Work related stress and blood glucose levels.

AIM: The aim of the study is to evaluate work-related subjective stress in a group of workers on a major Italian company in the field of healthcare through the administration of a valid "questionnaire-tool indicator" (HSE Indicator Tool), and to analyze any correlation between stress levels taken from questionnaire scores and blood glucose values. MATERIAL AND METHODS: We studied a final sample consisting of 241 subjects with different tasks. The HSE questionnaire - made up of 35 items (divided into 7 organizational dimensions) with 5 possible answers - has been distributed to all the subjects in occasion of the health surveillance examinations provided by law. The questionnaire was then analyzed using its specific software to process the results related to the 7 dimensions. These results were compared using the Pearson correlation and multiple linear regression with the blood glucose values obtained from each subject. RESULTS: From the analysis of the data the following areas resulted critical, in other words linked to an intermediate (yellow area) or high (red area) condition of stress: sustain from managers, sustain from colleagues, quality of relationships and professional changes. A significant positive correlation (p <0.05) between the mean values of all critical areas and the concentrations of glucose values have been highlighted with the correlation index of Pearson. Multiple linear regression confirmed these findings, showing that the critical dimensions resulting from the questionnaire were the significant variables that can increase the levels of blood glucose. CONCLUSION: The preliminary results indicate that perceived work stress can be statistically associated with increased levels of blood glucose.

Work-related stress in healthcare workers.

BACKGROUND: In the assessment of work-related stress it is crucial to find the factors that generate and increase it in order to identify categories of individuals at risk, to plan interventions for prevention, elimination or reduction of risk. The aim of the study is to assess the subjective stress in 68 workers of a large Italian company dealing with human health, through the use of a questionnaire-indicating tool, elaborated by the Italian National Institute for insurance against accidents at work (INAIL) and developed by the Health and Safety Executive (HSE). METHODS: We studied a final sample of 68 individuals (34 drivers/rescuers and 34 video display unit (VDU) operators). The questionnaire consists of 35 items (divided into six areas) with five possible answers each, that cover working conditions considered potential causes of stress. RESULTS: The drivers/rescuers had a better performance than the VDU operators, especially in the areas "demand", "relationships" and "role". We compared men and women in the two groups, finding that, in VDU operators, women had a better performance than men in all areas, except "role" and "changes", in which the overall scores were the same in men and women. In the drivers/rescuers women showed more critical scores in the items "relationships" and "change". CONCLUSION: The results show that: the questionnaire-indicating tool is useful, with a demonstrated effectiveness for the occupational physician during the visits and proven validity; additional future efforts should focus on understanding the psycho-social, organizational and individual problems related to stress and the consequent implementation of preventive measures.

[Prolonged exposure to urban pollutants and arterial blood pressure: a whole evaluation of our researches]. / Esposizione protratta ad inquinanti urbani e pressione arteriosa: una valutazione d'insieme delle nostre ricerche

AIM: A significant relationship between exposure to cadmium and PAHs from urban air pollution and blood pressure has already been found. The aim of the study is to evaluate if other urban pollutants maintain a similar relationship in outdoor workers. MATERIALS AND METHODS: 349 subjects of both sexes were enrolled in the study; we evaluated values of environmental and biological monitoring of respirable dust, arsenic, lead, benzene, toluene, xylene and we measured blood pressure (BP) in upright and in supine position; to analyze data we used multiple linear regression. Also we valued our results in the light of those we have obtained in previous research. RESULTS: Multiple linear regression showed no significant results that demonstrate a relationship between BP and these pollutants. CONCLUSIONS: The results of our study lead to assume that exposure to urban pollutants studied has not connection with blood pressure, and to retain valid the relationship previously observed for cadmium and PAHs, which seem to be the only pollutants that can affect blood pressure.

Ballet and stress. A pilot study.

BACKGROUND: Work-related stress is a complex problem requiring a work environment-based assessment. Artists like dancers represent a category of atypical workers potentially at high risk for work-related stress. Aim of our pilot study is to evaluate organizational stress in a population of professional dancers, using the HSE Indicator Tool for Work Related Stress. METHODS: We administered the Italian version of the HSE Indicator Tool to 38 ballet dancers, males and females. The questionnaire evaluates 7 key organizational dimensions: demand, control, managers' support, peer support, relationships, role and change. RESULTS: The standards required-ideal conditions are achieved in none of the above-mentioned dimensions. Change is the only dimension for which results fall between the 20th and the 50th percentile, while for other dimensions results fall below the 20th percentile suggesting the need for immediate corrective action. In male dancers an acceptable situation is highlighted for the dimension "change" compared to female dancers. In both sexes there is a high frequency of subjects complaining of verbal abuse, bullying and harassment. CONCLUSIONS: Despite the small sample size, our pilot study highlights the presence of heightened levels of organizational stress. Preventive measures targeted towards improving communication between managers and dancers and aimed at team building should be implemented.

Work related etiology of amyotrophic lateral sclerosis (ALS): a meta-analysis.

BACKGROUND: The aim of this meta-analysis was to evaluate the association between ALS and occupational exposure to physical (ELF-EMF) and chemicals (solvents, heavy metals and pesticides) agents. METHODS: We considered articles published from 1980 up to April 2013; in total, 750 publications were evaluated. The studies had to satisfy the following criteria: 1) cohort or case-control studies; 2) the presence of individual exposures; 3) clinical diagnosis of sporadic ALS or sporadic ALS on the death certificate. We followed the evaluation of quality in two steps. The first step classified studies according to a rating system based on a mix of criteria developed by scientific organizations, especially developed for studies of risk factors for ALS. The ratings obtained range from I (highest) to V (lowest). The data on risk factors derived from studies with Armon ratings of I, II, and III can reach levels of evidence A (established risk factor), B (likely risk factor), or C (possible risk factor). The second step evaluated the exposure and a score from 1 to 4 was assigned to each item; an exposure with a score of 3 or 4 was considered sufficient. Different analyses were performed on ALS and exposure to metals, solvents, pesticides and electromagnetic fields. In our study the heterogeneity was assessed both by χ2-based Q-tests and through the index of inconsistency I² while the measure RR/OR and CI of 95% to estimate the relationship between ALS and the various considered risk factors was employed. RESULTS: The association between exposure to pesticides and ALS as a whole is weak and not significant. With regard to the results of individual studies the following critical synthesis can be reported: 1) the selected studies showed a low level of association between ALS and electromagnetic fields; 2) as regards the solvents, the association with ALS in some studies is combined with a slightly increased risk, particularly in women, and in others a slight but significant linear association is observed; 3) for the metals, in some cases there was a stronger association in women than in men; for individual metals, there was an association especially with chromium and lead; 4) lastly, with regard to the products of agricultural pesticides in general, there was an association with ALS in men but not in women, with a dose-response relationship. CONCLUSIONS: The lack of statistically significant association between occupational exposure and ALS is mainly due to the methodological diversity of the studies and the lack of prospective studies at the workplace.

Blood pressure changes and polycyclic aromatic hydrocarbons in outdoor workers.

OBJECTIVES: Everyday outdoor workers are exposed to chemicals including the polycyclic aromatic hydrocarbons (PAHs). The aim of the study is to evaluate the relationship between hydroxypyrene and blood pressure in outdoor workers. MATERIALS AND METHODS: 374 subjects of both sexes entered the study. We evaluated the assay of urinary hydroxypyrene (1-HOP); their blood pressure (BP) was measured in upright position and in the supine position and the correlation between the levels of 1-HOP and BP was assessed using Pearson test and linear multiple regression. RESULTS: The results obtained show that in the total sample the levels of urinary 1-OHP are negatively associated with systolic and diastolic BP in supine position and in upright position. The significance is maintained despite the stratification of the sample according to age; in non-smokers we found a negative relationship between 1-OHP and differential blood pressure, both systolic and diastolic. CONCLUSIONS: The results of the study suggest that occupational exposure to PAHs may be able to significantly influence the blood pressure probably acting on the autonomic nervous system.

Correlation between urinary nickel and testosterone plasma values in workers occupationally exposed to urban stressors.

BACKGROUND: The purpose of this study is to assess whether occupational exposure to low doses of nickel (Ni) present in urban air can cause alterations in the concentration of plasma testosterone in workers of the Municipal Police of a large Italian city assigned to different types of outdoor tasks. METHODS: 359 male subjects were included in the study and divided on the basis of job, age, length of service and smoking habits. The dosage of the atmospheric Ni was performed by personal dosimetries on a sample of the workers included in the study. For each worker included in the study the dosage of whole blood Ni and of the plasma testosterone was carried out. The total sample was subjected to the independent-samples T-test and the Mann-Whitney U test for variables with 2 modes (smoking cigarette) and the ANOVA test and the Kruskal Wallis test for variables with more than 2 modes (age, length of service and job function). The correlation of Pearson with p at 2 wings between the variables was evaluated in the total sample and after subdivision on the basis of smoking and on the basis of the job. After taking into account the major confounding factors the multiple linear regression was performed on the total sample and after breakdown by tasks. RESULTS: The correlation between the values of urinary Ni and the values of plasma testosterone on the total sample and for all classes of subdivision was found constantly negative. These results were confirmed by multiple linear regression, which indicated the Ni as the only significant variable that can contribute to the alterations of the testosterone. CONCLUSIONS: Based on the results, the Authors suggest that occupational exposure to low doses of Ni present in the urban environment is able to influence some lines of the hypothalamic-pituitary-gonadal axis in exposed workers.

Workers of the printing industry and hepatic damage.

BACKGROUND: Typesetting industry is still the primary instrument of communication, despite the development of new technological systems. This study focuses on the analysis of the hepatic effects induced by the use of some organic solvents employed in the printing industry. METHODS: We studied a group of 194 workers: 93 exposed and 101 not exposed. The level of the exposure to chemical pollutants were assessed through the environmental monitoring of blood concentrations and the analysis of airborne substances. The health survey was performed through the collection of the medical history and the use of hepatic tests, which were evaluated by calculating Mean, Standard Deviation, Student's t-test and X² test with Yates Correction, to investigate statistically significant differences in some hepatic parameters: AST, ALT, ALP, GGT, fractional and total bilirubin. The environmental data sometimes exceeded the TLV-TWA. RESULTS: The clinical evaluation of the hepatic parameters showed statistically significant differences as to the hematic concentrations of AST, ALT, GGT. CONCLUSIONS: The results we obtained support the hypothesis of a risk among the printing industrial workers attributable to the hepatotoxic solvents. This risk seems to be related to the use of a mixture of solvents, although at low doses, and the analysis of the results obtained confirms the validity of the investigation for the health screening protocol adopted in order to identify subjects and/or population at risk of hepatotoxicity.

Urinary hydroxypyrene and estradiol in an occupationally exposed "outdoor" population.

BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs) are widely present in the air pollution. The urinary hydroxypyrene (1-HOPu) is considered the main biological biomarker currently available to measure the exposure to PAH. It is supposed responsible of an increase of estradiol levels in males. Aim of this study is to verify whether there is a relation between 1-HOPu and plasmatic estradiol in non-smoker male workers. METHODS: The study was conducted on a sample of 122 non-smoker policemen in a large Italian city; we monitored their levels of 1-HOPu and the values of estradiol. The sample was divided into three groups according to the levels of urinary hydroxypyrene. The indices of correlation (r) and multiple linear regression (ß), between levels of 1-HOPu and estradiol were calculated. It was also calculated the student's t-test among the groups to check the differences. RESULTS: We found statistically significant correlations and multivariate linear regressions between 1-HOPu and estradiol in the total sample and in group III (levels of 1-HOPu above the 75th percentile). The average levels of estradiol in group III was statistically and significantly higher than in the group I (levels of 1-HOPu below the 25th percentile) and group II (levels 1-HOPu between 25th and the 75th percentile). CONCLUSIONS: 1-HOPu in non-smoker male workers is related with an increase of plasmatic estradiol. We believe that PAHs, of which 1-HOPu is the main biomarker, can interact with the hypothalamic-pituitary axis. The preliminary results suggest that the topic needs further research on male and female as well.

[Urban individual exposure to cadmium and baroreceptor response to posture]. / Esposizione ad inquinanti urbani e riflessi barocettivi posturali.

OBJECTIVE: Outdoor workers are daily exposed to urban pollutants. The aim of the study is to evaluate the relationship between the values of environmental monitoring collected by personal dosimetries and changes in blood pressure due to posture in outdoor workers. MATERIALS AND METHODS: 32 subjects of both sexes were enrolled in the study, we evaluated the values of environmental monitoring of breathable dust, nickel, arsenic, cadmium, lead, benzene, toluene, xylene and 16 PAHs. Blood pressure in supine and standing positions was measured in all subjects. RESULTS: The multiple linear regression analysis showed a significant reduction of orthostatic response of diastolic blood pressure in non-smoking outdoor workers occupationally exposed to cadmium. CONCLUSIONS: The results of our study let us to believe that exposure to low doses of urban polluted cadmium may affect the response of diastolic blood pressure to orthostatism, as per a paraphysiological condition of sympathetic down-regulation.

Liver damage in automotive and industrial workers of the glass.

OBJECTIVE: High doses of organic solvents can cause hepatic disease. We investigated whether exposure to low doses of solvents in automotive and industrial workers may lead to changes in liver tests. METHODS: We studied the liver parameters (glutamic oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), gamma-glutamyl-traspeptidasi (γ-GT), alkaline phosphatase (PHA), total (TB) and direct bilirubin (DB) of 24 workers exposed to organic solvents and of 30 unexposed controls. RESULTS: A significant increase of GOT, GPT and γ-GT was found in exposed workers compared to unexposed controls workers. The ratio GPT/GOT was significantly higher among the exposed compared to controls. CONCLUSIONS: The results confirmed the hypothesis that exposure to low doses of solvents may determine a liver damage.

Workers exposed to urban stressors and the effects on antidiuretic hormone secretion.

BACKGROUND: The aim of this study was to evaluate whether urban pollutants can affect plasma levels of antidiuretic hormone (ADH) in outdoor workers. MATERIALS AND METHODS: We selected 208 subjects, 104 exposed to urban stressors and 104 non exposed to urban stressors. We divided these workers in 3 groups: Group 1 (non-smokers and non-drinkers), Group 2 (smokers and not drinkers) and Group 3 (drinkers and not smokers). The means and standard deviations of ADH were calculated, and a Student's t-test was used to compare means. The data were considered significant at p ≤ 0.05. RESULTS: The outdoor workers in Group 1 had significantly reduced plasma levels of ADH. In contrast, the outdoor workers in Groups 2 and 3 had increased plasma levels of ADH. These results were consistent in both men and women. CONCLUSIONS: The results suggest that urban pollutants may influence the secretion of ADH.

[Carpal tunnel syndrome and steel industry]. / Tunnel carpale e industria metalmeccanica.

OBJECTIVES: The carpal tunnel syndrome (CTS) is a common working pathology. The CTS diagnosis is not so easy because neurophysiological investigations are necessary. The purpose of this study is to evaluate the working risks and the presence of CTS signs using a focused anamnestic and clinical procedure. MATERIALS AND METHODS: We evaluated the working risks of CTS in a population of 65 male workers of a steel industry (average age 25.1 and seniority 2.82), performing 5 different tasks. The Borg Scale was used to evaluate the subjective muscle effort. Diurnal paresthesia (V1FG), nocturnal paresthesia (V1FN), hypersensitivity (V1IS), hypostenia (V1IT) were considered. RESULTS: We identified three main working risks repetitiveness of single actions, static and prolonged posture of the truck, muscle effort. 21.5% of the workers showed at least one of the three symptoms;13.8% showed one or more symptoms; the clinical objectivity was observed in 18.5%. A relation between V1FG, V1FN, clinical objective linked to the workers age of the task 1 (p =0.035) is showed. CONCLUSIONS: To prevent CTS, the use of the Borg Scale associated with identification of the risks and with the anamenstic-clinical investigation is useful to discriminate people at risk of CTS.

[Assessment of otoacustic emissions efficiency in diagnosis of hearing loss in workers exposed to airport stressors]. / [Valutazione della validità delle emissioni otoacustiche nella diagnostica del danno uditivo in lavoratori esposti a stressor aeroportuali].

OBJECTIVES: Otoacoustic emissions are signals that originate from the cochlea, measuring them can be considered an objective method in the assessment of auditory function. In our study we wanted to examine their efficiency among normal audiological exams. MATERIALS AND METHODS: We examined 14 workers exposed to continuous aircraft noise. They underwent ENT examination, metric eardrum test, hearing test tone audiometry system powered by 1 dB, spontaneous otoacoustic emissions and evoked otoacoustic emissions. For inclusion in the study the patients had to show bilateral normoacusia at the audiometry. RESULTS: The variation of the audiometric tracks was statistically significant (p <0.05) at a frequency of 4 kHz. As to SNR parameter (relationship between sound/noise) we noticed a tendency of the transient-evoked otoacustic emission (TEOAE) to shift their spectral content, in particular a decrease in the high frequency response and on the other hand an increase at low frequencies. A similar trend for shifting in latency of otoacoustic waves emissions after exposure to chronic noise. CONCLUSIONS: The measurement of evoked transient otoacoustic emissions is well tolerated by the workers and provides objective results, so it is a more effective and objective method then the tone audiometry.

[Cardiovascular diseases in workers at risk]. / Cardiovasculopatie in lavoratori a rischio.

Our research group has conducted several studies to investigate the effects of occupational risks on the cardiovascular system of exposed workers. In these studies, groups of workers exposed to possible professional cardiovascular risk factors were compared with controls with respect to some parameters (blood pressure, ECG, etc.). The groups were made comparable by age, length of service, traditional cardiovascular risk factors and possible confounding factors outside work. Four studies investigated the effects of noise exposure, three studies the effects of exposure to urban stressors, other studies the presence of other cardiovascular risk factors in various occupational categories (manual workers, agricultural workers, workers exposed to ionizing radiation, workers in rotogravure factory). The results of our studies confirm the presence of cardiovascular risk factors in various professions and the consequent need to take develop preventive strategies in workplaces to prevent the onset of cardiovascular diseases associated with these risk factors.

[Radon risk and prevention]. / Rischio radon e prevenzione.

The chemical element Radon is the strongest source of natural ionizing radiations for men and it is responsible of some patologies, such as lungs cancer. The concentration of this gas in houses is in Italy on average 70-75 Bq/m3. Apart from a regulative first step, represented by the 2002 Radon National Plan, at the moment there are no specified rules regarding the risks of exposition to radon in general population. On the contrary, safeguarding workers exposed to natural sources of radiation, working places are regulated by legislative decrees. In order to carry out corrective actions in case of high rates, it is necessary to correctly measure the expositional levels both with active and passive instruments. The topical knowledge about radon and its effects urge us to take preventive and reductive measures, protecting the well-being if population.

Occupational exposure to noise and the cardiovascular system: a meta-analysis.

The aim of our meta-analysis is to evaluate the association between the modifications of the cardiovascular system and chronic exposure to noise in occupationally exposed subjects. We considered the articles published from 1950 to May 2008. Only 15 papers were conforming to the inclusion criteria identified for this meta-analysis. A total of 18,658 workers were divided in three groups according to the level of noise exposure as measured in the original studies (High Exposure, HE, Intermediate Exposure, IE, Low Exposure, LE). A preliminary evaluation of the type of data allowed for a classification of the type of performed measurements. Two classes of variables were identified: Class I, composed by continuous variables (systolic blood pressure, SBP, diastolic blood pressure, DBP, and heart rate, HR) and Class II, composed by not continuous variables (prevalence of hypertension and prevalence of ECG abnormalities). For each variable the calculation of heterogeneity was performed. For continuous variables the calculation of ES and its significance were performed while Odds Ratio (OR) and its significance were calculated for not continuous variables. The results show a statistically significant increase of SBP and DBP in HE workers compared to LE and IE workers while HR is statistically higher in HE participants compared to LE participants. The prevalence of both hypertension and ECG abnormalities is statistically higher in HE workers compared to LE and IE workers. Taking into account both the extremely high heterogeneity among studies and the ES/OR values we suggest a particular attention to the measurement and evaluation of SBP, DBP and HR in workers with chronic exposure to noise. Also ECG for workers with chronic exposure to noise is suggested in order to identify and evaluate possible abnormalities noise could be a concurrent cause of.

[Assessment of the cancerogenic risk in schools]. / Valutazione del rischio cancerogeno nelle scuole.

The aim of the study is to verify the presence of the carcinogenic risk for teachers, technical assistants and students in 96 secondary schools, providing suggestions for its assessment. Since the analysis of the national and international scientific literature does not reveal data on the evaluation of the carcinogenic risk nor in schools nor in similar environments, the authors gave importance to the preliminary phase of the risk assessment that is to say the inspections aimed to detect the possible presence of risk agents and to identify the possible exposed subjects. The evaluation of the exposition through the execution of environmental and biological monitoring has to be performed, according to the authors opinion, only after this indispensable preliminary phase. The carcinogenic risk has been ascertained in relation to the presence of substances used for didactical means (fuels, mineral oils, reagents, enamels and pitch, ceramic mixtures and metallic alloys) or produced during practical activities (hard wood dusts, Polycyclic Aromatic Hydrocarbons (PAHs) deriving from high temperatures cooking), analyzing the tasks implying their use and identifying the exposed subjects. The presence of carcinogenic agents has been found out in 54 on 96 schools. In order to preserve the health status of the exposed workers in schools, it is necessary the adoption of the suitable measures of prevention and protection similarly to what is established for all the work places, even before the eventual environmental monitoring.

[Mental health and life style changes in young workers]. / Salute mentale ed alterazione delle abitudini di vita dei lavoratori giovani.

Lifestyle's alterations are hazardous for health. On one hand they produce a high rate of mortality and disease, on the other hand they cause a reduction of work outcomes and an increase of occupational accidents with important consequences for both worker's health and his/her financial status. The aim of this study is to review the scientific literature for possible relationships between mental health and lifestyle alterations of young workers. We considered as lifestyle factors the attitudes towards: smoking, alcohol consumption, eating, use of medications and doping substances, physical activity and sleeping. From our study it clearly emerges the existence of correlation between lifestyle habits and mental health; in fact behavioural alterations can produce problems of mental health and vice versa. Furthermore, some work peculiarities can lead to psychic disturbances and/or to unhealthy habits which can themselves cause negative effects on working activity. It is very important for young workers to understand that unhealthy behaviours, which can be corrected, are hazardous in terms of health and safety for both the single worker and the collectivity and that those behaviours can enhances the other working risks. Because there is a close interaction between mental health and lifestyles, it would be necessary a careful promotion of mental health on workplaces and to take all the preventive measures, with particular regard for those related to the work organization, in order to reduce the onset, exacerbation and unmasking of mental disorders and psychological difficulties. In working environment, the occupational health physician and his relationship with the patient are of fundamental importance. During preventive and periodic medical examinations, the occupational health physician should take detailed information on young worker's habits regarding smoking, alcohol consumption, eating, physical activity, sleeping, pharmacological abuse and possible presence of mental disorders and furthermore he/she should actively take part in the information and education process of the worker.

Urban stressors and plasmatic 17-beta-estradiol (E2) in male exposed workers.

The aim of the study is to evaluate if the occupational exposure to urban stressors could cause alterations in 17-beta-estradiol (E2) plasma levels and related disorders in male traffic police compared with a control group. After excluding from the study, the subjects with the principal confounding factors, traffic police and controls were matched by age, working life, Body Mass Index (BMI), smoking and drinking habit. A total of 171 male traffic police and 171 controls were included in the study. In traffic police, mean E2 values were significantly lower versus controls (P < 0.001). The distribution of E2 values in traffic police and controls was significant (P < 0.001). No significant differences were found in percentage of traffic police versus controls concerning the following questionnaire items: fertility and mental health diseases. Our results suggest that the occupational exposure to chemical urban stressor, interacting with and adding to the psychosocial ones, could alter plasma E2 concentrations in male traffic police compared with a control group. According to our previous researches on other neuro-immune-endocrine parameters, E2 could be used as an early biological marker, valuable for the group, to be used in occupational set even before the onset of the pathologies.