[Trend of the asbestos related diseases mortality in workers of a company in the province Cremona which manufactured asbestos products]. / Andamento delle patologie e della mortalità asbesto correlate in lavoratori di un'azienda della provincia di Cremona che produceva manufatti in amianto.

The study analyzes the trend of asbestos-related diseases and mortality in workers of a company in the province of Cremona which manufactured asbestos products. It is confirmed that the exposure to a high concentration of asbestos fibers (estimated to more than 20 fibers/cc) strictly correlates with the onset of pathologies from asbestos. In the studied population were found 19 cases of neoplastic diseases (12 mesotheliomas and 7 bronchopulmonary carcinomas). This figure, compared to the company working population, which over the years has been an average of 80 units, while not enabling to calculate an incidence rate due to the lack of reliable data on population, is indicative of a very significant cause-effect relationship since these are neoplastic diseases that can still arise. So it is necessary to continue the health monitoring of formerly exposed workers and appropriate to try to extend it to all workers of the asbestos compartment.

[Theoretical-practical training for personnel involved in patient assistance for limiting the risk of manual handling of the patients in a hospital company]. / Corso teorico-pratico di formazione al personale di assistenza per il contenimento del rischio da mobilizzazione manuale dei pazienti in una Azienda Ospedaliera.

Worker education and training must represent a deep cultural change that can be achieved, fulfilled and strengthened through constant guiding steps and periodical checks regarding practical application of acquired knowledge. In our hospital, a multi-subject team has been identified to face such problem of risk reduction from inpatient mobilization in a shared and synergic manner. Therefore a theory and practical training course is being proposed, with a theoretic part of one hour and a half to be held in a classroom to small groups (not more than 20 people) and a practical part (addressed to 8 people groups) composed of 4 sections of 1 hour and a half each: once listening in class and then being subdivided in the relative belonging wards as well as after an explanation, everyone will have here the chance to perform the correct manual mobilization handlings also in association with the use of minor aid devices. At the end of each section, a referent-educator is identified for each Operative Unit: such a figure is extremely important as a reference for his/her collegues, for new employees and to support and/or substitute the outside inspector in checking operations during the year following the end of the course itself. This latest phase is thus considered absolutely necessary to realize the actual change in the staff habits.

[Analysis of work accidents during the years 1999-2006 in a hospital company in Lombardia]. / Analisi del fenomeno infortunistico 1999-2006 in un'Azienda Ospedaliera Lombarda.

This study describe accidents occurred in the period between 1999 and 2006 in the Hospital of Cremona, in which about 2400 subjects operate. The analysis of Accident Register showed a reduction of about 30% of the total number of accidents during the examined period and a non homogeneous distribution of the various types of accidents. The most frequent accidents were prick (25.8%), trauma (22.9%) and "in itinere" accidents (7.8%). One type of accident has been little considered up to now: the aggressions. Professional nurses were the most frequently involved and the most affected units were those that belong to the Internal Medicine Department. "In itinere" accidents had the longest average prognosis (11.6 days). The repetition of accidents occurred to the same operator hasn't been analysed before now: a professional nurse had nine accidents (of various type) in the seven years considered. Probably the reduction of accident must be attributed to the effectiveness of the prevention activities undertaken during the reviewed period. Biological accidents, for which it was possible to implement prevention programs, have been markedly reduced; it was not the same for "In Itinere" accidents, that depend significantly on external factors that are not easily dismissed.

[Medical surveillance and occupational identification of workers exposed to repeated movements of the upper limbs]. / Sorveglianza sanitaria e idoneità lavorativa in esposti a movimenti ripetuti dell'arto superiore.

Repetitive motions of the upper limb at work can induce muskulo-skeletal alterations, therefore a specific medical surveillance is needed, according to the intensity of risk. In low risk conditions, the medical surveillance is aimed at the identification of hyper-susceptible individuals and the administration of specific information programs. When the risk intensity is higher, medical surveillance should add the recognition of early symptoms and signs of muskulo-skeletal disturbances, in order to remove workers showing early alterations from the exposure and allow medical rehabilitation. The diagnostic protocols with the adequate instrumental evaluation are provided, and the required legal reporting is discussed.

[Prevalence of carpal tunnel syndrome in workers executing complex tasks with the upper extremities]. / Prevalenza di Sindrome del Tunnel Carpale in lavoratrici che effettuano operazioni complesse con gli arti superiori.

In 50 female workers of a manufacturing plant employed on the assembly line of metal and plastic products with cloth covering, we found a high prevalence of Carpal Tunnel Syndrome (16 cases, 32%, 5 of whom had already undergone surgical treatment). The subjects with positive diagnosis of Carpal Tunnel Syndrome also had a longer occupational exposure to repetitive movements, compared to the other subjects. Among the subjects with this disorder, the length of exposure was also significantly associated with the reported symptoms and the extension threshold measured on the 2nd finger of the dominant hand. Ergonomic assessment of the assembly lines revealed high-frequency repetitive movements and application of force, with insufficient rest intervals.

Resistance to Paracoccidioides brasiliensis infection is linked to a preferential Th1 immune response, whereas susceptibility is associated with absence of IFN-gamma production.

The secretion of interferon-gamma (IFN-gamma), interleukin-2 (IL-2), IL-4, IL-5, and IL-10 by antigen-stimulated lymph node cells, eosinophil maturation, and the antibody isotypes produced were examined during intraperitoneal infection of susceptible (B10.A) and resistant (A/Sn) mice with Paracoccidioides brasiliensis. Lymph node cells from resistant mice produced early and sustained levels of IFN-gamma and IL-2, whereas susceptible animals secreted low to undetectable amounts of these type 1 cytokines. Both mouse strains presented late and transient production of IL-4, whereas IL-10 was produced constantly throughout the course of disease. Resistant animals produced increasing levels of IL-5 in the chronic phase of the infection (from the eighth week on), whereas susceptible mice showed two peaks of IL-5 production, at the first and twelfth weeks after infection. Only the susceptible strain presented medullary and splenic eosinophilia concomitant with the raised IL-5 production. In resistant mice, the levels of IgG2a antibodies were significantly higher than those observed in susceptible mice, which preferentially secreted IgG2b and IgA isotypes. Taken together, these results demonstrate that a sustained production of IFN-gamma and IL-2 and a predominant secretion of IgG2a antibodies are associated with resistance to P. brasiliensis. In contrast, the production of low levels of IFN-gamma, early secretion of high levels of IL-5 and IL-10, eosinophilia, and a preferential secretion of IgG2b and IgA isotypes characterize the progressive disease in susceptible animals.

Reliability of data on smoking habit and coffee drinking collected by personal interview in a hospital-based case-control study.

A study on the reliability of information on smoking habits and coffee drinking collected via interview was conducted among 500 subjects enrolled in a case-control study on bladder cancer in Brescia, North Italy. A total of 215 cases (incident and prevalent) and 285 controls were interviewed personally in the hospital setting by a first interviewer, and then re-interviewed by telephone by either the same interviewer or another one. Agreement between the first and second interview was evaluated using the kappa statistic and the intra-class correlation coefficient and via multiple logistic regression modelling. No important differences in reliability were found according to sex, education or case/control status, while agreement was better among subjects below 65 than among older ones, and among incident than prevalent cases. A slightly better agreement was found among subjects interviewed twice by the same interviewer than those interviewed by two different individuals, which may reflect the presence of inter-observer reliability for the latter. Overall, these results show a very high reliability of data on smoking and a fairly high reliability regarding coffee drinking as collected through face-to-face interviews.

Bladder cancer, tobacco smoking, coffee and alcohol drinking in Brescia, northern Italy.

The association between tobacco smoking, the consumption of coffee and alcohol and bladder cancer was investigated in a hospital-based case-control study in Brescia, northern Italy. A total of 172 incident cases (135 men and 37 women) and 578 controls (398 men and 180 women) were enrolled. As expected, cigarette smoking was strongly associated with bladder cancer. The odds ratios (OR) for coffee drinking adjusted for age, education, residence and cigarette smoking in current drinkers were 2.6 (95% confidence interval, CI: 1.1-6.1) in men and 5.2 (95% CI: 1.0-30.4) in women. A dose-response relationship was found in men, with the highest risk in the highest category of exposure: drinkers of more than 5 cups per day had an OR of 4.5 (95% CI: 1.2-16.8). The ORs for current alcohol drinkers were 2.1 (95% CI: 1.0-4.8) in men and 3.4 (95% CI: 1.2-9.7) in women; according to grams of ethanol drunk per day (grams/day, g/d) the ORs were: 1.7 (1-20 g/d), 1.6 (21-40 g/d), 4.3 (41-60 g/d) and 4.6 (61+ g/d) in men and 3.1 (1-20 g/d) and 3.9 (21+ g/d) in women. These results suggest that regular consumption of both coffee and alcohol can be independently associated with an increased bladder cancer risk.

Bladder cancer and occupation: a case-control study in northern Italy.

OBJECTIVES: A hospital based case-control study was conducted between 1992 and 1993 in the province of Brescia, a highly industrialised area in northern Italy, to evaluate occupational risk factors of bladder cancer. METHODS: The study evaluated 355 histologically confirmed cases of bladder cancer (275 men, 80 women) and 579 controls affected by urological non-neoplastic diseases (397 men, 182 women). Lifetime occupational history, smoking and drinking habits, and sociodemographic characteristics were recorded by means of a structured questionnaire. Odds ratios (ORs) were computed with adjustment for age, smoking, alcohol and coffee consumption, education, and place of residence. RESULTS: A significant (P < 0.05) increase of risk of bladder cancer were found in men for labourers in the construction industry (OR 2.1, 95% confidence interval (95% CI) 1.1-3.9) and for recreational and cultural services (OR 5.0, 95% CI 1.3-18.9). Increased risks, although not significant, were found for various other occupations and industries such as machinery mechanics, metal processers and polishers, blacksmiths, gunsmiths, painters; for transport workers, an increased risk with increasing duration of employment was found. CONCLUSIONS: Occupational exposures seem to contribute to bladder cancer risk in the area under study.

Effect of macrophage blockade on the resistance of inbred mice to Paracoccidioides brasiliensis infection.

The effect of macrophage blockade on the natural resistance and on the adaptative immune response of susceptible (B10.D2/oSn) and resistant (A/Sn) mice to Paracoccidioides brasiliensis infection was investigated. B10.D2/oSn and A/Sn mice previously injected with colloidal carbon were infected ip with yeast cells to determine the 50% lethal dose, and to evaluate the anatomy and histopathology, macrophage activation, antibody production and DTH reactions. Macrophage blockade rendered both resistant and susceptible mice considerably more susceptible to infection, as evidenced by increased mortality and many disseminated lesions. P. brasiliensis infection and/or carbon treatment increased the ability of macrophages from resistant mice to spread up to 25 days after treatment. In susceptible mice the enhanced spreading capacity induced by carbon treatment was impaired at all assayed periods except at 1 week after infection. Macrophage blockade enhanced DTH reactions in resistant mice, but did not alter these reactions in susceptible mice, which remained anergic. To the contrary, macrophage blockade enhanced specific antibody production by susceptible mice, but did not affect the low levels produced by resistant mice. The effect of macrophage blockade confirms the natural tendency of resistant animals to mount DTH reactions in the course of the disease and the preferential antibody response developed by susceptible mice after P. brasiliensis infection. On the whole, macrophage functions appear to play a fundamental role in the natural and acquired resistance mechanisms to P. brasiliensis infection.

Paracoccidioides brasiliensis-stimulated human gamma/delta T cells support antibody production by B cells.

Paracoccidioidomycosis patients show hyperactive humoral immune responses. Consequently, we investigated whether cytokines in supernatants from Paracoccidioides brasiliensis-stimulated gamma/delta T cells support B-cell activation. We detected proliferation of B cells and increased immunoglobulin M (IgM) and IgG production. Thus, gamma/delta T cells may participate in polyclonal B-cell activation during paracoccidioidomycosis.

Neurobehavioral functions in operating theatre personnel exposed to anesthetic gases.

Neurobehavioral functions in paramedical operating theatre personnel were assessed in a cross-sectional survey. Sixty-two subjects (40 males and 22 females) occupationally exposed to anesthetic gases were examined and compared to 46 unexposed hospital workers (18 males and 28 females). The Simple Reaction Time (SRT) test was selected from the MANS battery (Milan Automated Neurobehavioural System). In order to evaluate acute and subacute types of effects on performance, the test was administered before and after the work shift, at the beginning and at the end of the working week. In addition, the complete battery was administered during one working day without exposure to anesthetic gases. On the last day of the working week, atmospheric nitrous oxide (N2Oa) ranged from 7 to 553 ppm (geometric mean 62.6), atmospheric ethrane (ETHa) ranged from 0.1 to 18.8 ppm (geometric mean 1.3), and urinary N2O (N2Ou) ranged from 4 to 297 micrograms/l (geometric mean 26.8). An impairment of performance on the SRT test was observed at the end of the working week in subjects exposed to anesthetic gases compared to controls. This alteration was observed also considering only the subjects exposed to less than 55 micrograms/l (which is the Italian exposure limit for N2Ou, equivalent to 100 ppm for N2Oa). No significant differences were observed for the other psychometric tests. No dose-effect relationships where found between SRT test score and the indicators of exposure (N2Oa, ETHa, N2Ou).(ABSTRACT TRUNCATED AT 250 WORDS)

Human alpha beta and gamma delta T cells from unexposed individuals respond to protein antigens of the yeast form of Paracoccidioides brasiliensis.

Paracoccidioides brasiliensis, a dimorphic fungus, causes chronic granulomatous mycosis in susceptible individuals. Different reports have shown that cell-mediated immunity is essential for protection against systemic mycosis, including paracoccidioidomycosis. We analyzed the reactivity of alpha beta and gamma delta T cells from unexposed Caucasian donors to P. brasiliensis yeast form components. Our results indicate: (i) alpha beta and gamma delta T cells proliferate after in vitro stimulation with lysates of P. brasiliensis; (ii) similar numbers of alpha beta T cells (f = 1/21,000) and of gamma delta T cells (f = 1/8000) respond to P. brasiliensis; (iii) P. brasiliensis-reactive gamma delta T cells express the V gamma 9V delta 2 TCR; (iv) the stimulatory activity of P. brasiliensis for both alpha beta and gamma delta T cells primarily resides in a high molecular weight (100 kDa) and in a low molecular weight (< 1 kDa) fraction; (v) the ligands responsible for stimulation of both alpha beta and gamma delta T cells are sensitive to proteinase treatment. We conclude that both alpha beta and gamma delta T cells from healthy individuals respond to ubiquitous protein antigens of P. brasiliensis.

Delayed-type hypersensitivity response in an isogenic murine model of paracoccidioidomycosis.

The specific delayed-type hypersensitivity (DTH) response was evaluated in resistant (A/SN) and susceptible (B10.A) mice intraperitoneally infected with yeasts from a virulent (Pb18) or from a non-virulent (Pb265) Paracoccidioides brasiliensis isolates. Both strains of mice were footpad challenged with homologous antigens. Pb18 infected A/SN mice developed an evident and persistent DTH response late in the course of the disease (90th day on) whereas B10.A animals mounted a discrete and ephemeral DTH response at the 14th day post-infection. A/SN mice infected with Pb265 developed cellular immune responses whereas B10.A mice were almost always anergic. Histological analysis of the footpads of infected mice at 48 hours after challenge showed a mixed infiltrate consisting of predominantly mononuclear cells. Previous infection of resistant and susceptible mice with Pb18 did not alter their DTH responses against heterologous unrelated antigens (sheep red blood cells and dinitrofluorobenzene) indicating that the observed cellular anergy was antigen-specific. When fungal related antigens (candidin and histoplasmin) were tested in resistant mice, absence of cross-reactivity was noted. Thus, specific DTH responses against P. brasiliensis depend on both the host's genetically determined resistance and the virulence of the fungal isolate.

Resistance to Paracoccidioides brasiliensis in mice is controlled by a single dominant autosomal gene.

In a previous report it was shown that there are resistant, susceptible, and intermediate strains of mice to intraperitoneal Paracoccidioides brasiliensis infection. In the present work, we investigated the type of inheritance and the number of genes that determine resistance to paracoccidioidomycosis. Parental and hybrid mice were inoculated intraperitoneally with 5 X 10(6) P. brasiliensis yeast cells, and mortality was scored daily. Analysis of susceptible and resistant parental strains and of F1, F2, and backcross mice showed that the resistance to P. brasiliensis seems to be controlled genetically by a single dominant gene, which we designated the Pbr locus. The mean survival times of susceptible F2 and backcross hybrids were very similar to that of the susceptible parent. Examination of the pathological changes observed in parental and F1 mice, 6 months after infection, showed that F1 offspring presented a similar number and distribution of lesions to those of the resistant strains. The Pbr gene is not linked to H-2, Hc, and albino genes. Furthermore, resistance to paracoccidioidomycosis is controlled by an autosomal gene.

Role of the fungal cell wall in the granulomatous response of mice to the agents of chromomycosis.

Mice were given, intraperitoneally, inocula of a cell-wall preparation and fractions thereof from Fonsecaea pedrosoi, F. compactum, Cladosporium carrioni and Phialophora verrucosum. Large doses of cell-wall preparation, with or without trypsin treatment, produced a pronounced loss of body weight, a granulomatous reaction and, sometimes, death. After extraction of the cell wall preparation with 1N NaOH, three fractions were obtained: an alkali-insoluble fraction 1; an alkali-soluble acid-insoluble fraction 2; and an alkali- and acid-soluble fraction 3. Intravenous administration showed that only fraction 1 induced a granulomatous reaction and death in mice.

A Paracoccidioides brasiliensis polysaccharide having granuloma-inducing, toxic and macrophage-stimulating activity.

The occurrence of a polysaccharide fraction of Paracoccidioides brasiliensis cell wall with toxic, granuloma-inducing and macrophage-stimulating activities was demonstrated. After fractionation of the lipid-extracted wall with 1 M-NaOH, three fractions were obtained: (1) an alkali-insoluble fraction; (2) an alkali-soluble, acid-insoluble fraction and (3) an alkali-soluble, acid-soluble fraction. When the three fractions were injected into mice only fraction (1) was able to induce chronic lung inflammation, causing a marked loss in body weight and death at a dose of 6 mg per animal. Analysis of the stimulation of peritoneal macrophages of mice (measured by cell spreading on glass) after intraperitoneal injection of fraction 1 showed that 75% of the cells were able to spread even 20 d after inoculation.

Role of cord factor in the modulation of infection caused by mycobacteria.

The subcutaneous, intradermal, and pulmonary inflammatory lesions induced in mice by viable Mycobacterium bovis (BCG) with no glycolipid cord factor (CF) on the outer cell wall (delipidated BCG, dBCG) was drastically different from that induced by inoculation with intact bacteria. The reaction caused by dBCG was of an acute nature: the cells making up the inflammatory infiltrate exhibited polymorphonuclear-like (PMNs) morphologic characteristics, there was a decrease on delayed hypersensitivity response, and the lesion was resolved around the 16th day after inoculation. Complete disappearance of viable organisms from the lungs, liver, and spleen of these animals occurred in parallel with the dissipation of the dBCG-induced inflammatory infiltrate, showing that CF plays an important role in the host-parasite relationship that takes place in infections caused by mycobacteria. In addition, when deprived of this glycolipid component, bacilli lose their immunostimulant ability.