Non-malignant occupational respiratory diseases and climate change.

BACKGROUND: Respiratory diseases of infectious, allergic, neoplastic or degenerative origin are due to the interaction of environmental and occupational risk factors, individual susceptibility and other co-factors and comorbidities. Asthma and other respiratory pathologies can be worsened by climate change and exposure to other agents in occupational environments.METHODS: PubMed and Scopus, and several websites on public and occupational health were queried to find publications and documents on work-related respiratory diseases, asthma, rhinitis, chronic obstructive pulmonary disease (COPD), pneumoconiosis and allergic alveolitis in association with climate change.RESULTS: Most of the retrieved articles concerned asthma (75 in Scopus), while the other topics were less frequently covered in the scientific literature, with a maximum of 29 papers for rhinitis and 23 for COPD. The most important terms highlighted by the word clouds were 'health', 'air', 'pollution', and, only for asthma and rhinitis, 'pollen' and 'allergic/allergy'. Website data on public and occupational health, and climate change were reported.CONCLUSIONS: Assessment and management of respiratory diseases that recognise occupational exposures should be improved, and more research into integrated approaches should be favoured. Health surveillance practices for workers exposed to agents that cause respiratory diseases should be implemented. The development of biomarkers of exposure, effect and susceptibility needs further study.

Risk assessment of aggression toward emergency health care workers.

BACKGROUND: Health care and social service workers face a significant risk of job-related violence. AIMS: To develop a method for quantitative evaluation of the risk of violence, as required by Italian and European regulations, against extra-hospital emergency health care workers employed by the Regional Emergency Healthcare Service (ARES 118) in the Lazio Region in Italy. METHODS: Violence to the ARES 118 workers during working hours was examined by analysing injuries reported by them between 2005 and 2007. The assessment method proposed should give a numerical indicator of the risk of violence for each homogeneous group. The quantitative risk was evaluated on the basis of variables such as the days off work for each episode, the total number of aggressive attacks, the type of health intervention involved, etc. RESULTS: The rate of accidents related to aggression during working hours at the ARES unit was 6.3%, which is significantly higher than the figure of 2% reported for the entire health care sector. CONCLUSIONS: The present evaluation is largely based on analysis of the Injury Register. To increase the sensitivity of the method so that it closely reflects active reporting of events, it would be necessary to implement a procedure for reporting events in a 'company register of acts of violence' and to make workers more aware of the need to report all such episodes.

Impact of heat on mortality in 15 European cities: attributable deaths under different weather scenarios.

BACKGROUND: High ambient summer temperatures have been shown to influence daily mortality in cities across Europe. Quantification of the population mortality burden attributable to heat is crucial to the development of adaptive approaches. The impact of summer heat on mortality for 15 European cities during the 1990s was evaluated, under hypothetical temperature scenarios warmer and cooler than the mean and under future scenarios derived from the Intergovernmental Panel on Climate Change Special Report on Emission Scenarios (SRES). METHODS: A Monte Carlo approach was used to estimate the number of deaths attributable to heat for each city. These estimates rely on the results of a Bayesian random-effects meta-analysis that combines city-specific heat-mortality functions. RESULTS: The number of heat-attributable deaths per summer ranged from 0 in Dublin to 423 in Paris. The mean attributable fraction of deaths was around 2%. The highest impact was in three Mediterranean cities (Barcelona, Rome and Valencia) and in two continental cities (Paris and Budapest). The largest impact was on persons over 75 years; however, in some cities, important proportions of heat-attributable deaths were also found for younger adults. Heat-attributable deaths markedly increased under warming scenarios. The impact under SRES scenarios was slightly lower or comparable to the impact during the observed hottest year. CONCLUSIONS: Current high summer ambient temperatures have an important impact on European population health. This impact is expected to increase in the future, according to the projected increase of mean ambient temperatures and frequency, intensity and duration of heat waves.

[Contribution of ISPESL (National Institute for Occupational Safety and Prevention) for protecting workers from exposure to avian influenza]. / Il contributo dell'ISPESL per la protezione di lavoratori esposti a virus dell'influenza aviaria.

Influenza virus A/H5N1 occurs mainly in birds, in which is highly contagious and deadly, and does not usually infect people. Most of the cases occurred in humans resulted from people having direct or close contact with H5N1 infected poultry or contaminated surfaces. The circulation of influenza viruses in birds, humans and other hosts represents a public and animal health threat, with important economic consequences. Controlling avian influenza in poultry, in particular with biosecurity measures, is the primary method to reduce human risk from infection. Enhanced surveillance both in poultry and in wild birds proved effective for the early detection of the infection. Worldwide most countries developed strategic plans, guidelines and recommendations for effective disease prevention and control. Moreover documents were specifically prepared to keep specific categories of workers adequately informed on how to avoid or minimize exposure to the viruses. In accordance with the Italian Decree 626/94, recently amended by the Decree 81/08, regarding the protection of workers from risks related to exposure to biological agents at work, the Department of Occupational Medicine of ISPESL prepared one booklet directed to people working with poultry and, together with Corpo Nazionale Vigili del Fuoco, two booklets addressed to fire brigade who could be at various levels involved in outbreak disease control and eradication activities. In fact information and training are essential aspects of a global preventive and protective strategy.

[HCV genotyping in health professionals: controversies and perspectives]. / Genotipizzazione dell'HCV in operatori sanitari: controversie e prospettive.

Healthcare workers (HCW) are at risk of acquiring blood-borne infections, including HCV Although current evidence does not suggest an increased prevalence of HCV infection among HCW, transmission of infection following occupational exposure has been demonstrated. Moreover, HCV can establish a persistent, chronic infection contributing to progressive liver disease, and post-exposure prophylaxis against HCV infection is not currently available. Problems still arise in the health surveillance of healthcare workers HCV infected. The use of virologic assays has become essential in the management of hepatitis C virus (HCV) infection, in order to improve the diagnosis of the infection, to guide the treatment decisions, and to assess the virologic response to antiviral therapy. Although several studies have specifically evaluated the role of HCV genotypes, many questions have not been answered. It is thought that HCV genotypes are important epidemiological markers, but more investigations are needed to elucidate their role regarding the progression and the pathogenesis of liver disease. The clinical implication of HCV genome heterogeneity, the different genotyping methods and the possible role of HCV genotypes as a parameter that could help health surveillance of infected HCW are described in this paper.

The concurrent COPD mortality doubles the mortality estimate from COPD as underlying cause in Lazio, Italy.

BACKGROUND: In Lazio region (Italy), mortality data are currently available from the death cause registry (DCR), which reports only underlying causes. Mortality due to other causes, defined concurrent mortality, are need to appropriately estimate the health impact from chronic diseases. The aims of the study were to estimate concurrent mortality from chronic obstructive pulmonary disease (COPD), using hospital discharge registry (HDR), to discuss the validity and limits of this method, and to compare underlying and concurrent mortality from COPD in the Lazio region. METHODS: A mortality study was carried out for residents who died in 1996-2000 with COPD listed as the underlying cause of death and those who died in the hospital with a different underlying cause of death listed but with a discharge diagnosis of COPD. Age-standardized mortality rates were obtained for males and females separately, using the direct method. A random sample of death certificates was used to validate concurrent causes of death as defined from discharge diagnoses. RESULTS: Age-standardised mortality for COPD as underlying cause of death was 3.68/10,000 in male and 2.29/10,000 in female residents. Mortality increased slightly in the study period for women, but no trend was evident. Age-standardised mortality for COPD as concurrent cause of death was 2.39/10,000 in male and 1.31/10,000 in female residents. The positive predictive value for concurrent COPD mortality was 54.3%. CONCLUSIONS: Concurrent COPD mortality contributed 62.3% to the whole mortality. The estimates of concurrent COPD mortality were comparable to those reported in other countries, though using hospital data may overestimate the real concurrent mortality as estimated from death certificates.

[The need to improve the quality of laboratory results in the study of biological occupational risk]. / Necessità di migliorare la qualità dei risultati di laboratorio nello studio del rischio biologico occupazionale.

In the field of occupational medicine, the laboratory medicine gives fundamental contribution not only to evaluate the risk connected to different environmental, biologic, chemical and physical factors, but also to manage the quality of the work condition. For this purpose, it's fundamental that the finalized health efficiency measures and the individuation of interventions partially or totally based on laboratory results, have to be correlated to reliable analytical results, to be validated by internal and external quality controls. During the last years, a new and in some way innovative interest in occupational exposition to biological agents increased. Although, in this sphere, the immunoenzimatic methods are widely used, standardization and quality controls are often absent. For the molecular investigation that is widely used in occupational medicine, adequate quality control systems should be promoted. The work medicine, as the laboratory medicine, should develop "Quality Assurance" programmes not only referred to different occupational infections study, but also to the use of different laboratory methodologies, including immunochemical, cellular, molecular or the ones ending by ... omic as proteomic, genomic, transcriptomic, etc.. The carrying out of such programmes is necessary to aim to support the integration in the involved different professional positions, to guarantee higher comprehension, transparency and reliability on analytical results.

[New tools for the study of occupational allergies related to animals]. / Nuovi strumenti per lo studio delle allergie occupazionali di origine animale.

Animal laboratory workers are exposed at the Laboratory Animal Allergy (LAA). About 10% of them develop asthma. Currently, by the use of innovative methodologies, numerous allergens from the laboratory animals have been sequenced and analyzed. Between them, the allergens by rats and mouse, the experimental models more utilized. Proteomic approach or protein microarray permit the study of several allergens, belonging to the proteins known as lipocalins, and of immunological response in susceptible individuals. Moreover, availability of on-line data banks permit a knowledge more and more detailed and up-to-date regarding the allergens of the interest. Between the advantage of the proteomic there is the use of small amount of biological fluids, as the serum, in association with the possibility to studied a great number of allergens on a single support. The study of LAA by the use of proteomic will permit to identify the animal allergens more accurately, providing also a valid tool at the methodologies traditionally used, and for the planning of the preventive and protective measures.

[Use of the comet test in occupational medicine and industrial toxicology: considerations and prospects]. / Impiego del comet test in medicina del lavoro e tossicologia industriale: considerazioni e prospettive.

The comet test (Single Cell Gel Electrophoresis or SCGE) is an easy to perform, rapid and highly sensitive genotoxicity assay; it requires small amounts of biological substrate and is applicable in vivo and in vitro to a wide variety of cells and tissues. Modified versions of the comet test able to detect oxidative damage or the effects of agents inducing DNA-DNA or DNA-protein crosslinks are available. Similarly to other genotoxicity assays, the comet test is not predictive far individual cancer risk. Limitations and critical features presently linked to comet test applications, with particular regard to the biomonitoring of individuals exposed to genotoxic agents, include: lack of sensitivity with respect to aneugens (agents inducing numerical chromosomal aberrations), possible underestimation of genotoxic potency of agents with mixed action mechanisms, sensitivity depending on the genotoxic agent itself, dependence an biological substrate with regard to the influence of cytotoxicity on the assay results, influence of age, tobacco smoke, alcohol and drug consumption, diet, kinetics of DNA adducts and DNA repair mechanisms. Consequently, a routine use of the comet test in biological monitoring of individuals that are occupationally and environmentally exposed to genotoxic agents is submitted to its validation by multicentric studies on large population samples with different exposure patterns, with a suitable characterisation of the role played by the above mentioned factors. Human studies should also be increasingly focused on the direct cellular targets of exposure to genotoxicants (e.g. epithelial cells of oral cavity and airways).

The impact of the summer 2003 heat waves on mortality in four Italian cities.

This study evaluates the impact of the 2003 heat wave on cause-specific mortality and the role of demographic characteristics and socioeconomic conditions that may have increased the risk of mortality in four Italian cities: Bologna, Milan, Rome and Turin. Daily mortality counts, for the resident population by age, sex and cause of death were considered. Daily excess mortality was calculated as the difference between the number of deaths observed and the smoothed average. The impact of heat on health is measured in terms of maximum apparent temperature. The greatest excess in mortality was observed in the north west of Italy (Turin, +23% and Milan, +23%). The old (75-84 years) and the very old (85+ years) were the age groups most affected, and when stratifying by sex, the increase in mortality seemed to be greater among females. The greatest excess in mortality was registered in those with low socioeconomic status in Rome (+17.8%) and in those with lower education levels in Turin (+43%). The analysis of cause-specific mortality not only confirms results from previous studies of an increase in heat-related mortality by respiratory and cardiovascular diseases, but also shows a significant excess in mortality for diseases of the central nervous system and for metabolic/endocrine disorders. Results from 2003 highlight the necessity of targeting future prevention programmes at the susceptible sub-groups identified. The introduction of warning systems alongside efficient preventive plans and the monitoring of mortality during heat waves may represent a valid tool for the reduction of heat-related deaths.

Prevalence and incidence of antibodies to Borrelia burgdorferi and to tick-borne encephalitis virus in agricultural and forestry workers from Tuscany, Italy.

The ticks Ixodes persulcatus and Ixodes ricinus are the main vectors of both Borrelia burgdorferi sensu lato and tick-borne encephalitis (TBE) virus in Eurasia. Borrelia burgdorferi is the cause of Lyme borreliosis, and TBE is a biphasic meningoencephalitis induced by an arbovirus belonging to the flavivirus family. The principal aims of the current investigation were (i) to determine the frequency of serological evidence of Borrelia burgdorferi sensu lato and TBE infections in healthy agricultural and forestry workers, (ii) to determine the incidence of seroconversion for antibodies against Borrelia burgdorferi sensu lato and TBE virus in Tuscan workers during a 1-year survey; and (iii) to assess the occupational risk for agricultural and forestry activities in a defined area (Tuscany, Italy). A total of 412 blood samples were taken from agricultural and forestry workers, and information on age, duration of employment, and history of tick bites was collected in a questionnaire to establish the risk factors for the diseases. Three hundred sixty-five blood donors from the same region served as controls. To estimate the rate of seroconversion, 176 of the agricultural and forestry workers were tested 1 year later. IgG and IgM antibodies against Borrelia burgdorferi sensu lato and TBE virus were detected in serum by an enzyme-linked immunosorbent assay and confirmed by Western blot analysis for Borrelia burgdorferi and by a test for inhibition of hemagglutination for TBE. Antibodies against Borrelia burgdorferi were more frequent among the workers than in the control group (7.8% vs. 4.9% in the IgG-IgM enzyme-linked immunosorbent assay and 7.03% vs. 3.56% in the confirmatory test). No seropositivity was observed for TBE virus. Eighteen of 176 subjects who underwent a second blood test developed specific antibodies against Borrelia burgdorferi within 1 year.

The impact of the summer 2003 heat waves on mortality in four Italian cities.

This study evaluates the impact of the 2003 heat wave on cause-specific mortality and the role of demographic characteristics and socioeconomic conditions that may have increased the risk of mortality in four Italian cities: Bologna, Milan, Rome and Turin. Daily mortality counts, for the resident population by age, sex and cause of death were considered. Daily excess mortality was calculated as the difference between the number of deaths observed and the smoothed average. The impact of heat on health is measured in terms of maximum apparent temperature. The greatest excess in mortality was observed in the north west of Italy (Turin, +23% and Milan, +23%). The old (75-84 years) and the very old (85+ years) were the age groups most affected, and when stratifying by sex, the increase in mortality seemed to be greater among females. The greatest excess in mortality was registered in those with low socioeconomic status in Rome (+17.8%) and in those with lower education levels in Turin (+43%). The analysis of cause-specific mortality not only confirms results from previous studies of an increase in heat-related mortality by respiratory and cardiovascular diseases, but also shows a significant excess in mortality for diseases of the central nervous system and for metabolic/endocrine disorders. Results from 2003 highlight the necessity of targeting future prevention programmes at the susceptible sub-groups identified. The introduction of warning systems alongside efficient preventive plans and the monitoring of mortality during heat waves may represent a valid tool for the reduction of heat-related deaths.

Intratumoral microvessel density and expression of ED-A/ED-B sequences of fibronectin in breast carcinoma.

The aim of this study was to examine the correlation between intratumoral microvessel density (iMVD) and the presence of cellular fibronectin isoforms, ED-A and ED-B, in order to identify those tumours with a prominent angiogenic phenotype. 91 cases of invasive ductal breast carcinoma were evaluated for TNM, histological grading, percentage of Ki-67+ cells and receptor hormonal status. iMVD was determined as a single microvessel count in a 200 x microscope field from the region of the tumour that appeared to be most densely vascular. When the mean values of iMVD of the various groups were compared, no significant difference was noted (Mann-Whitney test). When tumours were classified as high or low iMVD, based on a cut-off value (99 vessels/0.74 mm2), cases with high iMVD were significantly more numerous in poorly differentiated G3 tumours (P = 0.01, Chi-square test), and in tumours with lymph node metastasis (N0 versus N1 + N2; P = 0.002). The possibility that high iMVD was the expression of prominent vascular neoformation was explored using ED-A and ED-B isoforms of fibronectin as markers of neoformed vessels. ED-A + and/or ED-B + blood vessels were < 10% of total vessels, were detected in approximately 50% of cases independently of iMVD values, and were not more numerous in tumour areas with hot spot vascularisation. Our findings indicate that iMVD and expression of ED-A/ED-B reflect different aspects of tumour-associated angiogenesis.

Role of delivery on serum iron-related parameters in Macaca fascicularis females.

Few data exist on the iron status and metabolism in macaques, which are considered optimal models for the study of reproductive biology and anemia. The delivery influence on the hematological parameters of iron metabolism was investigated in adult Macaca fascicularis females during late pregnancy and at 6 weeks postpartum follow-up. No significant differences were detected for each parameter by one-way analysis of variance. A decrease of all parameters was observed at delivery. During the following weeks, however, the hematological values progressively came back to normal. In conclusion, notwithstanding the increased need of iron faced during pregnancy, a balanced diet, including iron, does not allow the development of either iron deficiency or sideropenic anemia.

Serum kappa and lambda light immunoglobulin chains in cynomolgus macaques (Macaca fascicularis) during the first twenty months of age.

Growth is coupled to physiological modifications of the immune system which reaches the functional capabilities according to age-related milestones. Few data are available on the circulating immunoglobulin levels and no data exist on total immunoglobulin light chains in infant macaques. Therefore we studied by a nephelometric assay, the age-dependent variations of kappa and lambda serum light chains in the experimental animal model Macaca fascicularis during the first 20 months of age. Both kappa and lambda showed a marked increase in their concentrations during the first 7-8 months of life. Infants' light chain levels were anyhow significantly lower than those of the nursing dams and of the control group, never attaining, even at the 20th month, the same concentration as the adult, although the value of the kappa/lambda ratio was apparently the same.

Humoral immunity factors in cynomolgus macaques (Macaca fascicularis) serum: immunoglobulins and total light chains in nursing dams.

This study was aimed at the identification of variations in humoral immunity parameters during the lactation period in macaque females, a recognized model in reproductive physiology and pathology. The importance of such evaluation is evidenced in particular by the central role played by the maternally transferred immunity to the progeny. The trends of serum immunoglobulins and light chains were characterized by immunonephelometry during the 6-months of lactation. The levels attained by nursing females were evaluated against a control group. The main modifications induced by lactation were in the IgM class, whose levels remained constantly lower than in the control group; the other Igs, even if showing different trends, returned to levels comparable to the control group by the end of the sixth month. Light chains quantification evidenced a significant decrease in Kappa levels; Lambda chains showed a similar trend. The variation of the Kappa/Lambda ratio was therefore minimal.

Changes in serum protein fractions and specific alpha and beta concentrations during lactation in Macaca fascicularis.

Physiologic variations are known to develop in milk and serum proteins of women during lactation. This study was intended to evaluate whether modifications of the major serum proteins and alpha, beta, and gamma fractions occur during lactation in Macaca fascicularis. The alpha 1 and gamma globulins decreased and the alpha 2 and beta globulins increased; results of specific protein determinations indicated a decrease in almost all globulins. The protein trends during lactation in M. fascicularis are probably modified by estrogen and progesterone variations after delivery. Estrogen trends are similar in women and cynomolgus monkey females, whereas progesterone patterns between women and female macaques are different during the postpartum period.