[Prevalence of obstructive sleep apnea syndrome in a group of obese workers]. / La prevalenza della sindrome delle apnee ostruttive del sonno un gruppo di lavoratori affetti da obesità.

The Obstructive Sleep Apnea Syndrome (OSAS) is a quite diffused in workers disease, mainly in obese or overweight subjects. This syndrome can cause cardiovascular and cerebral complications and have negative effects on job performances. We evaluated 214 obese/overweight workers referred from different job areas. A diagnosis of OSAS was pre-existent in about 5% of the examined subjects, and clinical elements suggesting suspect of OSAS were present in about 15% of the sample. The risk of development Obstructive Sleep Apnea Syndrome seems to be linear correlated with BMI, neck and waist circumference. We did not find any correlation between OSAS risk and job area. We strongly suggest that health surveillance should include the evaluation of the possible presence of sleep disorders to reduce the risks associated and the negative consequences on job performances.

[Respiratory diseases in agriculture and breeding]. / Le patologie respiratorie in agricoltura e allevamento.

Agriculture is a particularly critical field for the health and safety of workers, especially because of the exposure to a variety of risk factors for respiratory system. Organic and mineral dusts, micro-organisms (fungi and bacteria), animal proteins, chemicals (pesticides, disinfectants and toxic gases (NH3, CO, H2S, SO2, NO2 CO2) often cause respiratory diseases in workers in this sector. In Italy, occupational diseases in agriculture have had a record growth--in terms of percentage increase--in the last few years, much higher than other industries (+ 341.8% between 2006 and 2010). This is due mainly to the exponential increase in number of musculoskeletal disorders and bronchopulmonary diseases; in particular, respiratory diseases have had a percentage increase equal to + 60.8% in the last six years. In this paper we'll discuss about the most frequent occupational respiratory diseases affecting agricultural workers and about their main causal agents.

[Occupational allergic "march". Rapid evolution of contact dermatitis to ammonium persulfate into airborne contact dermatitis with rhinitis and asthma in a hairdresser]. / La marcia dell'allergia. Rapida evoluzione di una dermatite da contatto da ammonio persolfato in airborne contact dermatitis con rinite ed asma bronchiale.

BACKGROUND: Hairdressers are exposed to irritants and allergenic compounds that may cause contact dermatitis, rhinitis and asthma. OBJECTIVES: In this paper we describe the case of a female, age 33 years, who developed contact dermatitis after 10 years of exposure to ammonium persulfate. METHODS: After 7 months of progressively extensive and persistent skin lesions, respiratory symptoms appeared that were related to the occupational exposure (on-off test). SIDAPA and specific occupational patch test for hairdressers and occupational challenge with ammonium persulfate were performed. Clinical parameters of inflammation, ECP (eosinophil cationic protein) and exhaled nitric oxide (FeNO) were detected before and after the specific bronchial challenge. RESULTS: The patch test was positive to ammonium persulfate (++), and bronchial challenge for ammonium persulfate showed a significant late response (FEV1 decrease--33%). Both FeNO and ECP showed a significant increase after 24 hours. Dermatitis, urticaria and angioedema occurred on the uncovered skin due to airborne contact. Topic steroids and anti-histaminic drugs resolved the clinical symptoms. CONCLUSIONS: Bronchial challenge is, in fact, considered to be the gold standard for the diagnosis of occupational asthma, although new inflammatory parameters can contribute to the diagnosis and can be useful for monitoring after a specific inhalation test with occupational agents. The described case summarizes the evolution from contact dermatitis to inhalation allergy, suggesting the occurrence of an allergic "march" for occupational allergy.

Use of total reflection X-ray fluorescence (TXRF) for the evaluation of heavy metal poisoning due to the improper use of a traditional ayurvedic drug.

An Indian patient referred to Clinica del Lavoro 'L.Devoto' of Milano showed clinical signs of heavy metal poisoning, possibly related to a sustained 6-month use of approx. 3 g/day of a traditional preparation (a whitish powder with a 'mineral' appearance) to treat urological problems. To confirm the causal relationship between the disease and the use of such product, metal testing was performed on the patient's hair and the ayurvedic remedy samples by total reflection X-ray fluorescence (TXRF). For TXRF analysis 1-cm cut of the patient's hair was directly deposited onto the quartz glass sample carrier, then 10 microl of nitric acid 65% were added and dried in air. TXRF showed high versatility, rapid and simultaneous element detection, and short analysis time, thus supporting a wider use in emergency medicine and in forensic analyses.

[Respiratory allergy to nickel. Description of an atypical clinical case]. / Allergia do nichel. Descrizione di un caso di rinite ed asma professionale atipico.

BACKGROUND: Exposure to nickel sulphate, other than contact dermatitis, can potentially cause respiratory symptoms. Although few cases of occupational rhinitis and asthma are reported in literature, a prolonged exposure can determine sensitization and evolution to respiratory symptoms. OBJECTIVES: Clinical evaluation of a case of occupational rhinitis and asthma due to nickel sulphate. METHODS: A female worker, aged 43 years, has been occupationally exposed to nickel for 22 years. After 1 year she experienced asthma, apparently not work related. She treated the respiratory symptoms for many years, but a slow and progressive increase of the disease was observed. During the last five years a straight relationship between work and symptoms was observed. On-off test was positive. The diagnosis of occupational respiratory disease was based on the work-related symptoms and the specific nasal challenge test result. RESULTS: An early response was observed with nasal symptoms (score 4), increase of anterior nasal airflow resistance (33%), severe dyspnea, haematic eosinophilia, and fall in FEV-1 of 18%. CONCLUSIONS: The prolonged exposure to nickel determined impairment of respiratory function. Nasal challenge, more safe and useful than bronchial challenge, can be considered gold standard for the diagnosis of occupational rhinitis and asthma due to occupational allergens.

[Alcohol intake, complex ability and responsibility towards others: experience on a cohort of personnel employed to public transport services]. / Consumo di alcool, idoneità complesse e responsabilità verso terzi: 1'esperienza di una coorte di addetti al trasporto pubblico urbano.

BACKGROUND: The excessive intake or the abuse of alcoholic substances represent an important hazard's source for the individual health and for the carrying out of any complex working activities, above all if characterized by elevated responsibility toward other people. In this context the recent Provision of 16 March 2006 of the Permanent Lecture for the Relationships among the State the Regions and the Autonomous Provinces of Trento and Bolzano, has individualized bus driver among the activities or tasks of which is forbidden the assumption of alcoholic drinks at work and can performed alcoholic controls by the competent physician (art. 15 of the Law March 30 th 2001, n. 125). Within the normative considering the DM 23 February 1999 n. 88s (Rule bringing norms dealing about the check and the control of the physical and psycho-aptitude ability of the personnel employed to public transport services), we introduced experience growing up in the period from January 2005 to August 2006, on about 1500 employees, for over 90% of men, employed in a public transport company of the Lombardy as bus driver or railwayman. METHODS: In order to assess driver's alcoholic abuse the analytical determination of carbohydrate-deficient transferring (CDT) has been used as a marker of alcohol intake. Within the visits of hiring in service (equal to 10% of the total one of the effected visits) the determination of the CDT has always been performed, while in revision visits (equal to 90% of the total one) this analytical determination has been performed only if possible alcohol abuse has been hypothesized by elevated values of gamma-GT before the Provision March 16th 2006 (and eventually of MCV, AST and ALT) and of routine from April 2006. CONCLUSIONS: This experience on this large population has confirmed the importance of a careful behaviours of abuse monitoring in workers with high responsibility toward other people. The CDT values reflect high alcoholic consumption, while is poorly remarkable the contribution furnished by anamnestic questionnaire.

[Assessment of the efficacy of limitations and indications issued by the occupational physician regarding the health of the staff working in public transportation vehicles]. / La valutazione dell'efficacia delle limitazioni e delle prescrizioni espresse dal medico del lavoro sulla salute del personale addetto alla guida di automezzi di trasporto pubblico.

In this study we assessed the evidence of some specific, "ad hoc", medical indications for city bus, tram and subway professional drivers. As known, professional drivers have very little chances of modifying shift organization and many chronic degenerative diseases (low back pain, diabetes type 2, cardiovascular diseases, ecc.) are difficult to manage according to job planning. In our study we observed a positive association between introduction of specific shift, in particular when shift is divided in two-piece, on morning "turno spezzato 1(0)/1(0)" or one on morning and the second part on afternoon "turno binato 1(0)/2(0)". Evidence of the real impact on professional drivers health conditions has been found from analysis of sickness leave during two, or in same case, one year before and after such medical indications intoduction. In our occupational drivers cohort a positive association, evidence based on real rates of two years sick absence before and after medical indications, was found between improvement of health general conditions and reduction of sickness leave rates correlated.