[Cardiovascular risk factors and metabolic shift workers in a population of railway workers]. / Fattori di rischio cardiovascolari e metabolici in lavoratori a turni del settore ferroviario.

Cardiovascular and metabolic risk factors prevalence is studied with an increasing interest, involving also working-age people, Several studies had evidenced that shift-work is a key factor in the etiology of cardiovascular illnesses. Railway workers--especially those who are involved in the monitoring of rail traffic--are often shift-workers. Their shift-schedule is based on a rotation of--in this order--afternoon, morning and night. Regarding the important role played by this kind of workers for the public safety, the evaluation of their cardiovascular risk is of utmost importance. In this study we evaluated the prevalence of cardiovascular risk factors in railway shift-workers to define prevention strategies.

[Risk assessment of arterial hypertension in a working population]. / Alutazione del rischio di ipertensione arteriosa in una popolazione di lavoratori.

During last years life expectation and working-life are increased and, consequently, the evaluation of workers whit chronic age-related diseases is more frequent than in the previous decades. We analyzed 9616 (2337 females and 7279 males) medical reports collected during health surveillance. Workers with arterial hypertension were 1770 (254 females and 1516 males) with an average age of 49.02 years +/- 9.52, and an average BMI of 27.9 +/- 4.43 Kg/m_. Workers who reported a complete fitness-to-work certification were 88.6%, ones with a fitness-to-work certification whit limitations were 11.2%, and only 0.2% were unfit to work. Our data confirm the importance of company strategies oriented to health promotion on the workplaces considering the progressive ageing of the workforces.

[Employment of disabled people regarding Italian Law "68/99": Florence's ASL N. 10 experience]. / Inserimento lavorativo dei soggetti disabili ai sensi della legge 68/99: l'esperienza della ASL10 di Firenze.

The reform of mandatory employment in Italy, performed by the national Law 68/99, represented a crucial step for the assertion of the right to work for disabled people. The aim of our experience is to obtain information about health and safety conditions of disabled people employed in targeted workplaces and about the issues for that workers keep or lose their job, possibly in order to take actions on workplaces and to improve job conditions for all other workers also. In this paper we used data regarding targeted employments of disabled people, collected during the year 2008 in the Province of Florence.

[Evaluation of the impact of night-work on health in a population of workers in Tuscany]. / Valutazione dell'impatto del lavoro notturno sulla salute in una popolazione di lavoratori della Toscana.

Night-work, loading to subversion of physiological circadian rhythms and habits, may cause a lowering of work performance, an increase in the risk of accidental events and, more generally, a perception of less satisfactory living condition. In our experience we have interviewed 359 workers (night-workers and not). We found, in line with the Literature, that night-workers receive a less satisfactory quality of sleep, often associated with daytime sleepiness. The prevalence of disorders of various organs and systems is higher in these subjects, as well as the consumption of caffeine and nicotine. Regarding road and work-accidents, a similar trend is not so clearly confirmed in our series; in this context we have, nevertheless, to take account of some potential bias. Our experience confirmed that night-work may produce animpact on the individual overall well-being and, consequently, on the companies' productivity. To reduce this impact and the related costs, it is necessary to plan interventions on both workers and work organization.

[Promoting the quality of health surveillance of workers exposed to wood dust, with particular care to NPSC, in the territory of the Health Agency of Florence]. / Promozione della qualità della sorveglianza sanitaria dei lavoratori esposti a polvere di legno, con particolare riferimento ai TuNS, nel territorio di competenza della Azienda Sanitoria di Firenze.

Wood dust can cause occupational-related naso-sinusal cancer, characterized by a latency period of about 40 years. The Tuscany Cancer Registry estimates that cases of NPSC are from 20-25 per year into the Region (33% related to wood dust). These neoplasms are surgically treatable at early-stage and, for this reason, a rapid endoscopic diagnosis is considered to be reasonably useful for prognostic issues. We used a questionnaire to investigate nasal symptoms and NOSQ and SOLAR questionnaires to highlight respiratory/skins diseases, and a spirometry for each worker. Subjects with a working-age of more than 15 years, and those that were positive to the questionnaire and/or to the medical history were were referred to a specialist in otolaryngology. The prevalence of endoscopic positive findings--detected especially in subjects with a working age of more than 15 years--confirms the significance of the problem.

Fully automated solid-phase microextraction-fast gas chromatography-mass spectrometry method using a new ionic liquid column for high-throughput analysis of sarcosine and N-ethylglycine in human urine and urinary sediments.

A fully automated, non invasive, rapid and high-throughput method for the direct determination of sarcosine and N-ethylglycine in urine and urinary sediments using hexyl chloroformate derivatization followed by direct immersion solid-phase micro extraction and fast gas chromatography-mass spectrometric analysis was developed and validated. The use of a new ionic liquid narrow bore column, as well as the automation and miniaturization of the preparation procedure by a customized configuration of the utilized XYZ robotic system, allowed a friendly use of the GC apparatus achieving a quantitation limit of 0.06 µg L(-1) for sarcosine, good repeatability with CV always lower than 7% and reduced analysis times useful for point-of-care testing. The method was then applied for the analysis of 56 samples of urine and urinary sediments in healthy subjects, in those with benign prostatic hypertrophy and in patients with clinically localized prostate cancer. The results obtained showed that the medians of sarcosine/creatinine in urine were 103, 137 and 267 µg g(-1) respectively, thus assessing the potential use of sarcosine as urinary biomarker for prostate cancer detection. The highest values of sensitivity (79%) and specificity (87%) were obtained in correspondence of a cut-off value of 179 µg sarcosine(g creatinine)(-1), thus by using this cut-off threshold, sarcosine was significantly associated with the presence of cancer (p<0.0001). Finally, ROC analyses proved that the discrimination between clinically localized prostate cancer and patients without evidence of tumor is significantly correlated with sarcosine.

Locating industrial VOC sources with aircraft observations.

Observation and characterization of environmental pollution, focussing on Volatile Organic Compounds (VOCs), in a high-risk industrial area, are particularly important in order to provide indications on a safe level of exposure, indicate eventual priorities and advise on policy interventions. The aim of this study is to use the Solid Phase Micro Extraction (SPME) method to measure VOCs, directly coupled with atmospheric measurements taken on a small aircraft environmental platform, to evaluate and locate the presence of VOC emission sources in the Marghera industrial area. Lab analysis of collected SPME fibres and subsequent analysis of mass spectrum and chromatograms in Scan Mode allowed the detection of a wide range of VOCs. The combination of this information during the monitoring campaign allowed a model (Gaussian Plume) to be implemented that estimates the localization of emission sources on the ground.

[Occupational cardiovascular diseases]. / Cardiovasculopatie professionali.

Cardiovascular system may be the target of multiple occupational risk-factors which can act as causal and co-causal agents. A clinical background of cardiovascular diseases is made difficult by the non-specific anatomic and clinical characteristics and by the simultaneous presence of non-occupational confounding factors. Similarly, a strong distinction between macro- and microangiopathies is not easy because many noxae play a role on both components of the vascular system. Etiologically speaking, cardiovascular diseases can be classified into three different groups: diseases caused by chemical agents, by physical agents, and the ones related to psychosocial and organizational factors. These last factors represent an emerging risk, with related costs for the individual and the society. The assessment of relationships between occupational exposure and cardiovascular diseases allows both to verify the efficacy and the effectiveness of current prevention strategies and to enable the identification of new risk factors.

[The control of drugs consumption in occupational contexts: management of the test results]. / La gestione dei risultati dei test per il controllo dell'assunzione di sostanze stupefacenti.

From November 2008 to July 2010 we made 8300 drug tests to verify the absence of drug addiction or drugs/psychotropic substances consumption. We found 101 positive subjects (1.2%) at the first screening test; for fifty-five of them (54.5% of positives) we obtain a confirmation at second level test (0.7% of total tests). Sixty percent of these were positive for cannabinoids, 18.1% for opiates, 12.7% for cocaine, 9.0% for methadone, 3.6% for ecstasy and nobody for amphetamines. We noticed a good correlation between screening and confirmation tests for cannabinoids, methadone and cocaine. The analysis of the population of positive subjects shows that it's almost entirely composed by males, Italians, middle aged, heavy smokers and generally overweight, in apparent good health (average blood tests, any reported illnesses, any disability or any contraindications/limitations in employment).

[Accidents in health care workers: the experience from the Careggi Teaching Hospital]. / Gli infortuni in sanità: l'esperienza dell'Azienda Ospedaliero Universitaria Careggi.

In the last eleven years in the Careggi Hospital 4941 occupational accident has been registered, and 2951 workers were involved (28.9% of the total of the workers present in the period). The highest frequency of accident has been registered within the cooking staff, about one half of whom had an accident, and 7.2% more than 0.6 accident for person-year; the more serious consequences were registered for traffic accident, more than half happened coming to the workplace before the beginning of the work. Only 154 workers registered more than 0.6 accidents for person-year.

[Satisfaction and stress if the health care system: comparison of two different situations]. / Fattori di soddisfazione e stress in sanità: confronto tra due realtà differenti.

We examined two different health care settings to identify if some stress and satisfaction factors are common. In both neonatological ward and psychiatric residence the relation with the patient has been perceived as gratifying but in paediatric setting it is perceived through procedures and protocols, on the opposite site, in the psychiatric setting the daily life care is perceived as a low technical degree. Formation of workers is indispensable tools to understand the "technical" aspects of the work, without promoving a remoteness from the patient.

[Noise related risk: assessment of the efficacy of the prevention in the light of the new legislation]. / Il rischio da rumore: controllo dell'efficacia della prevenzione alla luce delle nuove normative.

Italian law on occupational exposure to noise identify 87 dBA as ceiling exposure level and 80 dBA as action level; the respect of ceiling level can be achieved by using devices, as ear plugs, whose efficacy must be verified. We studied 8119 audiometric of workers exposed to noise between 80 and 87 dBA. The hearing level of those who use ear plugs is significantly better than who don't use. Different devices show different efficacy, but for all, in the exposure setting studied, the level of protection that is provided is enough safe for othological protection. The workers must be informed about the efficacy of the protection and sensibilized to the use of the ear plugs within the periodical clinical surveillance.

[Work related sensitization risk in hotel school students, the role of garlic]. / Rischio di sensibilizzazione "professionale" in studenti di scuola alberghiera, il ruolo dell'aglio.

We want to evaluate the incidence of allergic problems in a population of catering students at the beginning and after 3 and 5 years of their course. We enrolled in the study 601 students of a professional catering school: 412 in the first year and 189 in the fifth years. We used two questionnaires to investigate respiratory problems and dermatological ones. All the subjects were also patch tested with 10 aptens. The incidence of reported symptoms of allergy was higher in fifth year than in first one. We can observe a rising in positive reaction between the two group of students to Balsam Perù, Nickel, Fragrance mix and Garlic. In particular we found an higher incidence of positive patch reaction in female population. On the contrary the rising in positive reaction to Garlic is higher in male. About two third of the subjects positive to garlic present a sensitization to diallyl disulphide. The rising of positive patch test reactions to Garlic and Balsam Perù should be caused by the contact with cooking spices. The higher incidence of allergic pathology between students during fifth year of school and students at first year is probably due to scholastic practical activity.

Evaluation of occupational exposure to high-level disinfectants in endoscopic services in an Italian hospital.

The aim of this study is the evaluation of exposure to airborne, high-level disinfectants to efficiently organize prevention of the risks due to the manipulation of these substances in the endoscopic units in medical facilities. In field and personal samples in the breathing zone of the workers were taken in 27 endoscopic units in a hospital during the replacement of high-level disinfectants in basins, tubes and lavaendoscopes. After a campaign of environmental monitoring of glutaraldehyde in nineteen endoscopic units (176 employees) of the hospital and considering the entity of glutaraldehyde problem, two substitutes, peracetic acid and electrolyzed acid water, have recently been introduced. The level of glutaraldehyde was higher than the TLV-Ceiling in 13 out of 19 working units, while the value of peracetic acid resulted higher than TLV-TWA in 1 out of 15. EAW has recently been used in two units and the chlorine environmental concentrations resulted lower than the sensibility limit of the method (<75 microg/m3). The results obtained during this study of measurements allowed to identify those operations which have the highest degree of risk for employees; this serves for taking suitable measures for prevention and individual protection as well as for evaluating current practices and decisional processes in the hospital.

Determination of S-phenylmercapturic acid by GC-MS and ELISA: a comparison of the two methods.

S-phenylmercapturic acid (PMA) is a specific urinary biomarker of benzene at exposure levels lower than 1 ppm. However, measuring PMA in urine is an expensive task by either GC or HPLC due to the necessity of extensive sample pretreatment. In the present study, a commercial chemiluminescence enzyme-linked immunosorbent assay (ELISA) test for PMA and GC-MS were used for screening urine samples of 60 workers employed in petrochemical settings. The ELISA results were evaluated by comparison with the GC-MS. Overall, the ELISA test proved sensitive (limit of detection=0.1 microg l(-1)), rapid, robust and reliable, affording results in good agreement with the GC-MS (54% of measurements) and no false-negatives. On the other hand, 46% of the ELISA assays were assigned as false-positives (arbitrarily established when ELISA >5 microg l(-1), GC-MS <5 microg l(-1) and a correlation coefficient of 0.687 was calculated between the two methods. It appears that urinary PMA routine biomonitoring on large numbers of samples is carried out in a cost-effective and rapid approach by preliminary screening with the ELISA assay followed by GC-MS confirmation of concentrations exceeding the biological exposure index for PMA.

Survival of malignant pleural mesothelioma cases in the Tuscan Mesothelioma Register, 1988-2000: a population-based study.

This study analyses survival of Tuscan residents (Italy, 3.5 million population) diagnosed by histological examination with malignant pleural mesothelioma (MPM) during the period 1988-2000, and recorded in the Tuscan Malignant Mesothelioma Register. The aim was to establish the prognostic role of demographic, diagnostic and asbestos exposure variables. During 1988-2000, 381 MPM cases were recorded (318 men; 63 women). Vital status was ascertained up to 31 December 2002. No cases were lost to follow-up. Median survival of certain MPM was 324 days (11 months; 95% CI 297-366); 45.7% (95% CI 40.6-50.6%) survived more than 1 year; 24.2% (95% CI 20.0-28.5%) more than 2 years. In univariate and multivariate analyses survival was associated with histological subtype (epithelioid subtype had the longest survival). Gender, age, period of diagnosis, hospital of diagnosis and asbestos exposure did not show significant effects. Therapeutic information was available for patients of the period 1997-2000. There was no significant difference in survival between treated versus untreated patients. In conclusion, no advance in prognosis at the population level in the most recent period can be suggested on the basis of the data available to the Tuscan Malignant Mesothelioma Register.

[Longitudinal study for assessing the efficacy of preventive measures in a population of health workers exposed to the risk of patient lifting]. / Studio longitudinale per la valutazione dell'efficacia di misure preventive in una popolazione di operatori sanitari esposta al rischio di movimentazione manuale di pazienti.

Preliminary data of a follow-up study on effectiveness of mechanical devices for patients handling are shown. Main study results highlight a statistical significant decrease for subjective referred episodes of acute low back pain during the previous 12 months, a decrease in perceived effort and Borg scale score in the subgroup who received any sort of mechanical devices. However no difference was found regarding to proportion of subjects positive at symptom questionnaire for low back pain and mean length of absenteeism for disease was similar even after the introduction of mechanical devices.

Respiratory risks in tunnel construction workers.

Respiratory diseases are frequent in tunnel construction workers. A group of 144 subjects randomly selected from the population of 2516 workers engaged in the construction of the railway tunnel under the Appennine Mountains, from Bologna to Firenze was investigated. A group of 69 males comparable for age, living area and habits was studied as a control group. Assessment of air pollutants (NO, NO2, SO2, total dust, silica %) was carried out by means of fixed monitoring stations as well as personal monitors. All the subjects included in the study were examined with a standardised protocol which included physical examination, lung function tests (before and after shift work) and a questionnaire to college respiratory symptoms. Low concentrations of environmental pollutants were evidenced. Significantly lower values of FEV1 and PEF were determined in the worker group pared to controls. A significant decrease in respiratory parameters was shown after shift work. Variables capable of influencing the decrease in parameters include smoking habits, work activity, presence of cough and expectoration, period of the year (spirometries resulted worse in the winter time). Significantly lower values of FEV1 and PEF were evidenced in the workers compared to controls. In spite of the present low work environmental exposure conditions, some physiologic parameters appear altered in tunnel construction workers. This may depend on a variety of noxious agents present in the working environment.

[Priority in occupational health in the USL 10 area of Florence]. / Priorità in salute occupazionale nella Azienda USL 10 di Firenze.

In order to experience a method for the choice in Public Health, a list of the problems in occupational health in Florence has been characterized one, using for the definition of the priorities a "Minnesota Department of Health's Community Health Services Planning Manual--Guidelines for Local Public Health Agencies: CHS Plan Cycle 2002-2003". The following priorities problems of health are emerged in order of: exposure to chemistries in agricultural workers, fatal and serious injures among construction and agricultural workers, musculoskeletal disorders by biomechanical overload of the upper limbs, hearing loss. For everyone of they, has been indicated a possible strategy.