Personal solar ultraviolet radiation dosimetry in an occupational setting across Europe.

BACKGROUND: Work-related solar ultraviolet radiation (UVR) is an important factor in the pathogenesis of non-melanoma skin cancer (NMSC). The World Health Organization, through the International Agency for Research on Cancer, has classified solar UVR as a group 1 carcinogen since 2012. The main problems encountered so far in the study of occupationally induced skin cancer include the lack of accurate occupational UVR dosimetry as well as insufficient distinction between occupational and leisure UVR exposure and underreporting of NMSC. OBJECTIVES: The aim of this study was to collect long-term individual UVR measurements in outdoor workers across European countries. METHODS: A prospective study was initiated through the European Academy of Dermatology and Venereology, Healthy Skin@Work Campaign, measuring UVR exposure doses at occupational settings of masons from five European countries. Measurements were performed for several consecutive months using the GENESIS-UV measurement system. RESULTS: The results identified alarming UVR exposure data. Average daily UVR doses ranged 148.40-680.48 J/m2 in Romania, 342.4-640.8 J/m2 in Italy, 165.5-466.2 J/m2 in Croatia, 41.8-473.8 J/m2 in Denmark and 88.15-400.22 J/m2 in Germany. Results showed an expected latitude dependence with increasing UVR yearly dosage from the north to the south of Europe. CONCLUSIONS: This study shows that outdoor workers from EU countries included in this study are exposed to high levels of occupational solar UVR, vastly exceeding the occupational exposure limits for solar UVR exposure, considered to be 1-1.33 SED/day in the period from May to September. This finding may serve as an evidence-based recommendation to authorities on implementing occupational skin cancer prevention strategies.

The European Status Quo in legal recognition and patient-care services of occupational skin cancer.

BACKGROUND: Skin cancer is the most common malignancy in Caucasian populations worldwide and ultraviolet radiation (UVR) is known for being the number one carcinogen. As, especially in outdoor workers, UVR is an inevitable carcinogen, the prevention and management of UVR-related skin cancers in these at-risk populations represent a collective challenge for dermatologists and healthcare policymakers likewise. OBJECTIVE: To provide an overview on the current regulations on the acknowledgement and management of work-related skin cancer in 11 European countries. METHODS: Dermatologists from 11 countries networking within the EU Horizon 2020 COST Action TD1206 'StanDerm' contributed to a standardized survey regarding current national regulations, implemented for the recognition, prevention and management as well as possible compensation regulations in their individual country of residence. RESULTS: Ten of 11 participating countries in this survey reported the existence of an established programme available on certain occupational diseases; work-related skin diseases were only specifically recognized in eight countries. Seven of 11 countries recognize cutaneous squamous cell carcinoma in outdoor workers as 'occupational skin cancer'. Basal cell carcinoma (6 of 11), actinic keratosis (5 of 11), Bowen's disease (5 of 11) and malignant melanoma (5 of 11) are not as regularly approved as potentially 'work-induced'. Only a few of the countries included into this survey established a general documentation system (national registry) on occupational skin diseases. So far, representatives of only three countries of this survey referred to a specific established national programme for the prevention, management or compensation of occupational skin cancers acquired during work-related UVR exposure. CONCLUSION: This survey highlights the need for mandatory regulations on the prevention, management and potential compensation of work-related UV-induced skin cancer across Europe. Against the background of a joint European domestic market, equal standards of occupational safety across Europe should include binding regulations for the protection and management of work-related skin cancer. The design of a common regulation to meet the increasing incidence of skin cancers in outdoor workers should become part of the European agenda, ensuring equal working and living conditions in the member states.

Skin photoaging in farmers occupationally exposed to ultraviolet radiation.

BACKGROUND: Most personal exposures to UV radiations occur from outdoor activities and several studies detected a significant association between skin cancer and outdoor occupation. OBJECTIVE: The aim of the study was to ascertain the prevalence of photoaging signs in a population of Italian farmers and in a population of indoor workers taking account of confounding factors. METHODS: 169 farmers and 198 indoor workers were classified for skin phototype and for skin photoaging, moreover 13 variables were taken into account. Marginal permutation tests were adopted for statistical analysis. RESULTS: Farmers were significantly older than the indoor workers. In workers occupationally exposed to UV photoaging increased with increasing age and years of occupational exposure to sunlight The distribution of skin phototype did not show significant differences in the two populations, while farmer showed a higher degree of photoaging than indoor workers. CONCLUSIONS: Even if farmers were older than the in door workers it seems that outdoor work produces a higher degree of photoaging.

[Prevention of occupational dermatitis in an international perspective]. / La prevenzione delle dermatiti occupazionali in una prospettiva internazionale.

Occupational dermatitis (OD) have always been a significant part of the occupational disease with huge social and economic costs. Traditionally, the standard program of OD prevention takes place in the three phases of protection, cleansing and use of emollient creams and other products able to improve the cutaneous trophism (skincare) at the end of the shiftwork. However, in countries like Germany where protection measures and skincare were widespread, there was not a simultaneous decrease in the OD. In recent years pilot programs for the prevention of OD have been implemented with positive results. In particular the integrated approach that includes three steps of primary, secondary and tertiary prevention (Osnabrueck model) is of great interest. Primary prevention is represented by introduction of technical regulations, pre-employment counselling and specific initiatives to promote health (healthy skin campaign). In the case of initial/minor OD, secondary prevention is accomplished through the dermatological treatment of the patient and 1-2 days outpatient education initiatives/skin protection training. In severe cases of individual OD, tertiary prevention involves the hospitalization of the patient in a dermatology department. In 2009 the European network EPOS (European Initiative for the Prevention of Occupational Skin Diseases) of preventive dermatology has been organized basing on the integrated approach of primary, secondary and tertiary prevention.

[Dose and effect biomarkers in the diagnosis of asbestos-related diseases and health surveillance of exposed workers]. / Gli indicatori biologici di dose ed effetto nella diagnostica delle patologie asbesto-correlate e nella sorveglianza sanitaria degli ex-esposti.

The aim of the study was to assess the reliability of the indicators of dose and effect in the health monitoring of asbestos exposed workers. In 49 cases out of 158 studied workers (31%) asbestos-related diseases were diagnosed following ATS criteria (2004). Using nonparametric statistical methods (permutation tests) 6 variables were analyzed with respect to asbestos-related diseases and working sectors, demonstrating a difference in the concentration of amphiboles (p < 0.01), greater in patients with asbestosis and workers involved in asbestos removal from railway carriages. There was not a correlation between mesothelin and amphiboles, chrysotile and total fibers concentrations (Spearman test).

Prevention of occupational dermatitis.

Occupational dermatitis is among the most frequent occupational diseases. Dermal exposure risk affects many professional categories such as healthcare workers, hairdressers, bakers, cleaning and kitchen employees. The economical burden of occupational dermatitis (OD) is huge (greater than 5 billion Euro per year in Europe), comprising direct costs (treatment, compensation), as well as indirect costs due to sick leave and lack of productivity. A scientifically based preventive program consisting of skin protection during work, cleaning and skin care after work has generally been recommended to prevent occupational contact dermatitis. However the rate of reported occupational skin diseases seems unchanged in the recent years. In cases of impaired skin condition the secondary prevention (i.e. therapeutic treatment by dermatologists and health-educational intervention seminars) is fundamental. For cases of occupational dermatoses in which these outpatient prevention measures are not successful, interdisciplinary inpatient rehabilitation measures have been developed (tertiary individual prevention). In the past years, various pilot-concepts to improve occupational dermatitis prevention have been successfully put into practice focussing on interdisciplinary (dermatological and educational) skin protection training programmes for high-risk professions. Currently a multi-step intervention approach is implemented which is aiming at offering quick preventive help at all levels of severity of occupational contact dermatitis. Recent data reveals that there are reliable evidence-based options for multidisciplinary prevention and patient management of occupational dermatitis using a combined approach by a network of clinics, practices and statutory social insurance bodies. At this stage, it seemed reasonable to form a European joint initiative for skin prevention. Recently a European network of preventive dermatology (European Initiative for the Prevention of Occupational Skin Diseases-EPOS) has been organized based on the German experience in the specific field.

[Chemical risk assessment in the leather goods producers: a comparison of the results obtained by measurements air concentration and algorithm ARChiMEDE]. / Valutazione del rischio chimico nel settore pellettiero: confronto dei risultati ottenuti con sistemi di campionamento attivo e algoritmo ARChi.MEDE.

The Italian legislation on chemical agents has undergone significant changes. The aim of the study was to compare the results obatained from an environmental investigation and the use of the ARChi.MEDE model The results of the survey were treated with the UNI EN 689/1997 that showed an acceptable result, while according to the use A.R.Chi.M.E.D.E. a significant risk was obtained. Actually the mathematical model assess workers exposure without considering in the calculation the specific preventive measures (personal protective equipment, training, uptake of pollutants at the source) as contemplated by law. So the mathematical model showed the need of preventive measures in the studied work place.

[Leather bags production: organization study, general identification of hazards, biomechanical overload risk pre-evaluation using an easily applied evaluation tool]. / Processo della pelle per la produzione di borse: studio organizzativo, identificazione generale dei pericoli, prevalutazione del rischio per il sovraccarico biomeccanico mediante un nuovo strumento di valutazione di semplice applicazione.

BACKGROUND: Craft industries are the backbone of the Italian manufacturing system and in this sector the leather trade plays a crucial role. OBJECTIVE AND METHODS: The aim of the study was to experiment with a risk pre-mapping data sheet in leather bag manufacture by analyzing the production cycle. RESULTS: The prevalence of biomechanical, organizational and physical factors was demonstrated in tanneries. With regard to chemical agents the lack of any priority of intervention could be due to the lack of information on the chemicals used. In the 2 enterprises that used mechanical processes the results showed different priorities for intervention and a different level of the extent of such intervention. In particular in the first enterprise biomechanical overload was a top priority, while in the second the results were very similar to those of the tannery. The analysis showed in both companies that there was a high prevalence of risk of upper limb biomechanical overload in leather bag manufacture. Chemical risk assessment was not shown as a priority because the list of chemicals used was neither complete nor sufficient. CONCLUSIONS: The risk pre-mapping data sheet allowed us to obtain a preliminary overview of all the major existing risks in the leather industry. Therefore the method can prove a useful tool for employers as it permits instant identification of priorities for intervention for the different risks.

Preventive oral kefir supplementation protects mice from ovariectomy-induced exacerbated allergic airway inflammation.

Asthma is an inflammatory lung disease that affects more women than men in adulthood. Clinical evidence shows that hormonal fluctuation during the menstrual cycle and menopause are related to increased asthma severity in women. Considering that life expectancy has increased and that most women now undergo menopause, strategies to prevent the worsening of asthma symptoms are particularly important. A recent study from our group showed that re-exposure of ovariectomised allergic mice to antigen (ovalbumin) leads to an exacerbation of lung inflammation that is similar to clinical conditions. However, little is known about the role of probiotics in the prevention of asthma exacerbations during the menstrual cycle or menopause. Thus, our objective was to evaluate the effects of supplementation with kefir, a popular fermented dairy beverage, as a preventive strategy for modulating allergic disease. The results show that the preventive kefir administration decreases the influx of inflammatory cells in the airways and exacerbates the production of mucus and the interleukin 13 cytokine. Additionally, kefir changes macrophage polarisation by decreasing the number of M2 macrophages, as shown by RT-PCR assay. Thus, kefir is a functional food that potentially prevents allergic airway inflammation exacerbations in ovariectomised mice.

[Diagnosis of occupational skin diseases]. / La diagnosi delle dermopatie da lavoro.

Occupational skin diseases (mainly irritative and allergic contact dermatitis) are a significant part of occupational diseases. The economical burden of occupational skin diseases (OSD) is huge comprising direct costs (treatment, compensation) as well as indirect costs due to sick leave and lack of productivity. The management of a case of OSD is complex requiring different steps ranging from diagnosis to prevention, through interpretation of patch tests and outpatient treatment and involving an interdisciplinary approach. Patch tests alone cannot prove the allergic origin of OSD because positive results can be referred to a previous contact dermatitis and negative ones may simply be apparent.

[SIMLII guidelines on workplace health promotion]. / Linee guida SIMLII sulla promozione della salute nei luoghi di lavoro.

Interventions of health promotion (HP) with the best evidence of effectiveness are reported in literature. However nothing is said about how to apply these interventions in the local specific situations. On the other hand in literature the role of the occupational physician in workplace HP is not highlighted. Currently there is a substantial amount of knowledge on effective HP interventions that meets internationally accepted criteria, but at least in our country it is not systematically applied. While several databases provide useful information on different HP programs, the Cochrane Collaboration systematic reviews should be considered the most reliable source.

[Asthma induced by chloramine T in nurses: case report]. / Asma da cloramina T nel personale sanitario: descrizione di un caso.

BACKGROUND: Chloramine T is used in hospitals as a disinfectant and for sterilization of endoscopy instruments. OBJECTIVES: A case of a nurse suffering from asthma due to Chloramine T is presented in order to focus attention on this occupational disease. METHODS AND RESULTS: The patient (male, 43 years) had been a nurse since 1993, working in various departments and operating rooms where he was exposed to glutaraldehyde and Chloramine T to disinfect surgical and endoscopy instruments. In 2007 he noticed the beginning of asthmatic reactions after exposure to the disinfectant. Skin tests with common allergens gave positive reactions and a skin test with Chloramine T gave a positive result. An inhalation test with glutaraldehyde gave negative results for both asthma and rhinitis. During the inhalation test with Chloramine T 0.5%, a significant biphasic decrease in FEVI was observed. The score of subjective symptoms for rhinitis was negative, CONCLUSIONS: The case confirms the current difficulty in diagnosing occupational asthma due to Chloramine T in health care workers, which is due to the frequent presence of late reactions and to exposure to several respiratory allergens and irritants in the workplace. The specific inhalation challenge is thus confirmed as the gold standard for the diagnosis of asthma induced by Chloramine T and in occupational asthma in general. It may very well be that the frequency of occupational asthma due to sensitization to Chloramine T in nurses is underestimated.

[Acute inorganic lead poisoning in workers employed on building renovation]. / Intossicazione acuta da piombo inorganico in addetti alla ristrutturazione edilizia.

BACKGROUND: Occupationally, there are a number of work processes that constitute a long-term risk as sources of exposure to lead. In these processes the presence of lead is not evident but represents a hidden risk of poisoning. OBJECTIVES: Study of two cases of hidden exposure to lead that were discovered during renovation work on a historical building. METHODS: Acute lead poisoning symptoms appeared in the 2 workers. The current protocol for treatment of lead poisoning was applied, which consisted in administration of a chelating agent (EDTA), with subsequent monitoring of indicators of dose (PbB. blood lead level, PbU: urinary lead level) and indicators of effect (erythrocyte Protoporphyrin IX, urinary delta-aminolevulinic acid (ALA-U), urinary coproporphyrins). RESULTS: The lead colic and anaemia appeared at PbB values (102 microg/dl e 104 microg/dl) that were higher than the PbB action value (40 microg/dl) and higher than the limit value (60 microg/dl). CONCLUSIONS: The gravity of the symptoms, the high number of persons potentially involved, the difficulty of reclamation and probable urban contamination, with relative consequences concerning particularly infants and women infertile age, are sufficient grounds to require effective legislative action and improvement in the services available at the hospitals involved.

The 2008 ICOH Workshop on Skin Notation.

BACKGROUND: On 29 March 2008 the International Commission on Occupational Health (ICOH) Scientific Committee on Occupational and Environmental Dermatoses organized a Skin Notation Workshop hosted by the 11th International Percutaneous Penetration Perspectives Conference (La Grande Motte, France). Skin notation (S) was chosen as a topic for discussion because this is the only example of existing regulation in the field of dermal risk assessment. The issue was discussed in a previous workshop held in Siena, Italy in 2006 with the objective of focussing on the problems related to S, the different assignment criteria and the attempts to improve the S system made by various international and governmental agencies. A position paper was subsequently published. OBJECTIVES: The workshop in France was a continuation of this activity with the aim of evaluating how the different strategies can improve S. METHODS AND DISCUSSION: The Workshop was divided into two sessions. The first was dedicated to lectures focused on different aspects of S. In the second session participants discussed key issues with the aim of exploring the actions needed to improve international S. systems.

Polycyclic Aromatic Hydrocarbons Exposure Assessment in a Refractory Brick Production.

In a refractory brick manufacturing company a qualitative and quantitative determination of the sources of occupational exposure to polycyclic aromatic hydrocarbons (PAHs) was obtained in order to validate targeted hygiene measurements. The study included the assessment of PAHs contamination of work surfaces by wipe-sampling, cutaneous exposure by hand washing, contamination of personal protective equipments (gloves) by extraction in solvent, and airborne PAHs concentration in atmospheric samples. Biomonitoring was also carried out by measurement of urinary 1-hydroxypyrene (1-OHPU) in three groups of workers (packaging, production, and controls). The surface contamination sampling was performed in production, packaging, and in other departments (external area) in theory less contaminated by PAHs. Two different areas were identified within the production, one included surfaces that were regularly cleaned (A area) and one included data from non-cleaned surfaces (B area). To confirm the source of exposure, a clear correspondence was observed between the percentage of the single compounds in the binder and those measured in wipes and air samples. As far as the wipes are concerned, the concentrations of phenanthrene, anthracene, fluoranthene, pyrene, benzo(a)pyrene (BaP), and the total PAHs mixture were higher in the B area than the A area of production. The same happened between the A area and the other two departments. According to results of the statistical analysis, these differences were significant. These results were confirmed by the hand washing data and the analysis of PPE. On the other hand, a marked difference does not exist between the packaging department and the external area. In air samples, the differences were much less evident with only higher concentrations of anthracene and total PAHs between production as a whole and the other two departments. Biological monitoring showed 1-OHPU values significantly higher in production workers than in packaging workers. In conclusion, the analysis of the wipes demonstrated that the production B area has a higher surface contamination compared to the production A area and the packaging department. In the absence of a significant difference in air concentrations of PAHs between A and B areas, this is attributable to surfaces not subject to cleaning. Results confirm that the measurement of surface contamination represents a valid tool for the assessment of sources of exposure to PAHs in the workplace.

[Working hypothesis of simplified techniques for the first mapping of occupational hazards in handicrafts. Part two: physical and chemical risks]. / Ipotesi di tecniche semplificate per la prima mappatura dei rischi professionali nel settore artigiano. Seconda parte: rischi fisici e chimici.

Craft features a strong link with tradition which preserves and perpetuates techniques created and consolidated over time, in a particular historical, cultural and geographical situation. Italy is home to excellent craftsmanship: fashion, furniture, giftware, design. The framework law for the craft n. 433/1985 defines the craft business carried on by the craftsman for a predominant objective of producing goods, including semi-finished or services. The D.L.gs 81/2008 defines the manner in which the employer must conduct risk assessment in the workplace and process the risk assessment document. The aim of the study is to provide employers with a simple methodology that allows the drafting of the first mapping of hazards/dangers identificating risk sources in the working process. The developed methodology is expressed as a model of information gathering, which brings to a first overview of all major risk indicators that may arise in the craftsmanship.

Advanced glycation end products and sorbitol in blood from differently compensated diabetic dogs.

Canine diabetes mellitus (DM) is a common metabolic disorder with long term complications, most of which are caused by glycosylation of structural proteins, decreases in antioxidant concentrations, altered osmotic balance and hypoxia due to impaired oxygen transport. Previous studies have demonstrated that under hyperglycemic conditions canine erythrocytes undergo swelling, probably due to activation of the polyol pathway. The present work aimed to assess the plasma concentration of advanced glycation end (AGE) products, stable Amadori-products generated by non-enzymatic glycosylation of proteins and the intracellular concentration of sorbitol, produced by the activation of polyol pathway in 34 blood samples from diabetic dogs and in 14 controls. AGE products were significantly higher (p<0.01) in plasma from diabetic dogs compared with control animals. The sorbitol concentration in erythrocytes was also significantly higher in diabetic dogs and, in particular, in poorly compensated animals and in dogs with ketonuria. In five cases that were analysed before and after clinical improvement, sorbitol concentration was found to correlate with improvement. These results suggest that non-specific glycosylation is increased and that the polyol pathway is activated in diabetic dogs in a manner that is proportionate to the severity of disease. Moreover, the concentration of AGE products and sorbitol may be useful for monitoring the onset of diabetic complications and assessing the most appropriate therapeutic approaches for management of canine DM.

[Medical and risk records]. / La cartella sanitaria e di rischio.

Aim of this report is to outline the importance of personal medical records collected from the occupational health surveillance practice. The Italian law D.Lgs. 81/08 puts a great emphasis on a national information system built up by health monitoring results in workplace as far as individual and general prevention is concerned. Private and public roles and duties are discussed.

[The occupational and active research, diagnosis and reporting of occupational diseases]. / Il Medico Competente e la ricerca attiva, diagnosi e denuncia delle malattie professionali.

The Occupational Doctor plays a key role on the protection of workers safety and prevention of occupational and work-related disease. His training and his need of updating, due to the constant transformation of work, the evolution of technology and the medical progress, set him in the center of all activities carried out to protect health in workplaces. The Occupational Doctor should devote special attention to the working anamnesis as well as to the pathological anamnesis both close and remote. He should also pay attention to semeiotics. Another important element is the relationship between the Occupational Doctor and the Doctor of General Medicine (MMG); this synergy is of vital importance in protecting health and in investigating diseases whether occupational or not. D.Lgs. 81/08 emphasizes this synergy, in fact name and phone number of Doctor of General Medicine is compulsory in Case History. Major source of information for all form of prevention is the survey of occupational disease which is a tool for epidemiological control. The use of a systematic collection of data, of protocols, of guidelines and of scientific evidence is the basis for identifying occupational diseases, their diagnosis and subsequent denunciations. This is the line suggested in MAL PROF informative system, made for registration of work-related diseases, and which is important, with other instruments, in realizing an integrated informative system for prevention in workplace. The Covenant for the Protection of Health and Prevention in Workplaces (DPCM 17/12/2007) indicates the strategic objectives of the National Health System for the consolidation and development of the existing system and of the programs promoting health and safety. These include the growth of the culture of prevention and of the epidemiological control of occupational diseases. The Occupational Doctor has an important role because he can identify the early onset of diseases during the working age and start all forms of prevention and health promotion. In the case of diagnosis of a suspected professional disease the Occupational Doctor has three distinct obligations. The first is to report to the legal authority (C.P.P. art. 365). The second requirement is the declaration of the occupational disease (D.P.R. 1124/65 art. 139) and the third is to issue the first certificate of occupational disease for compensation insurance (D.P.R. 1124/65 artt. 53, 251).