Ten-Year Efficacy and Safety of Once-Daily Tacrolimus in Kidney Transplant: A Prospective Cohort Study.

Tacrolimus is a cornerstone in the immunosuppressive therapy of kidney transplantation. The once-daily formulation of tacrolimus has been shown to improve adherence of patients without affecting short-term efficacy. However, long-term proof of once-daily tacrolimus efficacy and safety is still lacking. From January 2009 to November 2013, 170 clinically stable kidney transplant patients were offered to change from the ongoing twice-daily tacrolimus (TDT) formulation to a once-daily tacrolimus (ODT) regimen. Kidney transplant recipients agreeing to the change to be treated with an ODT regimen (n = 105, estimated glomerular filtration rate [eGFR] 57.1 ± 1.6 mL/min/1.73 m2) and patients continuing on a TDT formulation (n = 65, eGFR 52.0 ± 2.2 mL/min/1.73 m2) were prospectively followed (median follow-up time 10.4 and 12.6 years in the ODT and TDT groups, respectively, P = not significant). At the end of the follow-up, patients in both groups experienced similar eGFR (50.4 ± 2.2 vs 48.0 ± 2.7 mL/min/1.73 m2 in the ODT and TDT groups, respectively, P = not significant). No differences were observed in biopsy-proven acute rejection, overall graft survival, doubling of serum creatinine, and new onset of proteinuria. The 2 groups also had a comparable rate of death, sepsis, and neoplasia. In conclusion, ODT appears safe and effective in stable kidney graft recipients even 10 years after transplantation. These findings support the use of ODT as a primary tacrolimus formulation in patients with kidney transplantation.

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.

[Occupational cardiovascular diseases and phlebopathies]. / Cardiovasculopatie e flebopatie professionali.

The focus of the occupational physician to diseases of the cardiovascular system has always been high in relation to the presence in the work of specific risk factors, but also because of the high incidence and prevalence of disease in the general population cardiology chronic-degenerative diseases. The non-specificity and multifactorial diseases of the cardiovascular system, make an etiologic diagnosis of occupational disease extremely difficult. For this reason, increasingly, the occupational physician is faced with the specialist cardiologist on diseases that can be defined as work-related. Among the clinical conditions most frequently encountered by the occupational physician, considered to include hypertension, ischemic heart disease and arrhythmias. Exposure to work risk factors such as: high or low temperatures, the MMC, exposure to electromagnetic fields, and also those related to organization and psycho-social, including night work and work-related stress related, or exposure to chemicals such as organic solvents, especially halogenated, or nitrates, or carbon monoxide, are an aggravating factor in the clinical context of cardiovascular disease primarily unrelated to the etiology. All this underlines also the issue of fitness to work with high risk of accidents for the worker himself and to others, especially the suspension work, driving of vehicles in general, the roles of monitoring and oversight to senior management. From the above, the importance of careful assessment by the occupational physician and the need for good cooperation with the specialist cardiologist, for the formulation of the assessment of suitability for specific tasks.

[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.

[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.

[The risk management in health personnel tuberculosis]. / La gestione del rischio tbc nel personale sanitario.

Within work environment and even more among health service areas, to deepen the monitoring efforts and awareness of the workers in order to accomplish a more effective and fast response against morbidity indexes and prevalence of tbc, constitute the necessary prerequisite for any subsequent action of prevention and control. On the other hand, one of the employer's obligations toward a health facility is to identify professionally exposed subjects (Legislative Decree 626/94 art.78), and perform risk assessment. Continuous report from various hospitals concerning suspicious contacts between employees and patients affected by tbc further increase the threat. At AOUP in Palermo from 2003 to May 2007, 39 cases of suspected contact between employees and patients affected by tbc were reported to the 'Staff Union for Health Related Issues' by various hospital departments and the 'Office of the Medical Competent', 34 of these reported cases have pulmonary involvement. The above mentioned situation made necessary to launch an effective program capable of addressing the risks of tbc in both circumstances of suspected or certain contact and during normal work activities.

[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.

[Upper limb mechanical overcharge among health care workers]. / Il rischio da sovraccarico biomeccanico degli arti superiori in ambito sanitario.

In medical circle, the disclosure of recurrent symptomatologies on the upper limbs begins to assume characteristics common to many working classes, raising not few problematic issues regarding the interactions between them and the working environment. In the AOUP of Palermo, some working categories were identified, whose activity implicates the upper limbs for instrument use, as well as repetitious movements (odontologists, ultrasonographers, endoscope technicians). The analysis covered a group of endoscopy technicians, both of the medical area and of the surgical one, the first being middle aged and with working seniority significantly higher than the latter. To these people, a RULA questionnaire was given, partially modified with the addition of some questions finalized at pointing out environmental situations that determine physical stresses on the upper limbs, correlated to the working method, to the number of made tests, to the place where they were made. From the study made, it was found that there is high risk of biomechanical overcharge on the upper limbs in the activity of endoscopy technicians. Thus the necessity of preventive corrective measures geared at avoiding on the one hand insurance claims, and on the other, the pathologies which can limit the working activity.

[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?".

[Work related diseases: assistance to delivery among obstetricians]. / Patologie lavoro correlate: l'assistenza al parto nel gruppo degli ostetrici.

In the course of Sanitary Surveillance, a high incidence of pathologies of the superior limbs was encountered in a homogeneous group of midwives operating in the AOUP of Palermo. These findings induced the authors' starting a retrospective study aimed at understanding the possibility of correlation between work effected and damage to people, and geared at being able to frame the findings in the ambit of the related to occupational pathologies. It is a fact that the positions taken by midwives in the course of gynecological vaginal delivery, or those necessary to the maneuvers during childbirth, such as the lateral or the simple and/or exaggerated MacRoberts maneuver, require substantial overcharging of the spinal column and a significant engagement of the muscles of the upper limbs. The analysis of the data related to the working load effected in the various years (number of parts/years), highlighted how the group of midwives exposed to a higher risk were those with a longer working life, this in consideration of the great emphasis placed on the upper limbs. It cannot therefore be ruled out that the pathologies encountered in the group of midwives can be framed in the area of occupational related pathologies.

[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.

[Organization of work, hardship at work, mobbing: new problem areas that must be considered by the competent doctor in formulating fitness evaluation]. / L'organizzazione del lavoro, il disagio lavorativo, il mobbing: le nuove problematiche all'attenzione del medico competente per la formulazione del giudizio di idoneità.

In recent years, in addition to the more common occupational-health risks (chemical, physical, biological), increasing importance is given to psychological and psychosomatic illness as a result of malfunction in the organization of work: burn-out, mobbing, maladjustment at work. In order to be able to evaluate the influence of such phenomenon whilst judging fitness in some working realities in Sicily, 18 small, medium and large dimension companies with a total of 1413 employees were examined. The typology of the work embraced the industrial, health, information-technology, construction and telephony sectors. The research involved analyzing, with the respective competent physicians, (in a few cases the same physician dealt with more than one company) the Risk Evaluation document, the clinical and risk records and the fitness evaluations. The analysis of the data obtained pointed out that of the 1413 employees observed, 87% was judged fit, 2% fit with limitation and/or prescription, almost 1% not fit. Notwithstanding the type of judgment, it was ascertained how in the above evaluation, only classical "physical" risks were evaluated (noise, MMC, VDT, etc.). The worker is judged as an individual removed from the general context of the company, of it's organization, or, as one who participates only by means of his various organs and apparatus, and who can singularly become ill because of exposure to some occupational risk. As a matter of fact, in none of the DVR's of the 18 companies object of the research, was an element of evaluation of the working organization found. Nor on the communication means, on the transparency of the procedures, on the quality of relations, lack of instruments or physical sites fit to working activity, nor to emotionally extreme working activities. It must therefore be emphasized that the competent physician only possesses the individual pathologies encountered in the various working situations. He lacks elements of evaluation that would supply useful information on the working organization, and on the effects the latter can have on the health of the employees, and, therefore on their fitness to work. The latter; in our opinion, is data that cannot be disregarded in the correct judgment of psycho-physical fitness, as foreseen by the regulations in force.

Disability and work: fitness for work judgement.

BACKGROUND: The role of physicians, in particular those dealing with health promotion in the workplace, takes on a specific meaning in relation to the difficulties that disabled people encounter both in order to reach the workplace and to reconcile their working activity with the difficulties that result from their condition. Observing the data concerning employment of disabled persons in Italy, it becomes dramatically evident that among the disabled subjects of working age only 17% are employed. OBJECTIVE: The objective of the occupational health physician is to recognise the impairment, study the disability and, possibly, eliminate or reduce the handicap. Achieving this target is difficult, and there is often a lack in understanding the discomforts experienced by disabled people in their working activity. Expression of a judgement of work fitness for a specific task is a particularly delicate matter, all the more so if the worker is a disabled person. A judgement of work fitness of a disabled person should include evaluation of the person's ability and an analysis of the working task and the workplace. CONCLUSIONS: Based on our experience, one can safely say that working inclusion and integration in work is possible, without any decrease in productivity, if an appropriate position is found for disabled workers. The occupational health physician has a primary role in the entire process of inclusion of disabled people at work, since he/she knows the company, the tasks, and the associated risks, and furthermore is able to assess the capabilities and abilities of the worker and can thus identify the most suitable and safe working situation.

[Work organization and mobbing: application of cognitive methodology in medical circle]. / L'organizzazione del lavoro e mobbing: applicazione di una procedura conoscitiva in ambito sanitario.

Mobbing is a phenomenon produced for the most part by factors related to work organization. During the medical control of workers in Universitary Policlinico Hospital of Palermo, we used a methodology (in advance applied with effectiveness by ISPESL in other institutions) that is able to evidence factors of work organization causing Mobbing. 338 out 2060 workers (total staff) with different professional figures were recruited. We evidenced the working classes that had more troubles about communications of business information, about interpersonal relationships at work with top manager, with other members of team and with colleagues. Particularly doctors and OTA, in worrying percentage, stated that they suffered psychological molestations. Aim of our study was to assay a procedure that, even if it doesn't identify proclaimed mobbing phenomenon, enables us to acquire information about relationships between business management and workers and organizational aspects perceiving by subordinates. A I level study about a phenomenon in expansion is very useful to recognize preventively intentionally made mobbing actions.

[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.