[Mental disorders related to persistent negative working conditions]. / Disturbi psichici associabili a condizioni di lavoro negative persistenti.

BACKGROUND: Mental disorders are common in our industrialised society and inevitably affect the working population. Over the last few years greater attention has been focussed on work-related psychopathologies due to an increasing number of studies regarding workplace bullying. OBJECTIVES: This study reports our observations on patients with mental disorders who came to our Occupational Health Centre because they perceived themselves to be victims of negative working conditions. An indepth analysis of their working conditions led us to the conclusion that many of these disorders were to be attributed to the workplace. METHODS: Between 2004 and 2010, 449 workers attended our Occupational Health Centre, most suffering from mental disorders which they ascribed to negative working conditions. All patients had an initial consultation session with an occupational physician which focused on the environmental and relational characteristics of their place of work. Thereafter, patients underwent a second clinical evaluation with a psychologist including several psychological tests. At the end of diagnostic process, the occupational physician and the clinical psychologist drew their clinical conclusions and defined the possible relationship with the working condition. RESULTS: For 379 out of 449 patients/workers, a positive and causal relationship between medical disorders and working conditions was established. The mental disorders observed in these groups of workers were: mixed anxiety and depressive disorder (53.6%), depressive disorder (16.2%), adaptation disorder (15.9%), anxiety disorder (13%) and only 1.3% post-traumatic stress disorder. The working conditions favouring the mental disorders were: workplace bullying, such as person-related bullying (30.1%) and task-related bullying (14.8%), adverse situations causing work distress (38.2%) or non-specific work discomfort (16,9%). CONCLUSIONS: Our experience showed that not only workplace bullying can cause different psychiatric disorders but also adverse situations that favour work distress and non-specific work discomfort often give raise to the same disorders. Negative working conditions can play a significant role in the development of psychological-psychiatric disorders: such disorders related to occupational conditions are on the increase in many industrialised countries.

[Occupational risk by the pine processionary moth Thaumetopoea pityocampa in the forestry workers of Verona]. / Rischio professionale da processionaria del pino nero (Thaumetopoea pityocampa) nei forestali di Verona.

Pine processionary moth (Thaumetopoea pityocampa) is a lepidopteran living in the Mediterranean countries whose mature larvae have microscopic hairs that can be released and carried far from the source. The hairs are responsible of urticating symptoms on the exposed areas although systemic manifestation might be involved. The study involved 94 forestry workers (92 M, 2 F) of the Regional Forest Service of Verona and the objective was to determine the prevalence of skin and respiratory disorders due to exposure to this insect. 21 chainsaw operators and 2 labourers experienced symptoms on exposed skin areas; 3 of them reported also ocular and respiratory symptoms. The chainsaw operators resulted most at risk whereas individual already suffering from others allergies do not seem to be affected. The results highlight the importance of risk assessment to Thaumetopoea pityocampa in forestry workers and the need for instruments to assess the allergic sensitization in medical surveillance.

[Work-related stress and psychological distress assessment in urban and suburban public transportation companies]. / Valutazione del rischio stress lavero correlato e del distress psichico in aziende di trasporto pubblico urbane ed extraurbano.

The risk of work-related stress has been determined in bus drivers and workers employed in the service department of two urban and suburban public transportation companies. The INAIL evaluation method (Check list and HSE indicator tool) was used. The GHQ-12 questionnaire, which is widely used to assess the level of psychological distress, was also employed. 81.9% of workers involved in the survey answered both the HSE indicator tool and the GHQ-12 questionnaire. The Check list evaluation showed an increase in quantifiable company stress indicators while close examination using the HSE indicator tool demonstrated critical situations for all the subscales, with the control subscales more problematic in bus drivers. The demand, manager's support, relationships and change subscales were most associated with psychological distress in bus drivers, while relationships, role, change and demand subscales were negatively related in workers of the service department.

[The occupational physician and communication to workers]. / Il medico del lavoro e la comunicazione con i lavoratori.

Communication ability is essential for the Physician to the proper management of ambulatory activity and corporate training. The aim of this work is describe the communication strategies to be adopted in everyday healthcare practice. When the occupational physician relates with an employee his message must act both verbal both non-verbal. The medical history should be collected carefully and during the physical examination is important to put the employee at ease by adopting a discreet and attentive attitude. The clinical findings and the capacity to work with any limitations will be discussed at the end of health surveillance using understandable terminology to the worker. During the training-information process is important to define the primary objectives, organize the program and bring the display materials. The worker should be actively involved and encouraged to learn throughout the course information. In the text will also be shown the main aspects of information on line.

The Gene-Environment Interactions in Respiratory Diseases (GEIRD) Project.

The role of genetic and environmental factors, as well as their interaction, in the natural history of asthma, allergic rhinitis and chronic obstructive pulmonary disease (COPD) is largely unknown. This is mainly due to the lack of large-scale analytical epidemiological/genetic studies aimed at investigating these 3 respiratory conditions simultaneously. The GEIRD project is a collaborative initiative designed to collect information on biomarkers of inflammation and oxidative stress, individual and ecological exposures, diet, early-life factors, smoking habits, genetic traits and medication use in large and accurately defined series of asthma, allergic rhinitis and COPD phenotypes. It is a population-based multicase-control design, where cases and controls are identified through a 2-stage screening process (postal questionnaire and clinical examination) in pre-existing cohorts or new samples of subjects. It is aimed at elucidating the role that modifiable and genetic factors play in the occurrence, persistence, severity and control of inflammatory airway diseases, by way of the establishment of a historical multicentre standardized databank of phenotypes, contributed by and openly available to international epidemiologists. Researchers conducting population-based surveys with standardized methods may contribute to the public-domain case-control database, and use the resulting increased power to answer their own scientific questions.

[Analysis of body mass index in different sector workers for over ten years]. / Analisi dell'Indice di Massa Corporea nei lavoratori di diversi settori produttivi nell'arco di dieci anni.

A critical review of the literature on obesity and overweight underlines that a low educational level, a low social-economic status, certain working conditions, the lack of physical activity in leisure time, together with the availability of food, are the main factors favouring increased prevalence of obesity. Certain jobs also contribute significantly to this problem. Automation, the use of machines for heavy works and sedentary activities favour body weight increase. Jobs that are a source of stress, such as work with night shift can cause metabolic disorders leading to an increased prevalence of obesity. The main aim of this article is to study the trend of body weight in different working area during ten years, comparing this parameter to different factors such as job, blood pressure, smoke, alcool and health diseases.

[The combined use of capillaroscopy and skin thermometry in health surveillance of workers exposed to hand-arm vibration]. / L'utilizzo combinato della capillaroscopia e della termometria cutanea nella sorveglianza sanitaria dei lavoratori esposti a vibrazioni mano-braccio.

The use of nailfold capillaroscopy combined with skin thermometry in the study of microcirculation of the hands in workers exposed to hand-arm vibration is assessed. Fifty-eight subjects were studied; 40 asymptomatic forestry workers exposed to hand-arm vibration, 13 forestry workers exposed to hand-arm vibration with Raynaud-like symptoms confirmed by skin thermometry; 5 controls. Reduction of capillary density was observed in workers exposed to vibrating tools with respect to controls. Tortuosity of capillary loops was significantly more frequent in subjects exposed to vibrating tools than in controls. No statistically significant difference in capillary vessels of the hands was found between asymptomatic exposed subjects and workers affected by Raynaud-like symptoms. In our sample nailfold capillaroscopy shows good sensibilty and specificity in detecting capillary modifications secondary to exposure to hand-vibration. Weaker evidence is instead given in order to actual disturbances of hands circulation in chronic exposure to vibrating tools.

[Noise-induced hearing loss: are health service surveillance programs always effective?]. / Ipoacusia da rumore: i programmi di sorveglianza sanitaria sono sempre efficaci?

OBJECTIVES: To evaluate noise-induced hearing loss in a group of workers at a steel engineering works over a 20 year period (1979-1999). METHODS: A total of 2431 audiometric tests were performed in 708 workers (in 1979, 1984, 1989, 1994 and 1999). Audiometric tests were classified so that hearing loss could be assessed over time. Additionally, personal noise exposure was measured for each worker (average, 85 dB(A) in tests carried out in 1992, 1996 and 1999). RESULTS: Over 5 years of noise exposure, mean cumulative incidence of noise-induced hearing loss was 8,2%. Over 10 years ofexposure (1979-89 or 1984-94 or 1989-99), the mean incidence was 15,3%. This percentage increased to 22,9% and 25,7% when the exposure lasted 15 or 20 years respectively. CONCLUSIONS: The considerable incidence of noise-induced hearing loss within the wide group of steel workers examined greatly exceeds the expected incidence related to the occupational exposure limits. The Evidence Based Occupational Medicine suggests that our health surveillance was not effective enough.

Xenobiotic action on steroid hormone synthesis and sulfonation the example of lead and polychlorinated biphenyls.

OBJECTIVES: In the present study, the metabolism of steroid hormones has been investigated to determine whether and how xenobiotics like lead (Pb) and polychlorinated biphenyls (PCBs) interfere with steroid hormone biotransformation in humans. METHODS: Three groups of subjects were tested for concentration of urinary total steroids, 17-ketosteroids (n = 5), pregnane derivates (n = 6), 17-hydroxycorticosteroids (n = 11) and their sulfonated compounds: 14 workers exposed to lead, with a mean Pb blood concentration (PbB) of 29.21 microg/dl; 15 subjects exposed to PCBs, with a mean PCB blood concentration (PCBB) of 61.69 microg/l; a control group (n = 25). RESULTS: The urinary concentrations of 17-ketosteroids and 17-hydroxycorticosteroids were significantly lower in the PCB-exposed groups. There were significantly fewer sulfonated 17-hydroxycorticosteroids in the subjects exposed to PCBs as compared to the controls, while the percentage of sulfonated steroids was lower for both 17-ketosteroids and 17-hydroxycorticosteroids in the PCB-exposed subjects, but only for the 17-hydroxycorticosteroids in the group of subjects exposed to Pb (P < 0.05). Pregnane derivate urinary concentrations did not differ between the three groups. CONCLUSION: Our results suggest that PCBs and Pb act on steroid hormone metabolism with different effects and only partially using the same hormone pathways; they may cause changes in endogenous hormone homeostasis and interfere with the xenobiotic phase II of detoxification. PCBs interfere on a larger number of steroids and cause more significant effects than Pb. It is likely that different mechanisms are involved in steroid hormone metabolism interference.

Interethnic differences at the thermometric response to cold test: functional disorders of blood circulation in hand fingers and exposure to hand-arm vibration.

OBJECTIVES: To report some notable aspects regarding thermometric response to cold test in black African subjects compared with Caucasians: both groups comprised persons exposed to hand-arm vibration and controls. METHODS: An overall sample of 48 workers was examined in order to study their blood circulation in hand fingers: a control group of 12 healthy Caucasian workers never exposed before to hand-arm vibration; 12 Caucasian workers exposed for several years to vibrating tools and affected by occupational Raynaud's phenomenon; 12 healthy black African workers exposed to hand-arm vibration for almost 3 years; and 12 healthy black African workers never exposed to hand-arm vibration. Computerized skin thermometry was performed and thermometric curves were analyzed according to thermometric interpretation criteria such as the area-over-curve (AOC), the fifth minute of recovery/baseline temperature ratio (5REC/BT) and the temperature at the tenth minute of recovery (10REC) after cold test. RESULTS: Thermometric parameters in Caucasian subjects confirmed the basis of the existing literature in controls (basal finger temperature higher than 32 degrees C and complete recovery to the initial temperature after the cold test) and also in patients with Raynaud's phenomenon (basal temperature often lower than control subjects and slow recovery of finger temperature after cold test). Statistically significant difference was found between healthy Caucasians and healthy black subjects in all the parameters tested: healthy black subjects showed values of AOC and 10REC suggesting almost constantly lower finger temperatures during the thermometry test. Black people, both exposed and non-exposed to hand-arm vibration showed thermometric parameters suggesting poor blood microcirculation, which seems even poorer than in Caucasian people complaining Raynaud's phenomenon. CONCLUSIONS: Our chronothermometric tests suggest some significant interethnic differences in peripheral microcirculation, which seems rather poor in black African subjects in comparison with Caucasians.

[Evidence Based Occupational Medicine: ten year experience with audiometric examination in a handicraft company]. / Evidence Based Occupational Medicine: 10 anni di esami audiometrici in aziende artigianali.

This work describes the audiometry threshold assessment of 1000 workers employed in different artisan categories during a period of ten-year noise professional exposure. The hearing loss noise-induced rates were determined by analysing audiometric tests at the beginning of our period of study and after 5 and 10 years of noise exposure. Environmental noise exposures were on average 88 dB(A), but near 90 dB(A) in some work categories. Workers widely used hearing protection devices, nearly at 93%, during the period we studied. The Evidence Based Occupational Medicine should find out points of reference proving the efficiency and effectiveness of occupational physicians: in this case, a positive trend in the reduction of hearing loss rate will be expected to confirm the goodness of prevention practice. Our study suggests that the levels of protection so far accepted are not effective enough in order to reduce the incidence of noise-induced hearing loss in the course of the years: in despite of most accredited predicting models for hearing conservation programs, a significant percentage of workers exposed to industrial noise continues to present a high incidence of hearing loss. The Evidence Based Occupational Medicine suggests that the proposed prevention activities carried out in the described factories were not enough effective.

[Prevalence of occupational allergic symptoms among bakers of Verona]. / Prevalenza di sintomi allergici di origine professionale nei panificatori di Verona.

The aim of the study is to evaluate the prevalence of respiratory and skin symptoms among bakers in the district of Verona by means of two standardized questionnaires, a clinical one administered to the bakeries employees, either directly exposed to flour dust or not exposed, and one concerning the characteristics of the bakery environment. The study involved 613 bakery workers, 401 bakers and 212 sales personnel employed in 152 bakeries. Bakers exposed to flour dust reported nasal symptoms in 29.2% of cases, ocular symptoms in 13.2%, cough, shortness of breath, chest tightness, wheezing respectively in 8.7%, 7%, 4.5% 6.2% of cases, itch and skin burning with paleness respectively in 9.7% and 8.5%. A significantly lower prevalence of these symptoms, except skin paleness, was reported among the sales personnel. In bakers, a significant correlation was found between ocular-nasal and respiratory symptoms and family or self-reported history of atopy (p = 0.001). Reported flour dust air pollution at the workplace correlated with occupational ocular-nasal and respiratory symptoms (p = 0.001). Flour dust on skin and clothes correlated with crusts and excoriations (p = 0.01). Our study confirms the high prevalence of allergic symptoms among bakers and the need of clinical assessment.

[Follow up of person-related bullying and work-related bullying: evaluation of effectiveness of interventions]. / Follow up di lavoratori vittime di molestie morali protratte e costrittività organizzativa: valutazione dell'efficacia degli interventi messi in atto.

Person-related bullying is regarded as a form of stress capable of cause negative effects on workers' health, potentially leading to psycho-physical symptoms, alterations of mood and personality, psychiatric disorders such as anxiety-depression disorder, chronic adjustment disorder and posttraumatic stress disorder. At the Centre for the study of psychosocial risks and pathologies at work of Verona the health state of victims of person-related bullying and work-related bullying and their working conditions are periodically evaluated. On a regular bases these workers receive psychological support and, if necessary, psychiatric treatment; at the same time interventions on working environment are undertaken when possible. Verification of effectiveness is then carried out by means of interviews starting six months after the first consultation. Two questionnaires are used; a specific one for the assessment of working environment and health conditions, and Goldberg's General Health Questionnaire--G.H.Q-12. Improvement of health state related to better working conditions was obtained in general.

[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.

[Job as a risk factor for obesity... and the contrary]. / L'attività lavorativa come fattore di rischio per l'obesità... e il contrario.

BACKGROUND: Obesity constitutes a risk for several vascular, metabolic and neoplastic diseases. In industrialised countries, but more and more in developing countries too, the prevalence of obesity is increasing. Body Mass Index and circumference of the abdomen are the two simplest and most utilized methods of measuring the degree of obesity in an individual and of comparing selected groups with different ethnic, social, cultural and occupational features. OBJECTIVES: The main aim of this article is to initiate a discussion on the possible contribution that the Occupational Health Physician can make to solving the problem of obesity, which is becoming more and more alarming in social terms. The working conditions favouring an increase in body weight and the negative effects that obesity has on various types of work are reported. METHODS AND RESULTS: A critical review of the literature on obesity and overweight stresses that a low educational level, a low socio-economic status, lack of physical activity in leisure time and certain working conditions, together with the ready availability of food, are the main factors favouring increased prevalence of obesity. Certain jobs also contribute significantly to this problem. Automation and the use of machines/robots for very heavy work in industrialised countries have the "collateral effect" of favouring body weight increase due to low energy consumption. Jobs that are a source of stress, such as work on three rotating shifts, can cause metabolic disorders leading to an increased prevalence of obesity. Contrariwise, obesity renders the individual unfit for some jobs, in fact, an increased incidence of industrial accidents has been related to obesity. CONCLUSIONS: The occupational health physicians engaged in surveillance of workers' health conditions can make a positive contribution to alleviating this problem by focusing their activity on the primary prevention of obesity and advising workers on how to maintain the right weight; otherwise, obese workers should be referred to appropriate medical centres.

Biological monitoring in occupational exposure to low levels of 1,3-butadiene.

Exposure to 1,3-butadiene (BD), a probable carcinogen to humans, was investigated in two groups of subjects working in a petrochemical plant where BD is produced and used to prepare polymers: 42 occupationally exposed workers and 43 internal non-occupationally exposed controls. BD personal exposure was very low but significantly different in the two groups (median airborne BD 1.5 and 0.4 microg/m(3) in exposed and controls, respectively). Similarly, BD in blood and urine, but not in exhaled air, was higher in the exposed workers than in controls (blood BD 3.7 ng/l versus <1.8 ng/l, urinary BD 2.4 ng/l versus <1.0 ng/l). These three biomarkers correlated significantly with personal exposure ( 0.283 < or = Pearson's r < or = 0.383) and between them (0.780 < or = r < or = 0.896). Excretion of urinary mercapturic acids N-acetyl-S-(3,4-hydroxybutyl)-l-cysteine (MI), N-acetyl-S-(1-hydroxymethyl-2-propenyl)-l-cysteine and N-acetyl-S-(2-hydroxy-3-butenyl)-l-cysteine (MII), chromosomal aberrations (CA), and sister chromatid exchanges (SCE) in peripheral blood lymphocytes were not influenced by occupational exposure. Our results show that unmetabolised BD in biological fluids, and particularly urinary BD, represents the biomarker of choice for assessing occupational exposure to low airborne concentrations of BD.

Biological monitoring of occupational exposure to N,N-dimethylacetamide with identification of a new metabolite.

AIMS: To study the concentration of N,N-dimethylacetamide (DMA) and its metabolite, N-methylacetamide (NMA), in urine of workers occupationally exposed to DMA in a factory producing synthetic acrylic fibres. METHODS: During the first phase, 223 workers exposed to low environmental concentrations of DMA provided urine samples at the end of a work shift. High concentrations of the unmodified solvent and its metabolite were found in a group of workers whose job was to start up machinery. The second and third phases focused on conditions favouring high uptake of DMA. RESULTS: The highest concentrations of unmodified solvent and NMA were found in the urine of workers recently engaged in starting up machinery. NMA in urine was 1.5-173.6 mg/g creatinine (median 20.5). In spite of the low environmental concentration, about 20% of the urine concentration of NMA was higher than 30 mg/g creatinine. Dermal absorption of DMA was high. A shower and a change of clothing at the end of the work shift, and washing away any solvent left on the skin, ensured that dermal absorption of DMA did not continue. This significantly reduced the NMA urinary concentration at values lower than 30 mg/g creatinine. In some urine samples, S-acetamidomethyl-mercapturic acid was identified by NMR analysis; this is probably a metabolite of N,N-dimethylacetamide--it has never before been identified in humans or animals. CONCLUSIONS: Even at low environmental concentrations of DMA, dermal absorption can be considerable. Unmodified DMA and NMA concentrations in urine are good biomarkers for monitoring occupational exposure to the solvent.