Should Posterior Reversible Encephalopathy Syndrome Be Mainly Considered an Epileptic Disorder? Results of a Sequential Neurophysiological Study in a Pediatric Cohort.

Despite a wide number of studies trying to define clinical, physiopathological, and neuroradiological features of posterior reversible encephalopathy syndrome (PRES), the true nature of symptoms is still not fully understood. We studied a standard cohort of 24 pediatric patients, affected by hemato-oncological diseases, with a neuroradiological diagnosis consistent with PRES identified from 2006 to 2013. Ten of them developed PRES after hematopoietic stem cell transplantation. We analyzed the sequence of clinical, radiological, and electrophysiological data. In all the patients who were recorded at the onset of the first symptoms, electroencephalograms showed focal nonconvulsive seizures or status epilepticus (SE). We found a sensitivity of 100% for electroencephalogram (EEG) with a good correlation between clinical signs and the localization of seizures, whereas computed tomography scans showed a sensitivity of 50% only. Following prompt treatment, intensive care unit admission rate was only 8%. PRES is a multifactorial neurologic event with focal nonconvulsive seizures or SE as the main feature in pediatric patients. Clinical manifestations are epileptic in nature, and prompt EEG recording is useful for diagnosis and supports an earlier treatment, potentially preventing the appearance of complications such as generalized seizures or refractory SE.

Outdoor work and solar radiation exposure: Evaluation method for epidemiological studies.

BACKGROUND: The health risk related to an excessive exposure to solar radiation (SR) is well known. The Sun represents the main exposure source for all the frequency bands of optical radiation, that is the part of the electromagnetic spectrum ranging between 100 nm and 1 mm, including infrared (IR), ultraviolet (UV) and visible radiation. According to recent studies, outdoor workers have a relevant exposure to SR but few studies available in scientific literature have attempted to retrace a detailed history of individual exposure. MATERIAL AND METHODS: We propose a new method for the evaluation of SR cumulative exposure both during work and leisure time, integrating subjective and objective data. The former is collected by means of an interviewer administrated questionnaire. The latter is available through the Internet databases for many geographical regions and through individual exposure measurements. The data is integrated into a mathematical algorithm, in order to obtain an esteem of the individual total amount of SR the subjects have been exposed to during their lives. RESULTS: The questionnaire has been tested for 58 voluntary subjects. Environmental exposure data through online databases has been collected for 3 different places in Italy in 2012. Individual exposure by electronic UV dosimeter has been measured in 6 fishermen. A mathematical algorithm integrating subjective and objective data has been elaborated. CONCLUSIONS: The method proposed may be used in epidemiological studies to evaluate specific correlations with biological effects of SR and to weigh the role of the personal and environmental factors that may increase or reduce SR exposure. Med Pr 2016;67(5):577-587.

Life styles, anxiety, expertise: the perception of risk from electromagnetic fields.

INTRODUCTION: This study analyzed the effect of expertise, by comparing the opinions of groups of "experts" and "non-experts" on the so-called "classic" risks and on the risks from exposure to electromagnetic fields. METHODS: A protocol comprising personal history questionnaires, including lifestyle details, STAI-Y, and two rating scales based on the "psychometric paradigm" was administered to 48 people, 22 experts on these risks and 26 non-experts. The findings were analyzed by one-way analysis of variance, exploratory factor, correlational and bivariate regression analysis. RESULTS: Significant differences emerged between the perceptions of the two groups, though the underlying qualitative dimensions were similar. Bivariate regression analysis showed that both state and trait anxiety exert a statistically significant effect on some risks, both classic and related to electromagnetic fields exposure. CONCLUSIONS: This study displayed the role of expertise in risk perception processes, giving indications on the relationships between anxiety and risk perception. On the basis of the available data it is concluded that people prone to anxiety and individual emotional states filter the perception of risk arising from activities, technologies, substances etc. included in the present study.

Issues in the Implementation of Directive 2013/35/EU Regarding the Protection of Workers against Electromagnetic Fields.

In 2016 the Directive 2013/35/EU regarding the protection of health and safety of workers exposed to electromagnetic fields was transposed in Italy. Since then, the authors of this paper have been faced with several issues related to the implementation of the provisions of the Directive, which pose some interpretative and operative concerns. A primary critical feature of the Directive is that, in some circumstances, conditions of "overexposure", i.e., of exceeding the exposure limits, are allowed. In the case of transient effects, the "flexibility" concerning the compliance with exposure limits is based on the approach introduced by ICNIRP in its guidelines on static magnetic fields and on time-varying electric and magnetic fields. On the contrary, the possibility of exceeding the exposure limits for health effects, formally recognized in the article of the Directive dealing with derogations, is not included in the ICNIRP guidelines. This paper analyzes the main concerns in interpreting and managing some provisions of the Directive with particular reference to the issue of how the employer can manage the situations of overexposure.

Balance between Health Risks and Benefits for Outdoor Workers Exposed to Solar Radiation: An Overview on the Role of Near Infrared Radiation Alone and in Combination with Other Solar Spectral Bands.

Near infrared or infrared A (IRA) accounts for over 40% of the solar spectrum (SS) and is able to reach subcutaneous tissue as well as the retina. Outdoor workers are occupationally exposed to solar radiation (SR), but the level of exposure may differ widely depending on the job performed, time spent outdoors, latitude, altitude, season, personal protection, etc. Until now, risk assessment and management for outdoor workers has focused on the prevention of both acute and long-term effects on the eye and the skin due to solar ultraviolet radiation (UVR) with little consideration of the other components of the SS (a possible exception is represented by visible radiation with reference to the eye). A growing body of evidence coming from in vitro studies indicates that IRA is involved in cellular reactive oxygen species (ROS) production and may interfere with the respiratory chain in the mitochondria. Moreover, it can modulate gene expression and some metabolic pathways. The biological action of IRA is only partly attributable to a thermal mechanism, should it be also involved in photochemical ones. The cellular and molecular pathways affected by IRA are partly similar and partly different with respect to those involved in the case of visible ultraviolet A (UVA) and ultraviolet B (UVB) radiation. Consequently, the net effect of the SS is very difficult to predict at different levels of the biological organization, making more difficult the final balance of health risk and benefits (for the skin, eye, immune system, blood pressure, etc.) in a given exposure situation. Moreover, few in vivo studies and no epidemiological data are presently available in this regard. Investigating this topic may contribute to better defining the individual exposome. More practically, it is expected to bring benefits to the risk assessment and management for outdoor workers exposed to SS, contributing to: (1) better definition of the individual profiles of susceptibility, (2) more focused preventive and protective measures, (3) better implementation of the health surveillance and (4) a more effective information and training.

Occupational Exposure to Solar UV Radiation of a Group of Fishermen Working in the Italian North Adriatic Sea.

Occupational solar radiation exposure is a relevant heath risk in the fishing sector. Our aim was to provide a detailed evaluation of individual UV exposure in three different fishing activities in Italy, with personal UV dosimeters and a simple formula to calculate the fraction of ambient erythemal UV dose received by the workers. The potential individual UV exposure of the fishermen was between 65 and 542 Joules/m2. The percentages of the ambient exposure were estimated between 2.5% and 65.3%. Workers' UV exposure was mainly influenced by the characteristics of the work activity, the postures adopted, and the type of boats. Overall, our data showed that 43% of the daily measurements could result largely above the occupational limits of 1-1.3 standard erythemal dose (i.e., 100 Joules/m2) per day, in case of exposure of uncovered skin areas. Measurements of individual UV exposure are important not only to assess the risk but also to increase workers' perception and stimulate the adoption of preventive measures to reduce solar UV risk. Furthermore, the simple method proposed, linking ambient erythemal UV dose to the workers' exposure, can be a promising tool for a reliable assessment of the UV risk, as time series of environmental UV dose are widely available.

Encephalopathy syndrome in children with hemato-oncological disorders is not always posterior and reversible.

BACKGROUND: Posterior reversible leukoencephalopathy (PRES) is a clinical-radiological event that can affect children undergoing chemotherapy regimen. Studies have shown that it is not always reversible, in spite of its original definition. We analyzed PRES cases which occurred during the last 10 years at our institute to focus on their clinical, radiological and EEG follow-up. PROCEDURES: We analyzed 12 cases of PRES in children who underwent intensive chemotherapy regimens, detailing the acute neurological presentation of the syndrome, their neuro-imaging characteristics (MRI) and EEG findings, in both an acute phase and during follow-up. RESULTS: All patients survived the acute event, showing a clinical recovery of the acute neurological signs in 1-3 days and normalization of the EEG pattern in a period ranging from 1 to 8 months. During long term follow-up, four patients developed either clinical impairment or EEG-MRI anomalies. CONCLUSIONS: We suggest that a long term follow-up is necessary to determine the reversibility of the neurological events. Clinical observation, as well as EEG and MRI should be included in follow-up evaluations.

Impact of climate change on occupational exposure to solar radiation.

Occupational exposure to solar radiation may induce both acute and long-term effects on skin and eyes. Personal exposure is very difficult to assess accurately, as it depends on environmental, organisational and individual factors. The ongoing climate change interacting with stratospheric ozone dynamics may affect occupational exposure to solar radiation. In addition, tropospheric levels of environmental pollutants interacting with solar radiation may be altered by climate dynamics, so introducing another variable affecting the overall exposure to solar radiation. Given the uncertainties regarding the direction of changes in exposure to solar radiation due to climate change, compliance of outdoor workers with protective measures and a proper health surveillance are crucial. At the same time, education and training, along with the promotion of healthier lifestyles, are of paramount importance.

Climate change and safety at work with ionizing radiations.

The accident at Tokyo Electric Power Company's (TEPCO's) Fukushima Daiichi nuclear power plant (NPP) has been one of the dominant topic in nuclear safety and it has brought new attention on the matter of accidents in NPPs due to external events related to natural causes. Climate change has risen new risks and the growing probability of extreme external events has increased exposure and vulnerability of workers in the nuclear sector. However extreme natural events are a threat not only to NPPs but to all facilities dealing with radioactive material and in an emergency scenario they can affect the effectiveness and implementation of safety devices and procedures and also prevent communications, causing delays in the readiness of response. It is clear that adaptation strategies are necessary to cope with emerging changes in climate and a new nuclear safety culture is growing, that addresses accidents initiated not only by internal but also by external events.

National Institute for Occupational Safety and Prevention (ISPESL): role in occupational health and safety.

The article explains the role of the Italian National Institute for Occupational Safety and Prevention (ISPESL), a public research body dealing with occupational and environmental health. Its organization, institutional roles, activities, facilities, and resources are outlined. Especially important is ISPESL's participation in national and international occupational safety and health networks. The Institute is active in epidemiologic surveillance of workers exposed to physical, chemical, and biological hazards.