIONS: In this study, there was evidence for significant exposure-response relationships between HTV exposure and MSDs in the distal sites of the upper limbs. There were no differences in the prediction of neck and upper limb MSDs between measures of daily vibration exposure calculated with alternative frequency weightings of acceleration magnitude.

Diagnoses and prescriptions of antidepressants in suicides: Register findings from the Friuli Venezia Giulia Region, Italy, 2002-2008.

OBJECTIVE: To explore to what extent and under which diagnoses individuals who committed suicide had received psychiatric in-patient care, and how many had previously committed non-lethal self-harm. To investigate the antidepressant treatment received by these individuals. METHODS: Case-control study based on a health register. RESULTS: Psychiatric hospitalisation was found in 31.2% of the cases and 2.3% of the controls, and was a strong predictor for suicide with an odds ratio (OR) = 19.5. This did not differ significantly between diagnostic categories (except anxiety disorders with OR = 5.3). Non-lethal self-harm in the study period was committed by 14.3% of the cases and 0.14% of the controls, and was twice as common in female cases than in male cases. Previous self-harm was a very strong independent predictor for suicide with OR = 53.1 when a single episode of self-harm had occurred, and OR = 98.0 for repeated episodes (adjusted for age, gender and hospitalisation). Only 16.1% of the cases were currently on antidepressant medication at the time of suicide. CONCLUSIONS: Few of the suicides had previously been psychiatric in-patients. Even fewer had current prescriptions for antidepressants. This suggests that better diagnosis and treatment of psychiatric patients is an important suicide preventive intervention.