[Noise and ototoxic chemicals. State of the art and operative strategies for health surveillance]. / Il rumore e le sostanze ototossiche. Lo stato delle conoscenze, le implicazioni operative.

European (Directive 2003/10/CE) and italian rules (DLgs 81/08), both establish that "as far as technically achievable, any effects on workers' health and safety resulting from interactions between noise and work-related ototoxic substances, and between noise and vibrations". The scientific knowledge on this subject is still lacking, but are generally considered as ototoxic, either alone or in concert with noise, toluene, styrene, ethylbenzene, carbon disulphide, lead, mercury and carbon monoxide. With particular reference to health surveillance we propose yearly audiograms for workers whose exposures are at 50% or more of the specific OEL, for noise LEPd less than 85 dB(A); for concomitant noise LEPd greater than 85 dB(A) (by wich workers are normally submitted to an yearly audiogram) the occupational physician will consider if shorten the time between audiograms.

[Risk assessment of manual handling of loads: the choice of reference values in light of Leg. 81/2008]. / Valutazione del rischio da movimentazione manuale dei carichi: la scelta dei valori di riferimento alla luce del D.Lgs. 81/2008.

Italian law on safety at work does not clarify specific levels of load for safe manual material handling. For this reason professionals appointed for safety need to define new target range value for the correct application of D.Lgs. 81/2008 law. Authors, discussing about indication of the national laws and international rules, suggest the assumption of a load of 25 and 20 kg as reference values for male and female adult and healthy workers. They also examine the graduation of the acceptable loads in relation to workers' age and the Lifting Index values to be adopted as action limit and exposure limit.

First and subsequent asbestos exposures in relation to mesothelioma and lung cancer mortality.

We analysed data from a cohort of 1966 subjects (889 men and 1,077 women) employed by an Italian asbestos (mainly textile) company in the period 1946-1984, who were followed-up to 2004. A total of 62,025 person-years of observation were recorded. We computed standardised mortality ratios (SMR) for all causes and selected cancer sites using national death rates for each 5-year calendar period and age group. There were 68 deaths from mesothelioma (25 men and 43 women, 39 pleural and 29 peritoneal) vs 1.6 expected (SMR=4,159), and 109 from lung cancer vs 35.1 expected (SMR=310). The SMRs of pleural/peritoneal cancer were 6661 for subjects exposed only before 30 years of age, 8,019 for those first exposed before 30 and still employed at 30-39 years of age and 5,786 for those first exposed before 30 and still employed at 40 or more years of age. The corresponding SMRs for lung cancer were 227, 446 and 562. The SMR of mesothelioma was strongly related to time since first exposure. The SMR of lung cancer, but not of mesothelioma, appeared to be related to subsequent exposures.

[New biomarkers of exposure]. / Nuovi indicatori di esposizione.

In this paper we have defined the new biomarkers of exposure (NBE) as those biomarkers discovered in the last five years and, among previously validated biomarkers, also those applied in different ranges of doses or those determined in biological matrices which differ from matrices originally considered. We examined the results from the surveys carried out by the main Italian research units involved in biological monitoring, i.e. those from the Universities of Brescia, Milan, Naples, Padua, Parma, Pavia, Turin and Verona. The data were collected using a standardized model and included the following: type of element or organic compound, type of biomarker, analytical technique and method, their relationship with environmental monitoring data, their relationship with effect indicators or effects in general, improvement with respect to old biomarkers, reference values. Twenty two NBEs were identified: 14 elements and chemical compounds as such or as metabolites, 4 examples of mixtures, 3 of new matrices, one of speciation. Among the others, aspects such as interest in requiring NBE, quality assurance, availability, cost-benefit ratio were discussed. We conclude that development of this specific field of research appears to be a crucial point for future improvement in risk assessment and health surveillance procedures.

Occupational Mn parkinsonism: magnetic resonance imaging and clinical patterns following CaNa2-EDTA chelation.

We report a case of occupational parkinsonism due to manganese exposure in which professional exposure has been documented both by the high blood and urinary levels of the metal and by its presence in the materials used. A strong relation was evident among chelating treatment, cessation of exposure and clinical improvement. MRI confirmed the evolution of clinical pattern by means of reduction of heavy metal deposition in basal ganglia. These findings also agree with the few experimental and human studies published. This case study points to the need for an accurate occupational history collection and suggests the possibility of useful chelating therapy with CaNa2EDTA.

[The problem of lead exposure in the Piedmont: from the workplace to the general environment]. / Il problema dell'esposizione a piombo in Piemonte: dal posto di lavoro all'ambiente di vita.

In the first part of this study, the most frequently professional lead exposure observed since 1984 at the Occupational Health Clinic of Turin University are summarized and compared with exposure observed in the past. The second part analyzes the present blood lead levels in the general (non-occupationally exposed) population observed in a screening campaign carried out in Piedmont in 1993-94 within the framework of the national programme by biology surveillance prescribed by Presidential Decree no. 496 of 1982. Results agree with literature data and show a reduction in blood lead levels markedly below the Italian legal limits. Nevertheless, lead pollution in non-exposed subjects still represents a major hygienistic problem, because a relevant number of children have blood lead concentrations above 10 micrograms/ 100 ml, which is considered a safe level for avoiding irreversible injury to nervous system.

Effects of occupational exposure to mercury and lead on brainstem auditory evoked potentials.

A study was performed to examine the effects of industrial exposures to lead and mercury on the brainstem auditory pathway by recording brainstem auditory evoked potentials (BAEPs). BAEPs were recorded from 22 workers exposed to lead, from eight exposed to mercury and from two control groups of age- and sex-matched subjects never exposed to neurotoxic substances. The time between BAEP peaks I and V were evaluated. The mean durations of exposure were 9.3 and 11.7 years for lead and mercury, respectively. Blood lead concentration (PbBc) on the morning of the test day was 47.5 micrograms/dl, whereas urinary mercury content at the end of the previous work day was 325 micrograms/g creatinine. Both mercury and lead exposed workers showed a significant prolongation of wave I-V time. In addition, the interwave time was longer in a lead subgroup with the greatest mean level of lead in blood. These results are consistent with other studies and show that BAEPs may provide a sensitive tool for detecting subclinical central neurotoxicity caused by lead and mercury.

Longitudinal study of workers of an aluminium die casting factory.

We conducted a 5-year longitudinal study on 76 workers of a high and medium aluminium alloy die-casting factory. As in a previous cross-sectional study conducted in 1986 and in accordance with the data in the literature, the 1990 follow-up study showed: a low prevalence of chronic bronchitis (as defined by the ECSC questionnaire on respiratory symptoms); normal mean functional values of FVC, FEV1, FEV1/FVC%. We did not find any significant difference in the levels of lung function over the period of 1986-90. These results show that workers in the secondary aluminium industry are not exposed to a significant risk of chronic pulmonary disease.

Auditory brainstem evoked potentials (BAEPs) in lead-exposed workers.

Brainstem Evoked Potentials (BAEPs) were recorded in 49 lead exposed workers, and in a control group of 49 age- and sex-matched subjects, never exposed to neurotoxic substances. The mean duration of lead exposure was 7.4 (SD 5.6) yr. Blood lead concentration was analyzed in the morning of the experimental day (PbBc); an averaged PbB level was based on the levels of the 3 previous years (PbBm). Interpeak latency differences (IPLD) I-V, I-III and III-V were considered. The mean PbBc level was 54.6 (SD 16.1) micrograms/dl while the mean PbBm level was 53.5 (SD 15.9) micrograms/dl. Lead exposed workers showed a significant prolongation of IPLDs. IPLD I-V was longer in the subgroup with PbBm greater than 50 micrograms/dl (4.06 vs 3.98, c.l. 95% 0.00-0.16). These results are consistent with literature data and show that BAEPs may be a sensitive detector of subclinical lead effects on brainstem auditory pathways.

Exposure to paraphenylendiamine in hairdressing parlours.

Synopsis A certain number of hairdressing parlour employers have been taken to court because their employees allegedly suffered from lung allergies caused by the vapours from PPD (paraphenylendiamine) which allegedly developed when applying hair dyes. These conclusions may be reached if the specific hazards of the rubber and particularly leather and fur dyeing industry are extrapolated as is widely reported in literature, to hairdressing employees. The purpose of this study is to assess the actual exposure rate to PPD vapours of hairdressing employees during a working day, on the basis of the type and characteristics of the salon (small, medium and large), the number of dye applications per day and the chemical-physical characteristics of the oxidation dyes. The results prove that, even under the hypothesis of experimental conditions pushed to the extreme, it is not reasonable to speak of exposure to PPD through the lungs of hairdressing employees.

[Multiple myeloma and occupational risk factors: a case-control study]. / Mieloma multiplo e fattori di rischio occupazionali: studio caso controllo.

In order to identify possible relationships between multiple myeloma (MM) and occupational factors, a hospital-based case control type study was carried out on 94 cases of MM and on 188 controls matched for sex, age (S.D. = 2 years) and area of residence, suffering from orthopaedic trauma and free of chronic/degenerative or tumoral diseases. All jobs done for at least a year in a period of 5-30 years before diagnosis were considered. Statistical analysis showed a significant correlation between MM and agricultural work (OR 1.82; I.C. 95% 1.03-3.25), which agrees with the data in the literature. The etiopathogenetic hypotheses reported in the literature are discussed and proposals for further research are made.

[Use of somatosensory evoked potentials in the exposure of the hand-arm system to localized vibrations]. / Utilizzo dei potenziali evocati somatosensoriali (SEP) nell'esposizione a vibrazioni localizzate al sistema mano-braccio.

SEPs obtained by stimulation of the median nerve of the wrist were recorded in a group of 33 subjects working with vibrating instruments in 82% of whom the case history was positive for Raynaud's Phenomenon (RP). Electrophysiological investigation revealed a decrease in peripheral nerve conduction speed, which was related to the duration of exposure to risk and the presence of RP. No diseases of the central nervous system were found. The results are discussed on the basis of the data in the literature.

[Respiratory impairment and metal exposure in a group of 68 industrial welders]. / Compromissione respiratoria ed esposizione a metalli in un gruppo di 68 saldatori al lavoro.

A group of 68 currently employed welders were examined who were exposed to welding fumes either for the whole or for at least half the working day and who used at least two welding processes, which were mainly manual metal arc welding and metal active gas welding, but also metal and tungsten inert gas welding, or oxyacetylene welding. The welders were classified into 3 groups according to the class of materials used, i.e.: 1) only mild and stainless steel; 2) mild and stainless steel and other metals; 3) only other metals. Chronic bronchitis symptoms were observed in 22% of the subjects; signs of suspected radiological fibrosis were present in 18%, initial signs of radiological fibrosis in 4%. Small airway disease was prevalent in the smokers (28 smokers versus 2 nonsmokers); one worker had an obstructive syndrome and another a restrictive syndrome (both were smokers). There was a good correlation between years of exposure and: 1) MEF25 in non-smokers; 2) urinary cobalt in the whole group. There was also a correlation between smoking and FEV1, MEF50, MEF25, PaO2 and urinary cadmium. Serum copper was higher in workers exposed full time than in those exposed part time. Urinary chromium and cobalt and serum copper were high in steel welders, lower in welders using steel and other metals and low in welders using other metals. Urinary chromium was similar in smokers and non-smokers. Serum zinc was found to be of little use for biological monitoring of welders. Urinary chromium was studied for one week in 10 full-time exposed steel welders. The difference between the chromium values at the end of the workshift and those at the beginning was small (low current exposure); the chromium values at the end of the workshift were not uniform in the whole group (different past exposure levels).