COVID19 outbreak in Lombardy, Italy: An analysis on the short-term relationship between air pollution, climatic factors and the susceptibility to SARS-CoV-2 infection.

Short-term exposure to air pollution, as well as to climate variables have been linked to a higher incidence of respiratory viral diseases. The study aims to assess the short-term influence of air pollution and climate on COVID19 incidence in Lombardy (Italy), during the early stage of the outbreak, before the implementation of the lockdown measures. The daily number of COVID19 cases in Lombardy from February 25th to March 10th, 2020, and the daily average concentrations up to 15 days before the study period of particulate matter (PM10, PM2.5), O3, SO2, and NO2 together with climate variables (temperature, relative humidity - RH%, wind speed, precipitation), were analyzed. A univariable mixed model with a logarithm transformation as link function was applied for each day, from 15 days (lag15) to one day (lag1) before the day of detected cases, to evaluate the effect of each variable. Additionally, change points (Break Points-BP) in the relationship between incident cases and air pollution or climatic factors were estimated. The results did not show a univocal relationship between air quality or climate factors and COVID19 incidence. PM10, PM2.5 and O3 concentrations in the last lags seem to be related to an increased COVID19 incidence, probably due to an increased susceptibility of the host. In addition, low temperature and low wind speed in some lags resulted associated with increased daily COVID19 incidence. The findings observed suggest that these factors, in particular conditions and lags, may increase individual susceptibility to the development of viral infections such as SARS-CoV-2.

Clinical and radiological criteria for the differential diagnosis between asbestosis and idiopathic pulmonary fibrosis: Application in two cases.

INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) and asbestosis are pulmonary interstitial diseases that may present overlapping clinical aspects in the full-blown phase of the disease. For both clinical entities the gold standard for diagnosis is histological examination, but its execution poses ethical problems, especially when performed for preventive or forensic purposes. OBJECTIVE: To evaluate the application of internationally accepted clinical, anamnestic and radiological criteria for differential diagnosis between asbestosis and IPF, and to assess the ability to discriminate between the two diseases. Even if clinically similar, the two diseases present extremely different prognostic and therapeutic perspectives. METHODS: Two clinical cases of IPF are reported, in which the differential diagnosis was made by studying occupational exposure to asbestos, the onset and progression of clinical symptoms, and the identification of specific radiological elements by means of chest High Resolution Computed Tomography (HRCT). RESULTS: The diagnosis of IPF could be made on the basis of the absence of significant exposure to asbestos, the early onset and rapid progression of dyspnea and restrictive ventilatory defects, in association with a pulmonary radiological pattern characterized by peculiar elements such as honeycombing. DISCUSSION: The diagnostic procedure adopted to make a differential diagnosis with asbestosis provides practical clinical elements facilitating the differentiation between the two forms of pulmonary fibrosis, a fundamental aspect of the activity of the occupational physician.

Occupational exposure to carbon fibers impregnated with epoxy resins and evaluation of their respirability.

Objectives: The study aims to investigate occupational exposure to carbon fibers impregnated with epoxy resins (carbon fiber reinforced [CFR]) in workers at an airplane fuselage section construction plant, by environmental and biological monitoring.Materials and methods: Determination of airborne CFR was done by environmental sampling with active samplers, 11 of which were stationary and 19 personal samplings. The subsequent analyses were performed in the scanning electron microscope fitted with an X-ray microanalysis system (SEM-EDXA). Biological monitoring was carried out by determining CFR in exhaled breath condensate (EBC) collected from 19 male workers who wore personal environmental samplers (exposed workers) and from 10 male workers at the same factory who had no occupational exposure to CFR (internal controls). CFR analysis was done by SEM, applying the method used for determining asbestos fibers in aqueous samples.Results: The airborne CFR concentrations were found to be significantly higher (p = 0.03) at personal samplings (median value 7.01 ff/L, range 1.24-11.16 ff/L) than stationary samplings (median value 1.93 ff/L, range 0.55-10.09 ff/L). The aerodynamic diameters calculated starting from the length and geometric diameter of the sampled CFRs were always higher than 20 µm. CFR was not found in any of the EBC samples collected from the exposed workers and controls.Conclusions: Despite the evidence of occupational exposure to low concentrations of CFR, the absence of such fibers in the EBC in the exposed workers confirms their non-respirability, as expected based on their aerodynamic diameter.

Position Paper on Asbestos of the Italian Society of Occupational Medicine.

The Position Paper (PP) on asbestos of the Italian Society of Occupational Medicine (SIML) aims at providing a tool to the occupational physician to address current diagnostic criteria and results of epidemiological studies, and their consequences in terms of preventive and evaluation actions for insurance, compensation and litigation. The PP was based on an extensive review of the scientific literature and was compiled by a Working Group comprising researchers who have contributed to the international literature on asbestos-related diseases, as well as occupational physicians with extensive experience in the evaluation of risks and the medical surveillance of workers currently and formerly exposed to asbestos. The PP was drafted and reviewed between 2017 and 2018; its final version was prepared according to the guidelines of AGREE Reporting Checklist. All the members of the Working Group subscribed to the document, which was eventually approved by SIML's Executive Committee. The first section addresses industrial hygiene issues, such as methods for environmental monitoring, advantages and limitations of different microscopy techniques, the potential role of microfibers and approaches for retrospective assessment of exposure, in particular in epidemiological studies. The second section reviews the biological effects of asbestos with particular attention to the diagnostic aspects of asbestosis, pleural changes, mesothelioma and lung cancer. In the following section the criteria of causal attribution are discussed, together with different hypotheses on the form of the risk functions, with a comparison of the opinions prevalent in the literature. In particular, the models of the risk function for mesothelioma were examined, in the light of the hypothesis of an acceleration or anticipation of the events in relation to the dose. The last section discusses topics of immediate relevance for the occupational physician, such as health surveillance of former exposed and of workers currently exposed in remediation activities.

Biological monitoring of exposure to low concentrations of benzene in workers at a metallurgical coke production plant: new insights into S-phenylmercapturic acid and urinary benzene.

CONTEXT: Urinary S-phenylmercapturic acid (SPMA) and benzene (U-Ben) are usually measured at the end of the work shift (ES), although their kinetic of elimination is not clearly known. OBJECTIVE: To investigate SPMA and U-Ben elimination 16 h after the ES, in 93 coke production workers exposed to low benzene concentrations. MATERIALS AND METHODS: Airborne benzene (A-Ben) was measured by passive samplings, while SPMA, U-Ben, methyl-tert-butyl ether (U-MTBE), cotinine (U-Cot) and creatinine were determined on urine samples collected at ES and before the beginning of the next work shift (next BS). RESULTS: Median A-Ben concentrations were 17.2 µg/m3 in the personal and 34.7 µg/m3 in the stationary samplings. SPMA was always detectable, whereas U-Ben was below the limit of quantification in 26.7% of the ES and 35.6% of the next BS samples, and U-MTBE in more than the 80.0% of the samples. At both the sampling times, SPMA and U-Ben showed a positive dependence on personal A-Ben, as well as on creatinine and U-Cot values. DISCUSSION AND CONCLUSION: SPMA and U-Ben at the next BS were dependent on the exposure to low benzene concentrations suffered in the previous work shift, prompting a reconsideration of the urine sampling time recommended by the American Conference Governmental Industrial Hygienists (ACGIH).

Biological monitoring of exposure to polycyclic aromatic hydrocarbons and to metallic elements in Italian Navy workers operating near the industrial area in Taranto (South Italy).

OBJECTIVES: To assess, by means of biological monitoring, exposure to polycyclic aromatic hydrocarbons (PAHs) and to metallic elements in Italian Navy workers operating near the industrial area in Taranto, and thereby estimate the health risk. METHODS: A total of 450 workers in the Italian Navy were examined; they had office type jobs, and 150 of them worked near the industrial area in Taranto (exposed group), 150 in Taranto but far from this area (internal control group) and 150 in Brindisi (external control group). The recruited workers were administered a questionnaire inquiring about current and previous working activities, personal medical history, lifestyle and dietary habits, and their residence location. Then they collected a urine sample for the determination of 1-hydroxypyrene, 2-naphthol, cotinine and the metallic elements As, Cd, Co, Cr, Mn, Ni, Pb, Cu, Zn and Hg. The latter were measured in 110 workers in each group. In addition, in some of the work sites of the three groups, environmental samplings were carried out to determine PAHs and the 10 metallic elements, also taking into account the wind direction. RESULTS: Airborne benzo(a)pyrene concentrations at the different sampling sites ranged from 0.02 to 0.06 ng/m3 and naphthalene between <25 and 65.3 ng/m3, regardless of the wind direction. Among the metallic elements, As, Cd, Co, Cr, Hg, Pb, Cu and Zn were present at concentrations below or just above the limit of detection (LOD). Mn and Ni were slightly higher in the work sites of the exposed group. The urinary concentrations of 1-hydroxypyrene, 2-naphthol and the single metallic elements were not higher in the exposed workers group than in the other 2 groups. Smokers had significantly higher urinary 1-hydroxypyrene and 2-naphthol concentrations, whereas cigarette smoking did not condition a higher urinary elimination of metallic elements in the three groups with the exception of Cd and Pb. Moreover, residence location conditioned Mn, Hg and As urinary excretion, consumption of shellfish and/or crustaceans in the 72 hours before urine collection conditioned As elimination, and consumption of legumes in the 72 hours before urine collection conditioned Ni elimination. CONCLUSIONS: This research did not find a higher urinary excretion of 1-hydroxypyrene, 2-naphthol and As, Cd, Co, Cr, Mn, Ni, Pb, Cu, Zn and Hg in the exposed workers group as compared to the internal control group working far from the industrial area of Taranto, nor in the group working in another city far away from Taranto, Brindisi. Therefore, it indicated that workers in the Italian Navy operating near the industrial area in Taranto were not exposed to a greater risk attributable to exposure to PAHs and metallic elements than the two control groups.

[The INSuLa Project: the knowledge survey of company physicians]. / Progetto INSuLa: I'indagine conoscitiva sui medici competenti.

The technological advancements, the occurrence of new emerging occupational risks and diseases, and the changes in the regulatory framework for occupational health and safety induce a constant evolution of occupational medicine. Consequently, the skills and training needs of the occupational physicians should be periodically revalued and upgraded in order to identify technical and operational issues and problems of this discipline. In this context, the aim of this national survey, carried out using a self-administered questionnaire submitted to a sample of 1,237 occupational physicians, has been to gain helpful information to ensure a continuous improvement of the quality and effectiveness of measures aimed at protecting the health and safety of workers. The questionnaire, that consists of 43 questions divided into 5 different areas (personal and professional information, training and updating needs of occupational physicians, professional activities and relationships with the corporate prevention system, relationships with the supervisory board of the Local Health Authority, relationships with the National Health Service), allowed to obtain personal and professional data, to assess the training needs and demands of occupational physicians and to evaluate their relationships with the other stakeholders of the Italian prevention system and with the National Health Service. The preliminary results of this survey appear extremely important. In fact, this findings, highlighting the current problems of occupational physician, constitute the starting point to identify, develop and implement management methodologies, operative procedures and training programs that are effective and modern.

[Protocols for the health surveillance of fisherman]. / Protocolli per la sorveglianza sanitaria dei lavoratori della pesca.

AIM: To define protocols for health surveillance of workers in the marine fishing sector for specific occupational risk factors, considering the latest and most advanced scientific knowledge. MATERIALS AND METHODS: The specific literature was analyzed to identify the occupational risk factors to which fishermen are exposed. Then, for each risk factor a protocol for the relative health checkups and their time schedule was defined. RESULTS AND DISCUSSION: The risk factors to which fishermen are exposed are essentially noise, vibrations, solar and ultraviolet radiation, climatic agents (heat, cold, wind, rain, damp), chemical agents, shifts, work rate, night work, physical strain, stress, manual handling of loads, upper limb repetitive tasks, incongruous postures. The health protocols stipulate the health screening investigations to be carried out in all workers of a homogeneous group, and in-depth diagnostic investigations to be carried out in symptomatic workers. Complementary health investigations must be focused on a functional exploration of the organs specifically exposed to the risk factor. For hearing impairments due to noise exposure, the medico-legal measures with which the occupational health physician must comply, in cases of occupational disease, are indicated.

[Monitoring of the occupational and environmental exposure to low doses of benzene]. / Il monitoraggio dell'esposizione occupazionale ed ambientale a basse dosi di benzene.

AIM: To verify which of the various biomarkers of internal dose of benzene can be considered reliable for biological monitoring of exposure to the low concentrations present nowadays in working and living environments. MATERIALS AND METHODS: The specific literature was analyzed to assess the reliability of the different biomarkers of internal dose. RESULTS AND CONCLUSIONS: T,t-muconic acid is a non specific biomarker for benzene, valid for exposure to concentrations up to one order of magnitude less than the threshold limit of 3250 microg/m3. S-phenylmercapturic acid (SPMA) is a reliable marker even for exposure to concentrations up to two orders below the threshold value of 3250 microg/m3, and can be considered the biomarker of choice for biological monitoring of workers exposed to benzene. Urinary benzene does not seem to have any real advantages over SPMA for monitoring occupational exposure to benzene, but it does seem to be more reliable than SPMA to assess exposure to concentrations like those present in living environments. A smoking habit influences the urinary excretion of all the described biomarkers, and for the current low levels of occupational and environmental exposure to benzene, must be taken into account when interpreting the results of biological monitoring.

[Health risk assessment of exposure to metals in the workers of the steel foundry and in the general population of Taranto (Italy)]. / Valutazione del rischio per la salute do esposizione a elementi metallici nei lavoratori del siderurgico e nella popolazione generale di Taranto (Italia).

OBJECTIVE: To study the urinary excretion of As, Cr, Mn, Co, Ni, Cu, Zn, Cd, Sn, Ba, Hg, Pb, Sb in workers at the Taranto integrated-cycle steel foundry and in subjects from the general population of Taranto, to assess the health risk posed by occupational exposure and environmental exposure, respectively, to these metals. MATERIALS AND METHODS: The study included 49 steel foundry workers (exposed), working in the minerals and agglomerates pools, steel processing plants 1 and 2 and maritime plants, and 50 subjects belonging to the general population of Taranto resident at various distances from the factory (controls), randomly selected from the exposed subjects and controls enrolled in previous research conducted in 2005. A questionnaire was administered to all participants, enquiring into general characteristics, lifestyle, diet, and any medical conditions. Informed written consent to take part in the study was obtained from all subjects before enrolment. The results of environmental monitoring performed in 2005 in the workers' sectors, consisting of determining As, Cr, Mn, Ni, Cu, Zn, Cd and Pb in the respirable dust, revealed by both samplers applied in fixed positions and personal samplers, were considered. Urine samples were obtained from all participants on a Friday, to determine As and Cr by AAS and all the other metal elements by a multielement technique with ICP-MS. Urinary creatinine was also determined to make any necessary adjustments. All urine analyses were performed in 2005 within one month of urine collection. RESULTS: In the respirable dust, As and Cd were always within the LOD, whereas Cr, Mn, Ni, Cu and Pb were 1-2 orders of magnitude below the respective TLV-TWA of the ACGIH. Mn was the only metal element that presented significantly higher urinary concentrations in exposed subjects as compared to controls, although the values in both groups were in any case within the Italian reference range. Co, Cu, Zn, Sn and Sb showed significantly higher urinary concentrations in controls than in the exposed subjects, while there were no differences in As, Cr, Cd, Ba, Hg and Pb between the two groups. Ni was within the LOD in the 60% of the subjects in the two groups. Multiple stepwise regression showed a dependence of Cr on age, of As on the number of days since the last meal of mollusks and crustaceans, of Zn on the consumption of mollusks, and of Cd and Pb on smoking expressed as the number of pack/year. DISCUSSION: The research did not reveal higher urinary excretion of the metal elements in the steelworkers than in the subjects from the general population of Taranto resident at different distances from the factory, except for Mn, that was anyway within the reference range. This allows us to consider that there is no relevant health risk posed by occupational exposure to metal elements in the steelworkers, nor by environmental exposure to the same elements in the residents of the city of Taranto. In particular, no pollution of the living environment by metal elements of industrial origin was demonstrated, whereas other non occupational factors seem to condition the intake of these metal elements.

Biomarkers of internal dose for the assessment of environmental exposure to benzene.

The urinary excretion of t,t-muconic acid (t,t-MA), S-phenylmercapturic acid (SPMA) and urinary benzene and the influence of a smoking habit and of exposure to urban traffic on the urinary excretion of these biomarkers were investigated in 137 male adults from the general population. All subjects were not occupationally exposed to benzene and resident in two cities in Puglia (Southern-Italy). Environmental exposure to benzene was measured using passive personal samplers. The biomarkers t,t-MA, SPMA and urinary benzene were determined in urine samples collected from each subject at the end of the environmental sampling. The percentage of cases above the limit of detection was higher for SPMA and urinary benzene in smokers than in non-smokers, and for airborne benzene and urinary benzene in subjects exposed to urban traffic. Airborne benzene was correlated with the time spent in urban traffic during the environmental sampling. Among the biomarkers, urinary benzene was found to be correlated with airborne benzene only in non-smokers, and with the time spent in urban traffic, both in smokers and non-smokers considered together, and in non-smokers only. Finally, multiple regression analysis showed that the urinary excretion of all the biomarkers was dependent on the number of cigarettes smoked per day and, for urinary benzene, also on the time spent in urban traffic. In conclusion, urinary benzene seems to be a more valid biomarker than t,t-MA and SPMA to assess environmental exposure to extremely low concentrations of benzene. Cigarette smoking prevailed over traffic exhaust fumes in determining the internal dose of benzene.

Validity of new biomarkers of internal dose for use in the biological monitoring of occupational and environmental exposure to low concentrations of benzene and toluene.

OBJECTIVES: This study analyzes the validity of new, more sensitive and specific urinary biomarkers of internal dose, namely, urinary benzene for benzene and urinary toluene and S-benzylmercapturic acid (SBMA) for toluene, to assess their efficacy when compared to traditional biomarkers for biological monitoring of occupational exposure to low concentrations of these two toxic substances. METHODS: Assessment was made of 41 workers occupationally exposed to benzene and toluene, 18 fuel tanker drivers and 23 filling-station attendants, as well as 31 subjects with no occupational exposure to these toxic substances (controls). Exposure to airborne benzene and toluene was measured using passive Radiello personal samplers worn throughout the work shift. In urine samples collected from all subjects at the end of the workday, both the traditional and the new internal dose biomarkers of benzene and toluene were assessed, as well as creatinine so as to apply suitable adjustments. RESULTS: Occupational exposure to benzene and toluene resulted significantly higher in the fuel tanker drivers than the filling-station attendants, and higher in the latter than in controls. Significantly higher concentrations of t,t-muconic acid (t,t-MA), S-phenylmercapturic acid (SPMA), urinary benzene, SBMA and urinary toluene were found in the drivers than the filling-station attendants or the controls. Instead, urinary phenol and hippuric acid were not different in the three groups. In the entire sample, airborne benzene and toluene values were significantly correlated, as were the respective urinary biomarkers, showing coefficients ranging from 0.36 to 0.98. Subdividing the subjects by smoking habit, higher coefficients were evident in non-smokers than in smokers; at multiple regression analysis t,t-MA, SPMA and urinary benzene and toluene were dependent on the number of cigarettes smoked daily and on airborne benzene and toluene, respectively. Instead, SBMA was dependent only on airborne toluene. CONCLUSIONS: Our research confirmed the validity of t,t-MA and SPMA for use in the biological monitoring of exposure to low concentrations of benzene. Urinary benzene showed comparable validity to SPMA; both parameters are affected by smoking cigarettes in the hours before urine collection, so it is best to ask subjects to refrain from smoking for 2 h before urine collection. Urinary toluene was found to be a more specific biomarker than SBMA.

Urinary biomarkers of nucleic acid oxidation and methylation in workers exposed to low concentrations of benzene.

The study aims to investigate the influence of exposure to low concentrations of benzene on urinary biomarkers of nucleic acid oxidative damage and methylation. Benzene exposure was characterized for 93 coke production workers by measuring both airborne benzene and S-phenylmercapturic acid (SPMA) and unmodified benzene (U-B) in urine samples, collected at the end of the shift (ES) and at the next morning before shift (next BS). In the same urinary samples, biomarkers of nucleic acid oxidative damage and methylation were determined. Urinary concentrations of cotinine and creatinine were also determined to evaluate the smoking effect and to normalize urinary concentrations of analytes, respectively. The biomarkers of benzene internal dose, of oxidative damage (8-hydroxyy-7,8-dihydroguanine, 8-hydroxy-7,8-dihydroguanosine and 8-hydroxy-7,8-2'deoxyguanosine) and some of the biomarkers of nucleic acid methylation (5-Methyl-Cytosine, 1-Methyl-Guanine and 7-Methyl-Guanine) were higher in the ES than the next BS samples. Positive associations between ES 5-Methyl-Cytosine and both SPMA and U-B were found. In conclusion, occupational exposure to low levels of benzene seems to be related to urinary ES 5-Methyl-Cytosine that could be a possible biomarker to evaluate the changes of the nucleic acid methylation status.

Indoor formaldehyde and acetaldehyde levels in the province of Bari, South Italy, and estimated health risk.

Indoor and outdoor formaldehyde and acetaldehyde levels were assessed to characterize pollution in dwellings in the city and the Province of Bari, also taking into account seasonal variability, and to investigate health effects of aldehyde exposure on the general population. In 2007, passive environmental monitoring was performed, for 24 hours, in the kitchen of 59 dwellings, as well as outdoors for 27 of them. A questionnaire probing personal and home characteristics was administered to all 182 subjects habitually resident in the homes. During the period January-June 2008, formaldehyde and acetaldehyde levels were monitored monthly in 20 of the investigated dwellings inhabited only by non smokers. Indoor formaldehyde and acetaldehyde concentrations were significantly higher (16.0 +/- 8.0 and 10.7 +/- 8.8 microg m(-3)) than outdoor concentrations (4.4 +/- 1.7 and 3.4 +/- 2.0 microg m(-3)), showing a correlation between indoor levels of the two aldehydes (r = 0.41; p = 0.001). In dwellings inhabited only by non smokers, formaldehyde concentrations were higher in the presence of furniture bought new or restored less than one year before (p = 0.03). Formaldehyde and acetaldehyde levels were significantly higher in winter months than in spring-summer months (F = 2.86, p = 0.02; F = 5.39, p < 0.001) and seemed to be influenced by the time that kitchen windows were kept open. As regards the effects on human health, a low prevalence of allergic disease and no association between any irritant or allergic complaints and indoor levels of the two aldehydes was observed. In conclusion, the results showed low indoor and outdoor concentrations of formaldehyde and acetaldehyde, not generally posing a risk for human health.

Significance of urinary arsenic speciation in assessment of seafood ingestion as the main source of organic and inorganic arsenic in a population resident near a coastal area.

In order to characterize the different sources of exposure to arsenic (As), urinary excretion of total As, the sum of inorganic As+MMA+DMA determined by the hydride generation-atomic absorption spectrophotometry technique, and the species As3, As5, monomethylarsonic acid (MMA), dimethylarsinic acid (DMA) and arsenobetaine were determined in 49 workers at a steel foundry, with presumed occupational exposure to As, and 50 subjects from the general population, all males. No evidence of occupational exposure to As resulted from environmental monitoring performed in the foundry, although the analysis of minerals used as raw materials showed the presence of As, particularly in fossils and fine ores. The urinary concentrations of As3, MMA, DMA, the sum of inorganic As+MMA+DMA and total As were not different in the two groups, while arsenobetaine appeared significantly higher in the controls than in the workers. The different species of urinary As were all significantly correlated. Urinary excretion of As3 was associated with the consumption of mineral water and with residence in an industrial zone, while MMA, DMA, arsenobetaine, the sum of inorganic As+MMA+DMA and total As urinary excretion were associated with the consumption of crustaceans and/or shellfish 3 days or less before urine collection. Multiple regression analysis confirmed these results. In conclusion, in populations with a high consumption of seafood, living in areas characterized by coastal/marine As pollution, only speciation of As can identify a prevalent role of environmental sources, like the consumption of seafood contaminated by As, in determining urinary As excretion, and exclude an occupational origin of the exposure.

Allergic contact dermatitis with a fertilizer containing hydrogen cyanamide (Dormex).

Cyanamide is a chemical substance used in the treatment of chronic alcoholism as well in agriculture as a fertilizer. We report the case of a 28-year-old healthy non-atopic man that developed a severe skin eruption after the accidental penetration of a small amount of Dormex (a plant growth regulator containing cyanamide) through the patient's gloves. Patch tests revealed positive reactions to Dormex 1% pet. and cyanamide at a dilution of 0.1% pet. and 1% pet. We discuss the causes of sensitization in a patients that regularly used protective measures during anti-parasites treatments.

Risk due to exposure to metallic elements in a birdshot factory.

The contribution of biological and environmental monitoring to the risk assessment of occupational exposure to lead (Pb), arsenic (As), and antimony (Sb) was studied in 18 workers at a birdshot factory (Exposed) and in 18 control workers (Controls) by the determination of both airborne Pb (PbA) and airborne As (AsA) only in the exposed workers and blood Pb (PbB), erythrocytic zinc protoporphyrin (ZPP), urinary Sb (SbU), and the urinary As species in exposed workers and controls. PbA (12-42 µg/m3) and AsA (1-4 µg/m3) were strongly correlated (r = .95). PbB, ZPP, and the sum of As3+As5+MMA were significantly higher in the exposed workers. As3 was higher than the limit of detection in 14 exposed workers and 1 control, As5 only in 1 exposed worker, SbU in all the exposed workers and in 4 controls. Monitoring for more metallic elements reveals a wider spectrum of exposures than can be achieved by lead surveillance alone and is preferable for characterizing occupational risk wherever possible.

Applicability of the Nordic Occupational Skin Questionnaire for Screening Contact Dermatological Disorders in Sea Fishers.

This survey aimed to evaluate the applicability of the Nordic Occupational Skin Questionnaire (NOSQ) as a preliminary screening tool to investigate the presence of contact dermatological disorders in sea fishermen. The Italian version of the NOSQ was administered to 143 male fishermen working at an Apulia (Southern Italy) Fisheries, and 136 male workers who had never worked as sea fishers (controls). A significantly higher rate of frequency of transient itchy wheals on the hands, wrists, and forearms was recorded in the fishermen as compared to the controls (49.6% vs. 8.1%; p < 0.001), while there was no significant difference in the frequency of eczema (8.4% vs. 6.6%). In 46.1% of the fishermen, the onset of transient itchy wheals was associated with contact with specific agents and the most common causes were algae and aquatic plants (49.3%) and seabed sludge (25.3%). In conclusion, the administration of the NOSQ can be useful in preliminary screening for dermatitis in fishermen, although it could show a possible overestimation of the prevalence of transient itchy wheals.

Radon Levels in Indoor Environments of the University Hospital in Bari-Apulia Region Southern Italy.

Since 1988, the International Agency for Research on Cancer (IARC) has classified radon among the compounds for which there is scientific evidence of carcinogenicity for humans (group 1). The World Health Organization (WHO) recommends a reference radon level between 100 and 300 Bq/m³ for homes. The objective of this study is to measure the radon concentrations in 401 workplaces, different from the patient rooms, in 28 different buildings of the university hospital in Bari (Apulia region, Southern Italy) to evaluate the exposure of health care workers. Radon environmental sampling is performed over two consecutive six-month periods via the use of passive dosimeters of the CR-39 type. We find an average annual radon concentration expressed as median value of 48.0 Bq/m³ (range 6.5-388.0 Bq/m³) with a significant difference between the two six-month periods (median value: February/July 41.0 Bq/m³ vs. August/January 55.0 Bq/m³). An average concentration of radon lower than the WHO reference level (100 Bq/m³) is detected in 76.1% of monitored environments, while higher than 300 Bq/m³ only in the 0.9%. Most workplaces report radon concentrations within the WHO reference level, therefore, the risk to workers' health deriving from occupational exposure to radon can be considered to be low. Nevertheless, the goal is to achieve near-zero exposures to protect workers' health.