Predictors of Hepatitis B Surface Antigen Titers two decades after vaccination in a cohort of students and post-graduates of the Medical School at the University of Palermo, Italy.

Introduction and objective. The introduction of a vaccine against hepatitis B virus (HBV) for newborn babies in Italy in 1991, extended to 12-year-old children for the first 12 years of application, has been a major achievement in terms of the prevention of HBV infection. The objective of this study was to analyse the long-term immunogenicity and effectiveness of HBV vaccination among healthcare students with different working seniorities. Materials and method. A cross-sectional observational study of undergraduate and postgraduate students attending the Medical School of the University of Palermo was conducted from January 2014 - July 2016. HBV serum markers were performed with commercial chemiluminescence assays. Categorical variables were analyzed using the chi-square test (Mantel-Haenszel), whereas means were compared by using the Student's t test. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were also calculated by a multivariable logistic regression, using a model constructed to examine predictors of anti-HBs titer above 10 mIU/mL, assumed as protective. Results. Of the 2,114 subjects evaluated - all vaccinated at infancy or at the age of 12 years and were HBsAg/anti-HBc negative - 806 (38.1%) had an anti-HBs titre <10 IU/L. The latter were younger, more likely to be attending a healthcare profession school (i.e., nursing and midwifery), than a medical postgraduate level school, and more likely to have been vaccinated in infancy (p <0.001, 95% CI 2.63-5.26, adjusted OR 3.70). Conclusion. The results of the study suggest that assessment of HBV serum markers in workers potentially exposed to hospital infections is useful for identifying small numbers of unvaccinated subjects, or vaccinated subjects with low antibody titre, all of whom should be referred to a booster series of vaccinations.

Analysis of seroprevalence against Coxiella burnetii in a sample of farm workers in Western Sicily.

INTRODUCTION AND OBJECTIVE: Little is known about the development of chronic Q fever caused by Coxiella burnetii in occupational risk groups and in the general population in Italy, as well as in many countries in the world. The aim of this study was to highlight the presence of the infection in a sample of workers operating outdoors (but not directly in contact with animals), in three provinces of western Sicily, in order to detect the human seroprevalence and compare the obtained data with those found in animals raised in the same territory. MATERIALS AND METHODS: The study included 126 generic seasonal agricultural workers (labourers), 84 male and 42 female; none of whom were aware of any previous contact with Coxiella burnetii. Their immunologic status against Coxiella burnetii was tested through research and titration of both phases I and II specific antibodies (IgG) with an indirect immunofluorescence assay, using anti-antibodies labeled with fluorescein isothiocyanate. All data were statistically analyzed, comparing all positive results from the three provinces through variance analysis, and then comparing human results with those obtained from animals raised in the considered areas, specifically, 1,511 cows, 46 of which were found positive (3.04%), and 3,391 sheep, 548 of which were found positive (16.16%). RESULTS: Anti-Coxiella antibodies were found in nine of 42 females sampled (21.4%; 95%CI=[9.0-33.8]) and 21 of 84 males sampled (25.0%; 95%CI=[15.7-34.3]). 60% (18 of 30; 95%CI=[42.5-77.5]) of seropositive samples were positive either for Phase I antigen or for both Phase I and II antigens, representing cases of chronic infection. Applying Spearman's rank correlation, the percentage of seropositive humans was significantly correlated with that observed for sheep (r=1.00; p<0.001), but not for cows (r=-0.5; p=0.667). CONCLUSIONS: The results obtained, although based on a small sample, suggest that the disease is present in the territory of Western Sicily, both in animals and in humans. A closer collaboration between doctors and veterinarians is therefore necessary to fight against the spread of the infection.

[Blood and urine chromium: compared values between chromium exposed workers and common people]. / Cromemia e cromuria: valori a confronto tra soggetti professionalmente esposti al cromo e popolazione generale.

Aim of present study is the valutation and quantification of chromium in blood and urine. We compared 3 groups of persons formed by building workers, in particular masons, because cement contains potassium chromate that is dangerous for health, and by common people: urban population and outside the town population. In fact, exposure to CrVI risk is high for people who live near chromate industries. We maked a medical examination, blood and instrumental tests, chromium measuring in blood (recent exposure indicator) and urine (recent and previous indicator). Then we used statistical methods to estimate obtained values of blood and urine chromium among professional exposed people and common people. At the end we think that preventive measures in working environment reduced exposure to CrVI but environmental exposure (for example road dust from catalytic converter erosion, from brake lining erosion, cement dust and tobacco smoke), in the last years, has increased. So there are no difference between urban population and outside the town population and there are also no difference with professional exposed people for work prevention according to law in force, that let down professional risk using safe limits.

[Food service workers and cooks: occupational risk assessment]. / Mense e personale addetto alle cucine: valutazione dei rischi occupazionali.

The aim of the study is to evaluate the occupational risks among food service workers and cooks. During the occupational risks assessment the following risk factors must be evaluated: musculoskeletal disorders, chemical risk (cleaning kitchen work surface, dishes, utensils ecc.) biological risk (contact with foods or biological agents) cancerogenic risk (by baking smoke inhalation), and psycho-social stress. In this study the preventive measures and protective equipment to prevent health hazards for these workers have been evaluated (i.e. aspiration hood, adapted ventilation, chosen of less harmful methods of baking, ecc.). In particular the performance of rigid behavioural norms and hygienic procedures is very important for cooks and food service workers to reduce the risk of occupational infections.

[Observational study on a group of health care workers assigned to antiblastic drugs manipulation in three Sicilian hospitals]. / Studio osservazionale su un gruppo di operatori sanitari addetti alla manipolazione di farmaci antiblastici di tre nosocomi siciliani.

UNLABELLED: Neoplastic disease therapy problems, e.g. antiblastic drugs manipulation, is developing. We suggested correlation assessment between the lasting professional workers' exposition of three city hospital and disease development. We selected 43 exposed workers; we gave a questionnaire regarding the modality of activity; then we examined this sample with a protocol including clinical examination and special tests (blood tests, ECG, audiometry and spirometry). RESULTS: over 55% of the workers reported aspecific complaint related to antiblastic exposure (headache, nausea, vertigo, dermatitis, alopecia, rhino-conjunctivitis, asthenia, parageusia, fauces dryness); we registered, instead, the absence of significant diseases related to antiblastic drugs exposure, because of both environmental and personal prevention, and clinical surveillance co-ordinated by occupational physician.

[Occupational exposure to environmental pollution: observational study about a newspaper-agents group]. / Esposizione professionale ad agenti inquinanti ambientali: studio osservazionale su un gruppo di edicolanti della città di Palermo.

UNLABELLED: Environmental pollution constantly menaces urban people's health. This public-health question has a remarkable interest in occupational medicine, because some professions require operations outdoor for most of the day. Therefore airborne pollutants could be considered occupational risk factors. Our object is health evaluation of a newspaper-agents group of Palermo, in association with pollution level monitored during the 2006. We examined these subjects regarding especially lung, ear, kidney, liver and cardiovascular system, with particular consideration for endothelial structure. RESULTS: high prevalence of carotid artery damage can't exclude a concausal role of airborne pollutants.

[Benzene low dose exposure: comparison of different biologic markers among exposed workers and the general population]. / Esposizione a basse dosi di benzene: confronto di indicatori biologici tra soggetti professionalmente esposti e popolazione generale.

UNLABELLED: Exposure to low doses of benzene: biological monitoring exposure in a group of occupational exposed workers and a group of general population. Even if exposure to benzene is considerably decreased in last years, the interest for this cercinogenic agent is still important. Benzene is used as additive in gasoline and it is present in cigarette smoke. Therefore benzene is considered an important toxic agent not only for occupational exposed people, but also for general population, in particular if living in high polluted areas. Aim of the present study is evaluation of trans, trans-muconic acid in urine of workers exposed to benzene and in the general population, making a distinction between subjects living in an urban centre and subjects living in rural areas. Each subject was invited to complete a questionnaire about job, diet, residence, hobbies and tobacco-smoking. Every one was submit to a physical examination, exams as ECG, audiometry, spirometry and laboratory test to investigate about blood count, liver and kidney function. It was used as biological exposure index the urinary trans, trans-muconic acid (t,t-MA). RESULTS: t,t-MA was increased in smokers compared to nonsmokers, in exposed workers (t,t-MA = 0.09 mg/L, DS 0.22) compared to general population (t,t-MA = 0.08 mg/L, DS 0.21) and in people living in urban zone compared to people living in rural areas. In particular, among occupational exposed subjects, we found concentration of urinary t,t-MA greater in the subjects living in urban zone (t,t-MA = 0.10 mg/L, DS 0.23) in comparison with the subjects living in rural areas (t,t-MA = 0.09 mg/L, DS 0.3). The same result we found in general population divided in two groups, people living in urban zone (t,t-MA = 0.09 mg/L, DS 0.21) and people living in rural areas (t,t-MA = 0.07 mg/L, DS 0.21). We have to observe that the results obtained have not a statistical relevance and the concentrations of t,t-MA in urines is always less than biologic limits. Anyway, in consideration of the carcinogenic properties of benzene and of its dose-response relation, without a treshold dose, we believe that the environmental and occupational monitoring is very important.

[Professional exposure to hardwood dusts in a group of Sicilian joiners]. / Esposizione professionale a polveri di legno duro in un gruppo di falegnami siciliani.

Wood is a system of vegetable tissues chemically formed by biopolymers (90-99%) and phenolic substances, alkaloids, glucosides and saponins (1-10%). There are two botanical groups of wood: hardwood and softwood. Aim of present study was the research of possible work related diseases with professional exposure to hardwood about 25 joiners of Palermo in 2006; in fact wood dust inhalation is very dangerous for workers health because it is cancerogenous for nasal and paranasal sinus (1 IARC). We studied beech and fraxinus dusts (hardwood) and mahogany and teak dusts (exotic hardwood) in the environmental air of joiners during wood cutting and finishing touch. We also analysed exposed workers registry to know joiners duties, exposure values to wood dust, inhalatory exposure, wood type, chemical components, individual protection safety devices, environmental protection means. Then we examined workers medical case and risk histories. At the end we noticed that particle material in environmental air was regular according law reference values (D.Lgs. 66/2000: TLV-TWA 5 mg/m3); but although environmental dust values were normal, we found nasal haemorrhages in 3 workers and vasomotory headache in other 3; we also diagnosed one paranasal sinus polypus and then irritative contact dermatitis in 3 workers. So there is an answer: "can current TLV-TWA be protective and sure? And can it guarantee health of hardwood exposed workers?".

[Analysis of accidents at work in building yards: correlation between risk and law defaults in yards of Palermo]. / Analisi del fenomeno infortunistico nei cantieri edili: correlazione tra rischi ed inadempienze normative riscontrate nei cantieri di Palermo.

In the last years the building firm underwent real boom for investments and workers but not for safety measures. In the building sector there is a great accidents risks for falls from the top. The aim of present study is to analyze trend of accidents at work in building yards according to INAIL DATA and we will identify causes and risks then we will correlate these risks with frequent law defaults that we noticed in the province of Palermo. At the end we will value possible preventive measures to avoid this phenomenon. DATA INAIL of period 2001-2005 about building sector show us a reduction of denounced accidents at work but this phenomenon is changeable. Palermo is the first sicilian province for accidents at work although the number of denounced accidents (from 2001 to 2005) is decreasing while this number in Catania is increasing, CPT of Palermo gave us data (from 2004 to 2006) about inspections in building yards. Our study interests 609 yards and 1827 work stages. We noticed the most number of rests in civil yards.

[Epidemiological aspects of leishmaniosis in Italian regions]. / Rilievi epidemiologici della leishmaniosi nel territorio italiano.

The analysis of infectious diseases in Italy and regarding some working activities has pointed out several cases of leishmaniosis, in various shapes. Its persistent presence in some endemic areas in our country, together with possibility of work exposure and in assence of very sensitive or specific diagnostic methods, represents a problem in medical practice. It's necessary for physicians and veterinaries take greater attention about this illness and the other anthropozoonosis, always actual in some areas and increasing for AIDS's sicks, representing other infection sources.

[Occupational exposure to Mycobacterium tuberculosis complex: state of the art and prospects]. / Esposizione professionale a Mycobacterium tuberculosis complex: stato dell'arte e prospettive.

Tuberculosis, disease never wiped out in the world, is still actual for many reasons, such as imposing emigration from poor to industrialized countries, spreading of Mycobacteria drug-resistant and presence of AIDS sick subjects. Estimation of world cases seems to under-value real number; moreover physicians consider as etiological agent only Mycobacterium tuberculosis, disregarding others Mycobacteria, such as M. bovis, giving rise a disease similar to that caused by M. tuberculosis. To single out all these variants, it's necessary to use very specific and sensitive diagnostic methods, such as Polymerase Chain Reaction, evaluating also possible work exposure, especially when occurs contacts with infectious animals.

[Carbuncle in humans and animals: modern aspects of an ancient disease]. / Il Carbonchio in patologia umana ed animale: aspetti odierni di un'antica entità nosologica.

Carbuncle, very remarkable disease in the past for its spreading, recently seems to be forgotten as risk for general population and exposed workers too, among them we remember especially veterinary physicians, breeders, tanners, etc. World epidemiological data aren't exact, but a lot of researchers in vary countries confirm that this is a present problem in many areas. Therefore it's indispensable to know correct diffusion of this disease, to fight it and other zoonosis in some environments and mostly in working ones, hoping phycians identify and declare new cases.

[Case study of a population of subjects in Sicily operated for hydatidosis: correlation with profession and living environment]. / Studio casistico di una popolazione di soggetti residenti in Sicilia operati per idatidosi: correlazione con l'attività professionale e con l'ambiente di vita.

The aim of the study was to evaluate significant factors in the spread of echinococcosis in certain areas of Sicily. Data was obtained from operating registers of four surgical departments of the University Hospital of Palermo which covered 104 subjects, 57 women and 47 men, who underwent an operation for echinococcosis cysts in the period January 1996-June 1999. About 15% of these subjects were farmers, slaughterers, shepherds or gardeners and more than 80% lived in rural areas. The study showed that echinococcosis is still widespread in Sicily, at higher rates than the population, physicians and Health and safety Institutes generally believe. The place of origin is of particular importance because in rural areas it is very easy to be contaminated by infected animals or eat vegetables contaminated by parasitic eggs.

[Rickettsia infections in Sicily and mass media: attention not entirely groundless]. / Rickettsiosi in Sicilia e mezzi di comunicazione di massa: attenzione non del tutto immotivata.

The aim of the study was to assess the prevalence of rickettsiosis cases in Sicily with special attention to possible occupational exposure. This research was prompted by the high number of cases reported in the press in the summer of 1999. Epidemiological data for previous years showed that Sicily was always the region where most cases of rickettsiosis occurred; we therefore examined the clinical data of patients admitted to the major infectious diseases hospital department in Palermo in the period 1996-1999. Analysis of the cases showed that an occupational risk existed (among small farmers), but that there was also an environmental risk for subjects living in rural areas due to contact with infected dogs or rural areas activities. It is therefore of fundamental importance to carry out a primary prevention programme against rickettsiosis for everyone exposed to the risk either occupationally or in leisure activities in rural areas.

[The epidemiological trend of brucellosis in the provinces of Sicily]. / Considerazioni sull'andamento epidemiologico della brucellosi nelle province siciliane.

The epidemiological trend of brucellosis in Italy has been uneven over the last few years since there was a decrease in incidence in some regions and an increase in others, including Sicily. The peak was reached in 1997 when 59% of the cases were reported in Sicily alone. Appropriate intervention strategies are therefore needed both as regards the general population and exposed workers in order to reduce the spread of this disease.

[Considerations on correct diagnosis of atypical electrocardiographic T-wave findings in young subjects]. / Considerazioni per un corretto inquadramento diagnostico delle atipie elettrocardiografiche giovanili dell'onda T.

An analysis is made of the significance of the occasional observation of asymptomatic T-wave changes (inversion). The authors maintain that only an overall evaluation of the anamnestic, clinical and laboratory findings will enable the physician to make a correct diagnosis and exclude from the start, via coordinated protocols, any silent ischaemic disease, and also a series of clinical conditions that the ECG can reveal as this disease. In this connection the authors report a clinical case that is deemed interesting due to the finding of ECG anomalies in an asymptomatic young, athletic subject observed during a periodical medical examination for the purpose of certifying fitness for a specific type of work.

[Rhythm and conduction disorders in formulating a judgment of work fitness]. / Le turbe del ritmo e della conduzione nella formulazione del giudizio di idoneità lavorativa.

Assessment of work fitness must take due account of clinical and/or laboratory findings, which may at times not be clear, when these are indicative of heart "disease". It is, however, necessary to discriminate between invalidating conditions which in certain jobs may lead to adverse effects, morphological alterations, and/or "benign" rhythm anomalies.

[Primary prevention: environmental modification and changes in chronic respiratory pathology in workers in a metallurgical industry]. / In tema di prevenzione primaria: modifiche ambientali e variazioni della patologia respiratoria cronica in lavoratori di una industria metalmeccanica.

The authors analyse the data connected with chronic pulmonary diseases (mainly bronchitis) of two groups of workers, both belonging to the same metallurgical factory. The data is taken in two different periods, before and after the introduction of measures for primary prevention in the factory. The results confirm that the overall cases of pulmonary diseases are greatly reduced by a correct improvement in the working environment. Moreover, they confirm that a dangerous working environment affects the breathing system more prominently then other factors such as smoking, etc.