[Degree of hepatitis C infection risk in the health care setting]. / Entità del rischio infettivo per virus dell'epatite C in ambito sanitario.

BACKGROUND: Hepatitis C virus is the most important aetiologic agent for non A-non B hepatitis. The study of the prevalence of hepatitis C in health care workers is of primary interest because of the possible chronic evolution and the risk of cirrhosis and liver cancer. OBJECTIVES: The purpose of this study was to determine the prevalence of HCV among health care workers in 5 main hospitals and local health units in Turin and analyze the influence of occupational and non occupational risk factors. METHODS: Health care personnel were administered anonymous questionnaires and testing for anti-HCV antibody was performed. RESULTS: Prevalence rates in 4517 health care workers was 1.97%; the prevalence was higher in elderly workers (> 45 years) than in younger ones. The risk analysis did not reveal any significant correlation between HCV seroconversion and accidental blood exposure. However, a significant correlation was found with non-occupational risk factors. Unapparent infection was an unimportant risk factor for seroconversion. CONCLUSIONS: Hepatitis C prevalence in the population under study was comparable to that found in the general population. These results point to the need to reconsider the assumption that there is an increase of risk of seroconversion for health-care workers, in the absence of any occupational accidental exposure to hepatitis C virus.

Induced sputum cellularity. Reference values and distribution in normal volunteers.

Sputum induction has recently been proposed as the only direct noninvasive method for measuring airway inflammatory indices. The reference values and the distribution of cells in induced sputum in a control population have not yet been well defined. We therefore evaluated data from a large number of healthy volunteers. One hundred fourteen healthy, nonatopic, nonsmoking volunteers without airway hyperreactivity were enrolled (age: 38 +/- 13 yr [mean +/- SD]; FEV(1): 105 +/- 10% predicted; provocative dose of methacholine inducing a 20% decrease FEV(1) > 3,200 microgram). Ninety-six subjects (84%) produced adequate analysis samples. The subjects had a normal age distribution. Their induced sputum was rich in macrophages (69.2 +/- 13%) and neutrophils (27.3 +/- 13%), and poor in eosinophils (0.6 +/- 0.8%), lymphocytes (1.0 +/- 1.2%), and epithelial cells (1.5 +/- 1.8%). Only macrophages and neutrophils showed a normal distribution; total and differential counts of other cells did not. We propose that these data be used in comparison of the induced sputum cells of normal subjects and those of patients with airway inflammation.

Specific inhalation challenge with wheat flour in workers with suspected baker's asthma.

OBJECTIVE: The aim of this study was to evaluate the outcome of the specific inhalation challenge test (SIC) in 160 subjects with suspected baker's asthma and to assess its relation to total flour dust levels and to personal characteristics such as specific skin sensitisation, non-specific bronchial hyper-responsiveness (NSBH) and atopy. METHODS: We investigated the outcome of SIC tests performed with wheat flour in six Italian laboratories. For each subject, data was available regarding skin sensitisation to wheat flour, NSBH, atopy, forced expiratory volume at 1 s (FEV1) monitoring and airborne flour dust in the challenge chamber measured by the gravimetric method (total dust in mg/m(3)). RESULTS: The SIC test was positive for early asthma in 42 subjects (26%) and for late/dual asthma in 18 (11%). Positive outcome to SIC was significantly associated with NBSH (odds ratio, OR: 3.5, 95% CI: 1. 6-7.7) and skin sensitisation to wheat flour (OR: 3.1, 95% CI: 1.3-7. 0). Exposure level to wheat flour was less than or equal to 10 mg/m(3 )in 12% of individuals, ranged between 11 and 30 mg/m(3) in 43% and exceeded 30 mg/m(3) in 45%. The outcome of SIC was always negative among workers not skin sensitised to wheat flour and without NSBH and atopy. An increasing prevalence of positive SIC was observed among workers with one or more of the above-mentioned personal characteristics whose challenge exposure was greater than 10 mg/m(3) (P < 0.001). CONCLUSION: Procedures currently adopted for wheat flour dust exposure during SIC need to be better standardised in order to avoid excessive airborne dust exposure. Over-exposure seems to be of no use for the diagnosis and risks making the asthmatic reaction worse, particularly in patients who are both sensitised to wheat allergens and have NSBH and/or atopy.

Aerobiological analysis in a salami factory: a possible case of extrinsic allergic alveolitis by Penicillium camembertii.

A 39-year-old man was hospitalized with a history of fatigue, dyspnoea and low grade fever which seemed to be related to his working environment. The patient was employed in a salami factory, working near the area where the salami are seasoned with fungal inocula. Chest X-ray showed diffuse initial changes of reticulonodular pattern that disappeared after a brief course of steroids therapy. Precipitating antibodies to Penicillium notatum and Aspergillus fumigatus were found both in plasma and bronchoalveolar lavage fluid. This, together with the finding of a lymphocytic alveolitis with CD4+ depletion and CD8+ increase, suggested the possibility of extrinsic allergic alveolitis of fungal aetiology. Qualitative and quantitative monitoring with an impinger of both the working and outside environment for aerial fungal concentration demonstrated a very high level of contamination (up to 1.14x10(9) fungal propagules m-3 of air) and an inside/outside ratio from 21 to about 2000. Penicillium camembertii was the most common species found in all the indoor sites (60-100% of the fungal load). The patient's BALF and serum both displayed precipitating antibodies to P. camembertii from the powder used for the inoculum and the air samples. These results together with the patient's working history gave some evidence of relationship between the indoor P. camembertii concentration and the patient's symptoms.

Asbestos bodies in bronchoalveolar lavage fluid and sputum.

The aim of the study was to determine the concordance of asbestos body (AB) detection in sputum and bronchoalveolar lavage fluid (BALF). AB were detected in the BALF of 110 former or current asbestos workers with medium weak exposure level and, for 65 subjects, in sputum. Several spontaneous sputum samples were taken from each subject. AB prevalence in BALF was rather low (48.2%) especially in subjects with former chrysotile exposure (32.5%). AB prevalence was lower in smokers (40.9%) and ex-smokers (40.7%) than in non-smokers (68.7%). In the sub-group, who underwent both sputum and BALF examination, the concordance of AB detection was observed only in 56.8% of the cases. Neither of the two methods had significant prevalence over the other but were complementary, as both are useful in increasing the probability of AB detection.

Relationship between asbestos bodies in sputum and the number of specimens.

OBJECTIVES: This study investigated the relationship between asbestos body identification and the number of sputum specimens obtained from each subject. METHODS: The presence of asbestos bodies in sputum was studied in 142 asbestos workers with former low-exposure levels; the number of specimens collected during 1-3 weeks varied from 2 to more than 4. Furthermore the persistence of asbestos bodies in the sputum of 15 asbestos workers was studied during a long-time follow-up. RESULTS: Asbestos bodies were present in at least 1 specimen in 44.4% of the 142 subjects. The cumulative percentage of asbestos body presence increased linearly, from 20% to 68%, as the number of specimens increased. CONCLUSIONS: Five specimens did not seem to be sufficient to obtain satisfactory sensitivity in a group with low exposure to asbestos. Neither the type of exposure (to chrysotile only or to chrysotile plus amphibole) nor the presence of an asbestos-related disease clearly influenced the probability of finding asbestos bodies.

Asbestos bodies in sputum of asbestos exposed workers.

The prevalence of asbestos bodies (AB) in sputum was studied in a group of 220 former or current asbestos workers, who came under observation because of a claim for compensation and who had, in most cases, high levels of exposure. Only one sputum specimen was obtained from each subject. The overall AB prevalence was 34%; it was 24.5% among workers exposed to chrysotile only, and 42% among workers also exposed to amphiboles, thus showing a statistically significant difference. No significant differences were found in AB prevalence either between current asbestos workers and former workers or between asbestosis cases and those without asbestosis. AB prevalence among current smokers was significantly lower than that observed among non-smokers and ex-smokers pooled together. The highest AB prevalence was found among currently exposed textile workers (65.7%), especially in male subjects (66.7%). As the exposure of these groups was heavy and included amphiboles, it may be concluded that although AB counts are highly specific they have low sensitivity.

[Nasal patency patterns observed during working hours in a group of technicians habitually exposed to formaldehyde]. / Comportamento della pervietà nasale nell'arco di un turno lavorativo in un gruppo di soggetti professionalmente esposti a formaldeide.

Formaldehyde is a substance which is widely used in several work fields, including many medical and biological sectors. It appears that formaldehyde exposure may cause bronchial asthma. Little information is available, however, with regard to upper aereal tracts. The nose is a target organ of major importance for a large range of professional and extra-professional environmental pollutants. In particular, cases of professional rhinitis brought about by exposure to disinfectants have been reported in Literature. In the light of general knowledge related to the close correlation between upper and lower airways, and to the lack of information concerning the effects of short-term formaldehyde exposure on the upper aereal tract, the Authors decided that investigation of such exposure might prove interesting as well as worthwhile. A group of fifteen technicians who work in three different pathology departments and who had been exposed to formaldehyde for at least one year were studied. The purpose of the study was to assess possible alteration in nasal resistances at the end of a normal work shift. The subjects under study were observed according to a procedure which included several clinical, allergological, serological and functional evaluations carried out on specific days of the week. A control group, consisting of eight asymptomatic, non-atopic subjects who had never been exposed to inhalation of irritants was also monitored in the same way. Conclusions were drawn after considering some important variables such as exposure time, possible anatomical alterations of the nose, the presence of respiratory allergies and smoking habits. It was apparent that professional formaldehyde exposure typical of that experienced by technicians working in pathology departments induced a short-term irritant effect on the upper aereal tract, which, even though subclinical, is revealed by a statistically significant increase in nasal resistance. This effect seems to be favoured (at statistically not significant levels) by atopy, cigarette smoking and anatomical alterations of the nose. Our data seem to exclude a chronic cumulative effect of formaldehyde exposure.

Factors related to the development of sensitization to green coffee and castor bean allergens among coffee workers.

BACKGROUND: Occupational allergic respiratory symptoms in coffee workers have been frequently reported, but the ultimate cause of sensitization is still debated, castor bean being considered besides green coffee beans. Atopy and cigarette smoking have been suggested as promoting factors of sensitization for several occupational allergens. OBJECTIVE: This study was carried out to assess the prevalence of allergic respiratory symptoms and of sensitization to both green coffee beans and castor bean in the whole workforce of a coffee manufacturing plant. Furthermore we wanted to ascertain both the presence of castor bean antigens in the settled dust of the green coffee beans warehouse and the possible crossreactivity between the two beans. Meanwhile, the effect of smoking and atopy was considered. METHOD: Two-hundred and eleven workers were examined. A questionnaire on oculorhinitis and asthma was administered and skin-prick tests for green coffee beans, castor bean and 15 common inhalant allergens were carried out. Isoelectric focusing, isoelectric focusing immunoblot and radioallergosorbent assay (RAST) inhibition were performed on samples of settled environmental dust from the green coffee area, as well as on castor bean and green coffee beans. RESULTS: Ten per cent of the workers complained of oculorhinitis alone and 16% of asthma (nearly always associated with oculorhinitis). The overall prevalence of skin-sensitization was: 15% for green coffee beans, 22% for castor bean, 22% for common allergens. Evidence of sensitization to occupational allergens was more common in smokers, with a more than twofold increase in relative risk. The strong association between skin positivity to common and occupational allergens suggests that atopy acts as an enhancing host factor towards occupational sensitization. The analysis of the dust confirmed the presence of castor bean antigens. CONCLUSION: Our findings indicate that castor bean is the major cause of occupational sensitization among coffee workers, whereas smoking and atopy act as enhancing factors.

[Normal values of carboxyhemoglobinemia and methemoglobinemia in a sample of conscripts]. / Valori normali di carbossiemoglobinemia e di metaemoglobinemia in un campione di militari di leva.

Carboxyhemoglobin (COHb) and methemoglobin (MetHb) values in blood were measured in a population of 296 asymptomatic conscripts who were not under medical treatment and had no occupational exposure. The mean COHb value was 3.25 (S.D. = 1.45%) in smokers and 1.34 (S.D. = 0.8) in non-smokers, with a wide variability in both subgroups, particularly among smokers. The COHb levels in moderate smokers were lower than in heavy smokers, but smoking just before the blood test greatly increased the COHb levels. Non-smoking country dwellers had lower COHb levels than non-smoking city dwellers, but the COHb levels of smokers were independent of residence and were only smoking-related. The sample MetHb level was 0.81 (S.D. = 0.37) and was influenced by country living and smoking. Levels were lowest in non-smoking country dwellers (0.66, S.D. = 0.38%) and increased with moderate smoking (0.71, S.D. = 0.40%). Heavy smoker levels were independent of residence. Smoking just before the blood test had no effect on the value.

The prediction of recommended energy expenditure for an 8 h work-day using an air-purifying respirator.

Thirty railway workers executed maximal, or near maximal, stress tests with and without the use of a half mask air-purifying respirator (Spasciani 85 A1 P1) fitted with two combined filters for simultaneous protection from organic vapours and particulate matter. The pressure-flow characteristics of inspiratory and expiratory resistance at airflows in the range 0-90 l.min-1 were established by a continuous flow method on one test mask. Significant differences were found by paired t-test between the two exercises (with and without use of mask), showing reduced values with use of the mask, for breath frequency, ventilation rate, oxygen uptake, carbon dioxide production, maximal oxygen uptake, percentage of maximal voluntary ventilation used at the maximal exercise ventilation. No significant differences were found for tidal volume, respiratory quotient, heart rate, systolic blood pressure, oxygen uptake at anaerobic threshold, and duration of exercise. The predicted energy expenditure recommended for an 8 h work shift, corresponding to 40% of maximal oxygen uptake, is found to be reduced working with respirator and is significantly different from that observed during stress test without mask. The average ventilation rate at this workload is below 25 l.min-1, with predicted inspiratory mouth pressure equal to, or less than, 20 mm H2O. This maximal inspiratory mouth pressure is proposed as a safety limit for prolonged work using a respirator, with a recommended energy expenditure close to 40% of maximal oxygen uptake.

A new case of occupational asthma from reactive dyes with severe anaphylactic response to the specific challenge.

A case of occupational asthma in a wool and cotton dyer handling reactive dyes is described. The patient was skin positive, but asymptomatic to house dust mites. A bromoacrilamidic dye (Lanasol Yellow 4G) has been identified through chamber inhalation challenge as being responsible for the sensitization. A very short (4-minute) exposure produced a severe immediate obstructive ventilatory defect followed by arterial hypotension and urticaria. Bronchial hyperresponsiveness as tested through metacholine challenge was absent both in basal conditions and after the dye challenge. Both prick and patch test for the dye were positive in the absence of any sign of contact dermatitis.

Short-term respiratory changes in polyurethane foam workers exposed to low MDI concentration.

Our study included 27 polyurethane foam workers exposed to MDI only at low concentrations (ranging from 0.0005 to 0.001 ppm) and 27 clerks from the same factory matched by age. Respiratory function tests were performed on a Monday and Friday of the same week at shift onset, 4 h later and at shift end. The subjects under study were asymptomatic for asthma. The two groups had quite similar spirometric values with minimal functional impairment. A statistical analysis was carried out by Student's t-test for matched pairs and two-way analysis of variance (ANOVA), in order to take into account both occupational exposure and smoking habits. No significant differences between the two groups were observed with paired t-tests in the respiratory parameter trend during both the Monday and Friday work shift. Nor were differences observed within the two groups when Friday's and Monday's results were compared. No significant differences between the two groups were found in paired comparisons between Friday and Monday for respiratory parameters. ANOVA demonstrated that the FEV1 and FEF25-75 reduction present on Friday, when compared to Monday, was related to smoking and not to occupational exposure. In conclusion our findings showed no short-term respiratory changes in subjects exposed to low MDI concentration.

[Effects of long-term use of inhaled steroids (beclomethasone dipropionate) in patients with occupational asthma no longer exposed]. / Effetti dell'uso a lungo termine di steroidi inalatori (beclometasone dipropionato) in asmatici professionali non più esposti.

Ten subjects with occupational asthma who, were either no longer exposed or had minimal exposure, were controlled every three months after cessation of exposure. All subjects showed airway responsiveness to metacholine, complained of mild symptoms and had minor lung function abnormalities. The subjects underwent inhalation therapy with beclomethasone dipropionate (2000 micrograms/day) for 3 to 12 months. Although pulmonary function values and symptoms did not change significantly during treatment, PD20 FEV1 improved markedly after 3 months and further improved after the longest period of treatment. PD20 FEV1 after treatment was significantly correlated with the base PD20 FEV1 value and not with the FEV1 increase. Good therapeutic results were obtained in 6 subjects. In the remaining 4 subjects who did not respond to treatment, the base PD20 FEV1 value was below 200 micrograms. In 4 of the 6 subjects who responded to treatment PD20 FEV1 was lower than during treatment but higher than before treatment.

Heracleum mantegazzianum growth phases and furocoumarin content.

The observation of photocontact dermatitis from Heracleum mantegazzianum Sommier et Levier in 2 gardeners at work prompted the analysis of furocoumarin content of stem, leaves and fruits of the plant during a period of 1 year. Their concentration was found to be maximal in fruit, intermediate in leaf, and minimal in stem. Psoralen was the most prevalent substance in the leaf and bergapten in the fruit. In the stem, in contrast, individual furocoumarins were found in lower but variable concentrations. 3 furocoumarin seasonal peaks were observed in the leaf: the maximal peak occurred in June, the intermediate in August, the minimal in November. This trend corresponds to 3 biological phases of the weed.

[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).

Rare-earth pneumoconiosis: a new case.

A new case of rare-earth (RE) pneumoconiosis is described. The subject had worked as a photoengraver for 13 years and had not been exposed for 17 years. Chest X-ray showed a diffuse nodular pattern (q 2/3-ILO/1980). The patient was asymptomatic despite a restrictive spirometric impairment. The diagnosis derived from the finding, in the bronchoalveolar lavage fluid, of abnormal levels of La, Ce, Nd, Sm, Tb, Yb, and Lu. The presence of these elements was demonstrated by two methods: the neutron activation analysis and (as regards Ce alone) the X-ray energy spectrometry of mineral particles observed with electron microscope. Abnormal levels of rare earths were demonstrated also in the nails, suggesting an absorption of the RE from the lung.

Urinary cobalt as a measure of exposure in the hard metal industry.

Twenty-six workers in a hard metal manufacturing plant were monitored by cobalt urinary and ambient air measurements during the first month after summer holidays. Cobalt determinations were performed utilizing AAS, with a preliminary chelation and extraction procedure for urinary samples. Almost all personal ambient air samples turned out to be under the cobalt dust TLV of 0.1 mg/m3. When restarting work after the holidays, urinary values did not differ from the control group. At the end of the first working week, urinary cobalt had increased four fold, then decreased to the original values on the following Monday before restarting work. Thereafter, the weekend was no longer sufficient to reduce the levels to normal urinary cobalt values. The values rose to the same level observed before the holidays, and dit not substantially decrease even after the weekend. End-shift urinary cobalt values showed a good relationship with present as well as with mean past exposure on the first and the fifth weekday, but the third day did not. The correlation was better with present exposure on Monday and with mean past exposure on Friday. The observed differences may be explained by the minor influence of recent exposure on present exposure on Monday. The highest values were found on Wednesday. We suggest the utilization of end-shift urinary cobalt determination as a measure of the present exposure on Monday, and of mean recent or preceding exposure on Friday.