[Development of the agricultural sector in Italy: need to harmonize production and health protection]. / Lo sviluppo dell'agricoltura in Italia oggi: necessità di armonizzare aspetti produttivi e di tutela della salute.

Epidemiological data show excess of respiratory, dermatological, infectious, carcinogenic and musculoskeletal disorders among agricultural workers. Nevertheless, the national rates of reported cases do not correspond to the expected epidemiological data. In 2009, 3.914 cases of occupational diseases were reported to the national work compensation Institute (INAIL), as related to 1,200.000 agricultural workers employed in Italy. About 71% of these cases were related to musculoskeletal disorders. This shows a relevant difference between observed and expected cases, even more evident than in other sectors like constructions. More efficient preventive intervention is needed to improve this situation of under-reporting, through the implementation of epidemiological surveillance based on multiple sources of information. These sources should include the periodical health surveillance of active workers, the databank of General Practitioners, the hospital admission charts, and the case-lists of patients admitted to the Institutes of Occupational Health, according to a systematic active search of occupational cases.

[Analysis of work accidents during the years 1999-2006 in a hospital company in Lombardia]. / Analisi del fenomeno infortunistico 1999-2006 in un'Azienda Ospedaliera Lombarda.

This study describe accidents occurred in the period between 1999 and 2006 in the Hospital of Cremona, in which about 2400 subjects operate. The analysis of Accident Register showed a reduction of about 30% of the total number of accidents during the examined period and a non homogeneous distribution of the various types of accidents. The most frequent accidents were prick (25.8%), trauma (22.9%) and "in itinere" accidents (7.8%). One type of accident has been little considered up to now: the aggressions. Professional nurses were the most frequently involved and the most affected units were those that belong to the Internal Medicine Department. "In itinere" accidents had the longest average prognosis (11.6 days). The repetition of accidents occurred to the same operator hasn't been analysed before now: a professional nurse had nine accidents (of various type) in the seven years considered. Probably the reduction of accident must be attributed to the effectiveness of the prevention activities undertaken during the reviewed period. Biological accidents, for which it was possible to implement prevention programs, have been markedly reduced; it was not the same for "In Itinere" accidents, that depend significantly on external factors that are not easily dismissed.

[Exposure to asbestos dust in agricultural environment. Some significant exposure forms documented by the Hospital Unit of Occupational Medicine of Hospital Institute of Cremona]. / Esposizione a polvere d'asbesti in ambienti agricoli. Alcune significative modalità espositive documentate dalla UOOML (Unità Operativa Ospedaliera di Medicina del Lavoro) degli istituti Ospitalieri di Cremona.

Although it is difficult to document the exposition to asbestos in the agricultural workers, mesotelioma has however been noticed in the rural environment that may seem to have low risk because of its nature. This work describes the systematic diffusion of asbestos dust in the rural environment near Cremona due to the activity of "non-agricultural" workers who have fallen ill with mesothelioma. The patient described their work in details to the occupational medical doctor underlining the circumstances and the ways asbestos dust has been diffused in the rural environment. These ways were carefully analysed by the occupational medical doctor. They explain the onset of the mesothelioma in patients and they prove a systematic and long contamination of the involved rural areas. The described diffusion of dust has probably provoked a noteworthy exposure to the agricultural workers. At the moment there aren't full-blown asbestos-linked pathology but these workers are potentially at risk of getting them. So it has an importance both on individual and global level for the rural area near Cremona.

Neurobehavioral functions in operating theatre personnel: a multicenter study.

The study was conducted to evaluate neuropsychological symptoms, subjective stress and response speed functions in subjects occupationally exposed to low levels of anesthetic gases. A group of 112 operating theatre personnel exposed to anesthetic gases (nitrous oxide and isoflurane), and 135 non exposed hospital workers from 10 hospitals in Northern Italy were examined before and after the shift on the first and the last day of the working week. Three different tasks were administered: a complex reaction time test (the Stroop Color Word); a questionnaire for neuropsychological symptoms (EURO-QUEST); the block design subtest (WAIS). Biological and atmospheric indicators of exposure were measured. In the exposed group, the geometric mean of urinary nitrous oxide at the end of the shift was 7.1 micrograms/l (95th percentile 12.4, range 1.5-43) on the first and 7.8 micrograms/l (95th percentile 21.5, range 1.0-73.3) on the last day of the working week. On the same days, end of shift urinary isoflurane was 0.7 microgram/l (95th percentile 2.6, range 0-4.7) on the first day and 0.8 microgram/l (95th percentile 2.0, range 0-5.6) on the last. The exposed and control subjects were comparable for both basic intellectual abilities and subjective stress levels. No statistical differences were observed between exposed and control subjects for neuropsychological tests and symptoms. No dose-effect relationships were observed between the exposure indicators and the test results. In conclusion, no early behavioral effect on the central nervous system was detectable at the exposure levels measured. The biological exposure limits of 13 micrograms/l for nitrous oxide and 1.8 micrograms/l for isoflurane corresponding respectively to the atmospheric concentrations of 25 ppm and 0.5 ppm seem to be adequately protective for the integrity of workers' neurobehavioral functions, as measured with the tests used.

[Evaluation of the risk of anesthetic gases to exposed subjects with different tasks in operating rooms]. / Valutazione del rischio da gas anestetici in soggetti esposti con differente mansione in sala operatoria.

A research was carried out on risk evaluation of workers with different tasks in operating theatre. The airborne concentrations were determined by an IR analyzer with two distinct sampling lines: the first was placed in surgical zone and the second one in anesthesiological zone. The anesthetists resulted more at risk than surgical team. Nevertheless when the evaluation was based on N2O urinary concentration and data were stratified according to task a prevalent inhalation absorption resulted for non medical staff (instrumentist and professional nurse). Our data concerning N2O ranged between 95-764 ppm indoor and between 3-92 mcg/l in the urines of exposed subjects.

[Early effects of exposure to anesthetic gases and vapors. A critical review on the suitability of several indicators of the effect]. / Effetti precoci dell'esposizione a gas e vapori anestetici. Una rassegna critica sull'applicabilità di alcuni indicatori di effetto.

Apart from a risk excess of liver disease among operating theatre personnel and of spontaneous abortion in women exposed during pregnancy, no definitive conclusion can be drawn regarding health impairment among anaesthesiology staff. However, many studies pointed out that several adverse effects occur as a consequence of experimental, therapeutic and occupational exposure to inhalation anaesthetics. This paper reviews the early changes of the organ systems (hepatobiliary, renal, cardiac, hematopoietic, reproductive systems; immunologic functions; cytogenetic effects), which are considered to follow anaesthetics exposure, to evaluate their possible use as biological indices of effect. The liver microsomal enzyme system has received particular attention with the aim of clarifying the mechanisms involved in anaesthetics hepatotoxicity. An increased microsomal enzyme activity was observed in experimental conditions and in humans. This inductive effect, which reflects metabolic changes affecting liver function, is commonly considered the earliest sign caused by exposure to several chemicals (other than anaesthetics) and may be evaluated by means of biomarkers, among which the measurement of urinary D-glucaric acid excretion is a well established non-invasive tool. Urinary D-glucaric acid excretion represents the most promising early metabolic effect of the exposure to anaesthetics. However, its measurement is not yet suitable as an index of effect for use in biomonitoring practice. The main aspects to be studied in the future are the following: (i) the evaluation of urinary D-glucaric acid excretion in the acute and chronic exposure to low-dose anaesthetics to check the existence of a dose-response relationship; (ii) the study of other parameters (urinary enzymes, immunological profile, chromosome aberrations) in selected groups of exposed and control subjects, in which both exposure and confounding factors (age, gender, life style, former diseases) as well as concomitant occupational exposures should be carefully taken into account.

[Risk of infectious hepatitis and risk of anesthetic gases in operating rooms: considerations on 3 cases of chronic hepatic pathology]. / Rischio di epatite infettiva e rischio da gas anestetici in sala operatoria; considerazioni su tre casi di patologia epatica cronica.

Three subject with professional activity in operating theatre and with a diagnosis of chronic viral "C" hepatitis are considered. All cases (Two surgeons and an anesthetist) had been continuously exposed to low level of airborne anesthetic compounds (Nitrous oxide and halogenated compounds). According to possible, but not proved, synergic effects, two cases with a clinical picture of active chronic hepatitis were classified as unqualified to specific work. The third case, affected by a persistent chronic hepatitis, was admitted to operating activities only for four hours a week, i.e. only an operating session a week. Hepatitis B and C markers must be always monitored during the medical surveillance in exposed people of operating theatre.