Prevention of silica health effects in Italy: current challenges for the Occupational Health and Safety Unit of the Italian National Health Service.

BACKGROUND: Since its foundation in 2002, the Italian Silica Network (NIS), a collaborative network of professionals and public authorities, has been engaged in several aspects of research, control, and prevention of silica exposure and effects, and also in support for compensation claims for silica-related occupational health effects in Italy. METHODS: We start with a report on the NIS point of view concerning the recent scientific results (from epidemiology and laboratory studies), including those carried out by NIS in cooperation with Italian universities and other public agencies. This is followed by a description of the data on silica exposure in different Italian workplaces and guidelines for the management of occupational exposure to silica, as developed by two model regional programmes for the ceramics industry, metal foundries and tunnel excavation. RESULTS: The NIS initiatives highlighted the persistence of workplace conditions posing a significant risk for silica-related health effects, particularly in small industries and workshops. Experimental work has also shown that a number of physical and chemical factors affect the bioreactivity of silica particles. CONCLUSION: Based on NIS experience, it appears clear that currently conditions exist in Italy so as to positively contribute to the WHO Programme for the eradication of silicosis and the other diseases related to silica exposure. In order to achieve this goal, a coordinated and wide-ranging effort is required to reduce the wide gap in specific prevention activities, particularly in small industries and workshops, where high levels of silica exposure sometimes occur.

[The document of chemical risk assessment: experiences in small companies]. / Il documento di valutazione del rischio chimico: esperienze nelle piccole imprese.

Were examined 60 documents of chemical risk assessment of companies from 19 municipalities in the provinces of Siena and Grosseto. The review of evaluations was conducted initially by checking the internal coherence of the documents. What emerged was subsequently analyzed together with the staff who performed the inspection. Although in 12 companies has been declared the presence of carcinogens, in only 5 the evaluation of exposure have been done using measures, others have used models or other techniques. Overall assessment showed that only 8 out of 60 (13.3%) were wrote correctly.

[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.

Reference values of urinary trans,trans-muconic acid: Italian Multicentric Study.

This article reports the results of a study, conducted in the framework of the scientific activities of the Italian Society for Reference Values, aimed at defining reference values of urinary trans,trans-muconic acid (t,t-MA) in the general population not occupationally exposed to benzene. t,t-MA concentrations detected in 376 subjects of the resident population in three areas of Italy, two in central (Florence and southern Tuscany) and one in northern Italy (Padua), by three laboratories, compared by repeated interlaboratory controls, showed an interval of 14.4-225.0 microg/L (5th-95th percentile) and a geometric mean of 52.5 microg/L. The concentrations measured were influenced by tobacco smoking in a statistically significant way: Geometric mean concentrations were 44.8 microg/L and 76.1 microg/Ll in nonsmokers (264 subjects) and smokers (112 subjects), respectively. In the nonsmoking population, a significant influence of gender was found when concentrations were corrected for urinary creatinine, geometric mean concentrations being 36.7 microg/g creatinine in males (128 subjects) and 44.7 microg/g creatinine in females (136 subjects). The place of residence of subjects did not seem to influence urinary excretion of the metabolite, although personal inhalation exposure to benzene over a 24-h period showed slightly higher concentrations in Padua and Florence (geometric means of 6.5 microg/m(3) and 6.6 microg/m(3), respectively) than in southern Tuscany (geometric mean of 3.9 microg/m(3)). Concentration of t,t-MA in urine samples collected at the end of personal air sampling showed little relationship to personal inhalation exposure to benzene, confirming the importance of other factors in determining excretion of t,t-MA when concentrations in personal air samples are very low.

Determining exhaust fumes exposure in chainsaw operations.

The objective of this study was to investigate the inhalation exposure of forest operators to polycyclic aromatic hydrocarbons (PAHs) and BTEX (benzene, toluene, ethylbenzene and total xylenes) contained in the exhaust fumes released from chainsaws and to suggest possible countermeasures. The study was carried out in four silvicultural treatments (coppice clearcut, conifer thinning, conifer pruning, and sanitary cut), using three types of chainsaw fuel (normal two-stroke petrol mix and two alkylate fuels). Eighty personal air samples were collected; IOM samplers combined with Amberlite XAD-2 sorbent tubes were used for collecting PAHs and Radiello® samplers were used for BTEX. Results indicate that none of the four silvicultural treatments significantly affected the PAHs and BTEX inhalation exposure of forest workers. On the other hand, statistically significant differences were recorded in the inhalation exposure to PAHs and BTEX when using different fuel types. In particular, the inhalation exposure to PAHs and BTEX was generally one order of magnitude lower when using modern alkylate fuels as compared to the traditional oil and lead-free petrol mixture. The small, non-statistically significant differences in inhalation exposure recorded between the two alkylate fuels suggests that the two fuels might be equivalent in terms of quality. Our study indicates that while forest workers are exposed to PAHs and BTEX, the maximum values are generally well below accepted occupational exposure limits.

Environmental and biological monitoring of exposure to mancozeb, ethylenethiourea, and dimethoate during industrial formulation.

The results of environmental (11 subjects) and biological (57 subjects) monitoring of exposure to mancozeb, ethylenethiourea (ETU), and dimethoate are reported for employees of a firm producing commercial formulations containing these active ingredients. Urinary excretion [GM(GSD)] of ETU (microg/g creatinine) and alkylphosphates [dimethylphosphate (DMP) + dimethylthiophosphate (DMTP) + dimethyldithiophosphate (DMDTP)] (nmol/g creatinine) was 65.3(4.8) and 419.2(2.1), respectively, for employees engaged in the formulation of a product containing 80% mancozeb (n = 9), 36.6(1.9) and 296.4(2.4) for those formulating a product containing 35% mancozeb (n = 9), 9.5(6.1) and 1022.4(3.0) for those engaged in plant maintenance and internal transport of materials (n = 6), 10.3(4.2) and 322.8(3.3) for those engaged in packaging the mancozeb formulations (n = 16), 4.4(3.3) and 2545.4(3.9) for those formulating a product containing 40% dimethoate (n = 11), and 3.0(2.7) and 871.7(3.3) for those bottling the same dimethoate formulation (n = 10). Air concentrations (microg/m3) ranged from 25.3 to 194.4 for dimethoate, from 0.2 to 1.3 for ETU, and from 139.9 to 949.0 for mancozeb. Urinary excretion of ETU and alkylphosphates showed a significant correlation with mancozeb (r2 = .971), and ETU (r2 = .858), and dimethoate (r2 = .955) contamination of the hands. Potential dose estimates showed that the potential respiratory doses of mancozeb and dimethoate accounted, on the average, for 38% of the total potential dose. The potential respiratory dose of ETU was 7% of the total potential dose. Total estimated absorption did not exceed the accepted daily dose (ADI) for ETU and mancozeb, but the ADI for dimethoate was exceeded. Serum and erythrocyte cholinesterase activities in workers formulating dimethoate products were not significantly different before and after exposure.

Right occipital cerebral abscess caused by Aspergillus fumigatus.

A rare case of intracerebral abscess caused by aspergillus fumigatus located in the right occipital region is described; pathogenesis, prognosis and treatment of this particular infection are discussed.

Urinary excretion of alkylphosphates in the general population (Italy).

Xenobiotic residues and their metabolites in biological fluids of the general population are an important indicator of exposure to toxic substances dispersed in the environment. Urine samples collected from 124 subjects living in SW Tuscany, Italy were analyzed for alkylphosphates (dimethylphosphate, dimethylthiophosphate, dimethyldithiophosphate, diethylphosphate, diethylthiophosphate, diethyldithiophosphate), aspecific metabolites of organophosphorus insecticides. The compound most frequently found was dimethylthiophosphate which was detectable in 99% of the subjects analyzed, with a geometric mean of 70.7 nmol/g creatinine. The other substances were found in the following percentages of our population, at the following mean concentrations: dimethylphosphate, 87%, 62.8 nmol/g creat.; dimethyldithiophosphate, 48%, 21.1 nmol/g creat.; diethylphosphate, 81%, 27.4 nmol/g creat.; diethylthiophosphate, 73%, 22.8 nmol/g creat.; diethyldithiophosphate, 7%, 13.7 nmol/g creatinine. Subjects eating food (fruit, meat, vegetables) that was not their own produce showed higher urinary concentrations of nearly all the compounds. The other variables considered (sex, age, residence, alcohol, smoking, sampling period) seem to affect the percentages of positive values of the various substances but to different degrees. Age and source of foods were the most important variables for dimethylthiophosphate excretion when mean values were analyzed by Student's t-test and analysis of variance (ANOVA).

Assessment of reference values for mercury in urine: the results of an Italian polycentric study.

The results of a polycentric study to assess the reference values of urinary mercury (U-Hg) in four Italian cities are presented. A total of 383 subjects were selected on the basis of standardised criteria by a questionnaire on personal habits, lifestyle, occupational or non-occupational exposure to Hg, medical history, number and area of dental amalgams. U-Hg was determined by hydride generation atomic absorption method (HG-AAS), with a detection limit of 0.5 microg/l and by flow injection (FI) inductively coupled plasma mass spectrometry (ICP-MS), with a detection limit of 0.03 microg/l. The median value of U-Hg, determined by HG-AAS, was 0.78 microg/g creatinine (0.75 for males and 0.83 for females), with 5 degrees and 95 degrees percentiles, respectively, of 0.17 and 3.66 microg/g creatinine. When determined by FI ICP-MS, the median value was 0.79 microg/g creatinine (0.77 for males and 0.79 for females) with 5 degrees and 95 degrees percentiles of, respectively, 0.12 and 5.02 microg/g creatinine. Among the independent variables, city of origin, area of dental amalgams, fish intake and tobacco smoking significantly influenced the U-Hg levels. The U-Hg reference values from this survey are lower than those from other recent investigations, probably due to characteristics and selection of the examined individuals and to the strict control of pre-analytical and analytical factors of variability.

Urinary 1-hydroxypyrene as a marker of exposure to pyrene: an epidemiological survey on a general population group.

Urinary levels of 1-hydroxypyrene in a general adult population group are studied. Experimental data are not normally distributed; statistical analysis required a base 10 logarithmic transformation of data. The concentrations of urinary 1-hydroxypyrene measured were expressed as microgram g-1 urinary creatinine and are comparable with those reported by other authors, both for smoker and non-smoker subgroups. Multiple regression analysis shows that, for smokers, the number of cigarettes smoked per day and the body mass index (BMI) significantly influence the levels of urinary 1-hydroxypyrene expressed as microgram g-1 urinary creatinine, whereas no personal or behavioural variable (age, sex, alcohol consumption, dietary intake of pyrene, BMI) modified the 1-hydroxypyrene levels for non-smokers.

Urinary excretion of ethylenethiourea in five volunteers on a controlled diet (multicentric study).

Urinary excretion of ethylenethiourea (ETU) was monitored for 8 days in a group of five male non-smoker volunteers on a diet, the items of which were assayed for ETU and carbon sulphide. Urinary excretion of ETU reflected the consumption of wine, fruit and vegetables. Urinary ETU concentrations ranged from 0.6 to 6.7 micrograms/g creatinine. ETU concentrations in the food eaten by the volunteers were generally below the detection limit whereas in wine 8.8 micrograms/l ETU was detected. Evolution of carbon sulphide by food samples ranged from 0.03 to 0.17 mg/kg. Mean (+/- S.D.) daily intake of ETU in wine was 3.5 +/- 0.2% of the acceptable daily intake (ADI): 0.070 +/- 0.004 micrograms/kg body wt. During the 8 days of the study, an average of 48.3% of the ETU ingested in wine was excreted unmodified by the kidneys. Twenty-four hour urinary excretion of ETU was significantly correlated with daily intake of ETU (r = 0.768) and CS2 evolved by the daily food items (r = 0.414).

Reference values of urinary ethylenethiourea in four regions of Italy (multicentric study).

The results of a study in which urinary ethylenethiourea (ETU) was assayed in the general population (167 subjects) of four Regions of Italy (Veneto, Lombardy, Piedmont and Trentino Alto Adige) are reported. The results are compared with those in a population of 97 subjects from Rovescala, a hillside wine-producing town a few kilometers from Pavia, where ethylenebisdithiocarbamates are sprayed by helicopter. It was found that an average of 24% of the populations of the four regions, taken together, had urinary ETU levels above detection limits (1.0 microgram 1(-1)) as compared to 37% of the population of Rovescala. The ranges of concentration were 0.8-8.3 micrograms 1(-1) for the four regions and 0.9-61.4 micrograms 1(-1) for Rovescala. Statistically significant variables for urinary ETU levels were smoking and wine drinking.

Environmental and urinary reference values as markers of exposure to hydrocarbons in urban areas.

A study using individual dosimetry to evaluate the daily inhaled dose of sixteen aromatic and aliphatic hydrocarbons in three groups of primary school children, living in three Italian towns with 50,000 inhabitants or less, (Treviglio-Lombardy; Poggibonsi-Tuscany; Valenza-Piedmont) is presented. The simultaneous use of two passive samplers (radial diffusion) for each child, for a 24 h period, determined both the indoor and indoor + outdoor environmental reference concentrations. We measured the urinary levels of benzene, toluene, ethylbenzene and xylenes for each child and hence determined the urinary reference values for BTEX. We also considered the possibility of using benzene in urine as a biomarker of environmental exposure of the general population to this xenobiotic. We evaluated how both the environmental and biological measures were influenced by the presence of smokers in the surveyed children's houses. For the group of children living in Poggibonsi, we considered the influence of the living area and the traffic density on environmental concentrations of benzene (indoor and indoor + outdoor).

Analytical methods for the determination of urinary 2,4-dichlorophenoxyacetic acid and 2-methyl-4-chlorophenoxyacetic acid in occupationally exposed subjects and in the general population.

Two methods for the quantitative analysis of 2,4-dichlorophenoxyacetic acid (2,4-D) and 2-methyl-4-chlorophenoxyacetic acid (MCPA) in urine were compared. The first was an high-performance liquid chromatography method using a C8 column with ion suppression and diode array detection. The urine extracts were first purified by solid-phase extraction (SPE) on silica capillary columns. The detection limit of the method was 15 micrograms/L for both compounds. The percentage coefficient of variation of the whole analysis evaluated at a concentration of 125.0 micrograms/L was 6.2% for 2,4-D and 6.8% for MCPA. The mean recovery of analysis was 81% for 2,4-D and 85% for MCPA. The second was a gas chromatographic (GC) method in which the compounds were first derivatized with pentafluorobenzylbromide to pentafluorobenzyl esters, which were determined with a slightly polar capillary column and electron capture detection. Before GC analysis, the urine extracts were purified by SPE on silica capillary columns. This method had a detection limit of 1 microgram/L for both compounds and a percentage coefficient of variation of the whole analysis, evaluated at a concentration of 30.0 micrograms/L, of 8% for 2,4-D, and of 5.5% for MCPA. the mean recovery was 87% for 2,4-D and 94% for MCPA. The low detection limit made the second method suitable for assaying the two herbicides in the general population. Duplicate analysis of ten urine samples from occupationally exposed subjects by the two methods gave identical results for a wide range of concentrations.

Analytical method for the determination of urinary alkylphosphates in subjects occupationally exposed to organophosphorus pesticides and in the general population.

The determination of urinary alkylphosphates monitors occupational exposure to organophosphorus pesticides and insecticides. This paper describes a method for the quantitative determination of the following metabolites: O,O-dimethylphosphate (DMP), O,O-diethylphosphate (DEP), O,O-diethyldithiophosphate (DETP), O,O-dimethyldithiophosphate (DMDTP), O,O-diethyldithiophosphate (DEDTP), and O,O-dimethylthiophosphate (DMTP). The compounds are derivatized with pentafluorobenzylbromide into pentafluorobenzyl esters which are determined by gas chromatography with a capillary column of intermediate polarity and a flame photometric detector specific for phosphorus. Before the analytical gas chromatographic stage, the urinary extracts are purified on isolute SPE CN columns. The proposed method has a limit of detection of 2-3 micrograms/L at 62.5 micrograms/L and a mean recovery of the purification stage of 85.8-101.0% for all six compounds. The coefficient of variation of the analytical procedure was 7.9-11.9% for the six compounds. The low detection limits make this method suitable also for determining the six metabolites in the general population.

Reference values of urinary 3,5,6-trichloro-2-pyridinol in the Italian population--validation of analytical method and preliminary results (multicentric study).

The interlaboratory validation of analytical procedures for the assay of urinary 3,5,6-trichloro-2-pyridinol (TCP) in the general Italian population is reported. The determinations were performed by high-resolution gas chromatography (HRGS) with electron capture detection and HRGS with mass spectrometry (MS) in 2 laboratories. The urine samples were from 42 participants from 3 regions of Italy. The results were evaluated by interlaboratory quality control. Urinary TCP concentrations were above the detection limit (1.2 micrograms/L) in 88% of the population, with a mean detectable concentration [GM (GSD)] of 2.8 (1.9) micrograms/g creatinine (creat). (GM, geometric mean; GSD, geometric standard deviation.) The Mann-Whitney U test showed that wine consumption was a statistically significant variable (p < 0.05) for urinary concentrations of TCP. Analysis of variance of the logarithm of urinary TCP versus wine consumption and diet showed a statistically significant fit. The model used explained 30% of the total variance: wine consumption and diet accounted for 37 and 17% respectively of the explained variance.

[Blood zinc levels in patients with dermatologic and neurologic disorders]. / Valori di zinchemia in pazienti dermatologici e neurologici.

Plasma zinc levels in patients of both sexes suffering from an heterogeneous group of dermopathies were examined and compared with those in patients suffering from psychiatric-neurologic pathologies, in which recent literature has also suggested the role of low zinc levels. The results of the study show a prevalence of effective zinc deficiency in 9.2% of dermatologic patients and 3.9% of neurologic patients, as well as low plasma zinc levels with a different mean, mode and s.d. in comparison to other patients in the control group. These results were statistically significant. The findings are discussed and compared with those reported in the literature.

[Biologic monitoring of occupational and non-occupational exposure to pesticides]. / Il monitoraggio biologico dell'esposizione professionale e non ad antiparassitari.

Occupationally or otherwise, much of the population is exposed to pesticides. To obtain information on exposure levels, biological monitoring is often the best choice because it provides data that reflects total exposure by all routes. Biological monitoring has been used to evaluate exposure in agricultural and industrial environments, in subjects poisoned by accidental or voluntary contact, in volunteers for pharmacokinetic studies and in the general population. This paper is based on 100 studies published on this topic and reviews exposure indices for the main classes of pesticides. Methods of sampling and conservation of samples are outlined, together with the analytical procedures used. For compounds such as organophosphate and pyrethroid insecticides, ethylenebisdithiocarbamate fungicides, and phenoxyacetic herbicides, the results of studies on the general population and groups of occupationally exposed workers are reported.

[The risk of lead and health conditions of exposed workers in the Siena region]. / Il rischio da piombo e le condizioni di salute dei lavoratori esposti nel territorio senese.

A number of studies on the health of occupational exposure to lead of workers from various industrial sectors are summarized. These studies document the disappearance of severe cases of saturnism, as seen in the past, and the occurrence nowadays, mainly of sub-clinical manifestations, such as alterations of blood levels of lead and protoporphyrin IX, in the large majority of cases. For the period 1984-95, a statistical analysis of the results obtained for these parameters is reported, together with other clinical data, for seven industrial sectors: crystal, ceramics, chemistry, metallurgy and mechanics, iron and steel, printing and painting. These results show a drop of the mean concentrations of blood lead levels in all sectors but the ceramic industry, especially since 1991, when the law, Decreto Legislativo 277/91--in accomplishment of European directives on protection of workers, including the directive 82/605/EEC--has been put into force.

[Environmental and biological reference values of aromatic polycyclic hydrocarbons]. / Valori di riferimento ambientali e biologici degli idrocarburi policiclici aromatici.

Minimum requirements for the production of reference values are listed, namely: data of a sufficient number of monitored subjects, individual dosimetric measurements for at least 24 h, answers to an appropriate questionnaire, repetition of measurements at different times of year, and use of an analytical method with known reproducibility and detection limits, the accuracy of which has been established using certified materials or at least interlaboratory calibrations. The few studies reporting individual dosimetric measurements for airborne polycyclic aromatic hydrocarbons are reviewed. Only one of these studies (Minoia et al. 1997), conducted in Pavia with 28 male and 28 female subjects, meets all the requirements for definition of environmental reference values. It found mean benzo(a)pyrene values of 0.37 ng/m3 in winter and 0.12 ng/m3 in summer. Various papers on urinary 1-hydroxypyrene are then discussed and it is found impossible to propose a single biological reference value for populations of different nations, due to differences in environmental conditions and diet. A review of the literature produced in Italy suggests adoption of the biological reference value suggested by Roggi et al. (1996), namely 0.172 microgram/g creat. for non smokers (125 subjects from three Italian towns). Perusal of the literature for other biological indicators of exposure to PAHs, such as 1-naphthol and hydroxyphenanthrenes, suggests that insufficient data is available to establish any reference values.