Global MHD modeling of resonant ULF waves: Simulations with and without a plasmasphere.

We investigate the plasmaspheric influence on the resonant mode coupling of magnetospheric ultralow frequency (ULF) waves using the Lyon-Fedder-Mobarry (LFM) global magnetohydrodynamic (MHD) model. We present results from two different versions of the model, both driven by the same solar wind conditions: one version that contains a plasmasphere (the LFM coupled to the Rice Convection Model, where the Gallagher plasmasphere model is also included) and another that does not (the stand-alone LFM). We find that the inclusion of a cold, dense plasmasphere has a significant impact on the nature of the simulated ULF waves. For example, the inclusion of a plasmasphere leads to a deeper (more earthward) penetration of the compressional (azimuthal) electric field fluctuations, due to a shift in the location of the wave turning points. Consequently, the locations where the compressional electric field oscillations resonantly couple their energy into local toroidal mode field line resonances also shift earthward. We also find, in both simulations, that higher-frequency compressional (azimuthal) electric field oscillations penetrate deeper than lower frequency oscillations. In addition, the compressional wave mode structure in the simulations is consistent with a radial standing wave oscillation pattern, characteristic of a resonant waveguide. The incorporation of a plasmasphere into the LFM global MHD model represents an advance in the state of the art in regard to ULF wave modeling with such simulations. We offer a brief discussion of the implications for radiation belt modeling techniques that use the electric and magnetic field outputs from global MHD simulations to drive particle dynamics.

Occupational diseases due to allergic and toxic chemicals in health care workers: fitness for work.

The purpose of this review is to suggest job fitness criteria for health care workers exposed to sensitizing or chemical agents. These recommendations are derived from a comparison between previous documents on prevention and management of allergic and chemical risks in health care settings and updated evidence; the job fitness criteria and the main documents on these topics are summarized in tables. Glove allergy, in particular latex allergy, is still a significant problem but we should remember that a wide choice of alternative materials is now easily available; many different alternative health products are also currently available when an allergy to disinfectants or detergents is diagnosed. Hence the prevention of allergic diseases is mostly based on an appropriate choice and use of the gloves and health products according to the specific tasks and possible individual susceptibility; this meets the requirements of the "good health care organization", which translates into lower costs, if possible, as well as the best protection of worker's health. Concerning chemical risk, it should be remembered that during the last 20 years the improvements made in work environments have profoundly changed the mode and the levels of exposure to chemical substances and the current recommendations concerning the management of workers exposed to anesthetic gases, antineoplastic agents and sterilizers/disinfectants significantly differ from those of early 1990s. However, the past prudential guidelines are still valid for formaldehyde.

Assessment of efficacy and safety of pandemic A/H1N1/2009 influenza vaccine in a group of health care workers.

INTRODUCTION: The development in an extremely short time of an efficacious and safe vaccine against the pandemi A/H1N1 virus was a challenge that involved the entire scientific community. AIMS: To assess the immunological and clinical efficacy of the new H1N1v monovalent influenza vaccine (Focetria Novartis Vaccines, Siena, Italy) in a group of health care workers (HCWs). METHODS: A total of 148 volunteer HCWs were enrolled between Mid-Novembre 2009 and December 2009. After measuring antibody titers, a single intramuscular dose of 7.5 microg of Focetria monovalent vaccine against A/H1N1/2009 influenza virus with MF59C.1 adjuvant was administered. RESULTS: Antibody titers (median value) before and after a single dose of vaccine, measured by means of standard beam-agglutination inhibition test (HAI), increased from 32 to 256 (p < 0.001). After vaccination, 79.7% of the subjects showed antibody seroconversion, and in 97.3% seroprotection was achieved. The ratio between the geometric means of antibody titers (GMTR) was 6.69. For the 3 subjects who reported symptoms of ILI (Influenza-like illness), a regular nasal-pharyngeal swab sample was taken to identify the virus type by RT-PCR, the laboratory results of tests performed on these samples were negative for pandemic A/H1N1/2009 virus. During the entire follow-up period of 6 months no severe adverse events occurred. CONCLUSIONS: The vaccine against pandemic A/H1N1/2009 virus provided protection against the virus and not only contributed to a significant immunization (according to EMEA criteria), but kept all 148 subjects under study free from A/H1N1/2009 influenza illness.

[Does the occupational physician training convey the knowledge of the positive effects of work on the human quality of life?]. / La formazione specialistica del medico del lavoro valorizza la positività che il lavoro ha per il benessere dell'uomo?

Occupational Medicine has always been concerned with the negative aspects of work on human health. Much less frequently have the possible positive effects of work on health been studied and taught. In fact the cultural background of occupational medicine has for many years witnessed the development of a prevalently negative view of work, which is perceived as a deteriorating activity, as the inevitable cause of psychophysical deterioration, of illness and injury. The training of the Occupational Physician should instead provide a deep knowledge of the positive work value in all its aspects. We also considered necessary that, besides preventive knowledge, the Occupational Physician should also develop a good clinical training and adequate competence in rehabilitation field.

[Interactions between alcohol and work exposure to chemical substances]. / Interazioni fra consumo di alcol ed esposizione lavorativa ad agenti chimici.

BACKGROUND AND OBJECTIVES: The quite diffused habit of a significant assumption of alcohol drinks, can interfere with the professional exposure to chemical substances. The interaction may result in increasing their toxicity and/or modifying the parameters of the biological monitoring. It may also act as a confounding factor, not only in epidemiologic researches but also at individual level when the assessment of the occupational exposure and/or the diagnosis of an occupational diseases, is under consideration. We review available references in the literature summarizing major scientific evidences. RESULTS: The interaction between the alcohol assumption and industrial chemicals may be toxicokinetic or toxicodynamic. Alcohol can interfere in the processes of biotransformation of xenobiotics and modify the doses and the effect indicators used for the biological monitoring, causing wrong interpretations of the results. The metabolism of ethanol can be altered by the exposures to toxic industrial materials, creating some clinical pictures of alcohol intolerance, like an "antabuse syndrome" or an "degreaser flush syndrome". Professional exposure to carbon sulfide or to dimethylformamides, trichloroethylene as well as to nitroglycerin and nitroglycole ethylenic can produce similar syndromes. Interactions are reported between alcohol and solvents: on toxicokinetic bases for methanol, isopropanol, glycol ether, trichloroethylene, methyl ethyl ketone and toluene; and on toxicodynamic bases for CNS. Also between alcohol and metals there can occur toxicokinetic interactions, like in the case of lead and mercury. Alcohol can also interfere with the biological monitoring of solvents, producing an over-estimation of the exposure. CONCLUSIONS: For the biological monitoring of reported chemical substances, it is suitable to evaluate the biologic indicators in the days in which there is not assumed alcohol. If this cannot be guaranteed, it is necessary to know at least the quantity of the alcohol consumed or at least if the subject is an alcohol abuser.

[The presence of asbestos bodies in induced sputum as an indicator of asbestos exposure]. / La presenza di corpuscoli dell'asbesto nell'espettorato indotto come indicatore di esposizione ad amianto.

BACKGROUND: Very few references on the usability of presence of asbestos bodies (AB) in induced sputum as an indicator of asbestos exposure are to be found in the scientific literature. OBJECTIVES: The purpose of this study was to prove whether the presence of AB in induced sputum is a valid assessor of asbestos exposure. METHOD: This was achieved by comparing the above-mentioned method with the search for AB in bronchoalveolar lavage (BAL) fluid and repeating the trials over time in order to study the reproducibility of the results. RESULTS: There was good agreement of results for the presence/absence of AB in induced sputum and in BAL among subjects who were environmentally exposed and those with 'a medium-high risk occupational exposure (100%), and poor agreement (66%) among subjects with a low risk occupational exposure. Agreement of results regarding the amount of particles per test was low. The method showed a sufficient reproducibility level (Cohen K=0.5). CONCLUSION: Although the presence of asbestos bodies in induced sputum cannot replace bronchoalveolar lavage, it can however be used as a screening test for selecting subjects who should undergo BAL.

[Health surveillance on workers exposed to wood dust: usefulness of the assessment of the nasal mucosa]. / Sorveglianza sanitaria negli esposti a polveri di legno: utilità della valutazione della mucosa nasale.

The purpose of this paper is to evaluate alterations in the nasal mucosa in workers that for professional purpose, are exposed, for a long period of time, to wood dust (WD). The increased frequency in alterations could underline a mechanism for chronic damage that could lead to cancer This study took into account 50 cabinet workers (EW) who had been exposed to WD for an average of 33 years and were compared to 48 controls (CC). A questionnaire regarding nasal symptoms was submitted, the nasal mucosa was examined by fibroscopy, secretions were valuated, cytogram from a nasal swap was also done. 44% of the EW and 33.4% of CC showed macroscopic alterations of the mucosa (PR 1,32 IC95% 0,79-2,19). The cytogram was altered in 24% of EW and in 12.5% of CC (PR 1,92 IC95% 0,78-4,71). In EW there was an abnormal significant increase in nasal secretions compared to CS, 28% vs 11,4% (PR 2,69 IC95% 1,05-6,89). The results do not confirm our hypothesis, but they show an unexpected prevalence of alteration in the CC. While waiting for further results, we express doubts in proposing routinary specialistic evaluation to all the EW to WD. At present it is hard to pin point indicators that could help reach an early diagnosis in the development of sinus-nasal cancer.

[Hearing function and solvent exposure: study of a worker population exposed to styrene]. / Udito ed esposizioni a solventi: studio di una popolazione di lavoratori esposti a stirene.

The aim of the study was to investigate the ototoxic effects of occupational styrene exposure, in absence of other risk factors. Pure-tone audiometric thresholds of 32 workers exposed to styrene, but not to noise, in fibreglass reinforced plastic boat manufacturing process were detected and compared to audiometric thresholds of a control unexposed group composed by 60 subjects. Exposure to styrene was measured by urinary mandelic + phenylglyoxylic acid (mean value 149 mg/g crea, SD 80 mg/g crea). For all the frequencies investigated (0,5-1-2-3-4-6-8 KHz) the exposed group showed slight higher mean (median) audiometric thresholds (p < 0.05) compared to controls matched by age and sex, except for 8 KHz in the right ear. The present experience seems to confirm the hypothesis that styrene exposure alone can determine a weak sensorineural high-frequency hearing loss. Such slight impairment, even if statistically significant, does not remarkably limit social hearing and do not involve legal medical aspects. Sample expansion and objective diagnostic tests (auditory brainstem evoked potentials, acoustic otoemissions) are needed.

[Study of the olfactory function of a group of workers with significant lead exposure]. / Studio della funzione olfattiva di un gruppo di lavoratori con rilevante esposizione a piombo.

The aims of this study are to verify the potential lead damage on olfactory function and to identify early effects due to lead exposure. Our diagnostic evaluation included: (i) questionnaire to collect data about work and clinical history, (ii) olfactory evaluation: threshold test (Single-Starcaise) and identification/discrimination test (Wright). Lead exposure was evaluated by air sampling and biological monitoring (PbB, lead in blood). A sample of 18 exposed workers (mean age: 41.3 +/- 7.8; years exposure: 8.38 +/- 6) and of 39 controls (mean age: 41.9 +/- 9.7) were evaluated. The comparison between the threshold test of two groups confirmed a worse olfactory function in exposed (-4.97 log(10)vol/vol) compared to controls (-6.37 log(10)vol/vol), while the Wright test didn't show any significant correlation. The study didn't find a significant association between individual PbB levels and the threshold test. Knowledge of the effect of chronic occupational exposure to industrial chemicals on olfactory function is largely incomplete, but supports the hypothesis that olfactory neuroepithelium is susceptible to environmental exposures to chemicals. Occupational-related olfactory impairment is usually sub-clinical, and can be only detected using adeguate quantitative olfactory function testing procedures for quality research in this field.

[Research and formal demonstration of evidence of efficiency in occupational medicine]. / Ricerca e dimostrazione formale delle prove di efficacia in medicina del lavoro.

There is an increasing pressure on occupational health professionals to ensure that their practice is based on a quality standard and an evidence of appropriateness. The efficacy-effectiveness of their activity strictly depends on their intellectual and professional integrity, their technical and legal competence, but also on the quality of the relations with the company organisation they are able to establish. We asked to some occupational physician when they considered their interventions in the workplace to be efficacious. Then, accordingto our epexrience, we propose some effectiveness indicators, particular concerning health surveillance and health educttaon, that should be evaluated to verify the health professional agccvity agreement to quality standards.

[Efficacy in occupational medicine: proposals of the regional sections of SIMLII of Lombardy and Emilia Romagna]. / Efficacia in Medicina del Lavoro: le proposte delle sezioni regionali SIMLII della Lombardia e dell'Emilia Romagna.

The efficacy in Occupational Medicine is based on the degree of attainment of workers health and safety care. The Occupational Physician activity, attending on business parts, gives a contribution to the mission of the firm leading to the workers health/safety. The Occupational Physician actions are conditioned by workers features and by the other members of prevention system. It is necessary to verify the efficacy, the efficiency and the adequacy of the Occupational Physician activity finding goals and specific indicators.

[Characterisation of an HBsAg mutant of hepatitis B virus (HBV) isolated from a dialysed patient involved in an occupational accident]. / Caratterizzazione di un mutante dell'HBsAg del virus dell'epatite B (HBV) in un paziente dializzato coinvolto in un infortunio professionale.

BACKGROUND: Mutants of the hepatitis B virus (HBV) following vaccination (escape mutants) have been isolated over the course of the last decade. They consist most commonly of an aminoacid change from glycine to arginine at position 145 of the highly antigenic a determinant of the surface antigen (HBsAg). OBJECTIVE: Description of an escape mutant of HBV identified in the course of the post-exposure follow-up of a percutaneous exposure. METHODS: The viral DNA was extracted from serum samples of a dialysed patient vaccinated against hepatitis B, who developed an acute infection. A direct sequencing was performed on the amplified DNA followed by a sequence analysis. RESULTS AND CONCLUSIONS: A threonine to lysine substitution at position 118 of HBsAg (Thrll8Lys) was observed in the analysed viral aminoacid sequence. Such mutation could have significantly changed the antigenic profile of the HBsAg compared to that of the wild type.

Olfactory function in workers exposed to moderate airborne cadmium levels.

OBJECTIVE: The present study investigated the olfactory function in workers exposed to moderate airborne cadmium (Cd) levels, with the purpose of identifying possible early adverse effects of the metal, not demonstrable with the traditional diagnostic methods. METHODS: The exposed group consisted of 33 men employed in cadmium fusion, sintering and alloys lamination. Two reference groups were considered: the first consisted of 39 subjects assigned to manual workings, but not exposed to harmful substances for olfaction (drivers, warehousemen); the second was characterized by 23 subjects exposed to iron and steel welding fumes (iron base alloys), non-specific irritants on the respiratory tract. Olfactory threshold and odor identification ability were separately quantified. Individual occupational exposure was studied by calculating the mean blood and urinary cadmium values (CdB and CdU, respectively) of the five years period during which, for each worker, the highest levels of dose indicators were measured. As indicator of renal tubular damage, urinary beta(2)-microglobulin levels in the same quinquennium were monitored. RESULTS: Mean olfactory threshold scored significantly higher in Cd workers (-5.26 log(10)v/v, P=0.02) than did in controls (welders: -5.78 log(10)v/v; P=0.26 compared to non-exposed -6.37 log(10)v/v). The odor identification test findings for Cd workers were similar to those of the reference groups. Moderate blood and urine cadmium levels (mean CdB 3.7 microg/l; mean CdU 4.4 microg/g creatinine) accompanied threshold impairment. Olfactory threshold weakening was confirmed in the subgroup of Cd workers in which urinary beta(2)-microglobulin never exceeded 300 microg/l (-5.41 log(10)v/v; P=0.045 compared to non-exposed). CONCLUSIONS: These data suggested that possible early toxic effects of the metal can occur at low levels, close to the limits proposed by the American Conference of Governmental Industrial Hygienists (ACGIH), confirming the hypothesis that primary olfactory neuron may represent the early target for cadmium toxic action. The action of the metal seemed to be due to an elective tropism for the olfactory epithelium and not to a non-specific irritant effect on the nasal cavity. The mechanism of this effect did not appear linearly dose-related. These findings underline the importance of olfactory tests to identify the early effects of xenobiotics even at low-exposure levels, and to contribute to verify the adequacy of the current exposure limits.

[Determination of interleukin-8 in induced sputum of workers exposed to low concentrations of asbestos]. / Determinazione dell'interleuchina-8 nell'espettorato indotto di lavoratori esposti a basse concentrazioni di asbesto.

The concentration of interleukin-8 (IL-8) in the induced sputum of 17 workers exposed to low airborne asbestos levels and of 10 controls was determined. IL-8 levels were statistically significantly increased in the asbestos exposed group compared to controls. This finding underlines the usefulness of the study of proinflammatory mediators as possible predictors of alveolar damage.

[Ethical problems in health surveillance]. / I problemi etici della sorveglianza sanitaria.

Surveillance of workers' health in the field of occupational medicine poses substantial ethical problems in view of occupational medicine's complex responsibilities towards workers and employers, preventive and protection services, workers' representatives, public healthcare and preventive medicine facilities, controlling agencies and judicial authorities. Potentially conflicting rights and duties often come into play in this sector. In the last few years various international and national bodies have drawn up codes of ethics or guidelines for the conduct of physicians in occupational medicine, three of which are of particular importance: 1) The International Ethical Code of the International Commission on Occupational Health (ICOH, 1992); 2) The Code of Conduct of the National Association of Company Doctors (ANMA, 1997); 3) The Technical and Ethical Guidelines for workers' health (ILO, 1998). The chief purpose of all these documents is to safeguard the health of workers and to guarantee the safety of the workplace by defining programmes of health supervision to match specific risks. The methods should be non-invasive and should allow for a check or efficiency. The physician is expected to have a high degree of professionalism and up-to-date skills; to be independent and impartial; to be reserved and capable of inter-disciplinary co-operation. On the basis of the above documents, a number of problematic aspects may be appraised concerning the relationship between the occupational health physician responsible for the surveillance activities of the local health authority and the relative company physician. The documents stress the importance of keeping up to date and of quality, fields in which the dominant role played by Scientific Societies is underlined. Finally it is recommended that health supervision be arranged in such a manner as to foster the professionalism and responsibility of the physician in charge rather than the formal implementation of health-care procedures that are inadequate and not in line with up-to-date scientific knowledge.

[Health surveillance: from risk presumption to risk assessment]. / La sorveglianza sanitaria: dalla presunzione del rischio alla valutazione del rischio.

A working group of the Occupational Medicine and Industrial Hygiene Association of Lombardy, the National Association of Occupational Health Physicians the National Society of Prevention Operators made a paper in order to rationalize the sanitary surveillance, observing the laws in force and following the European Directives. The authors, thinking that everyday experience not very useful health examinations are carried out and that the sanitary surveillance should be planned according to the real working risks, give methodological directives about the way to make the mandatory clinical examinations less frequent, to the firms, to the occupational health physician and to the public occupational health operators of the local health units that must supervise the sanitary surveillance.

[Occupational medicine in Desio: 20 years of activities]. / Medicina del Lavoro a Desio: 20 anni di attività.

We describe the main factors determining the evolution of the Occupational Medicine Department of Desio Hospital (UOOML) during last twenty years. We report the more meaningful experiences achieved during this period of time. We also describe the present organization of the department in relation to the main activities.