Non-malignant occupational respiratory diseases and climate change

BACKGROUND: Respiratory diseases of infectious, allergic, neoplastic or degenerative origin are due to the interaction of environmental and occupational risk factors, individual susceptibility and other co-factors and comorbidities. Asthma and other respiratory pathologies can be worsened by climate change and exposure to other agents in occupational environments.METHODS: PubMed and Scopus, and several websites on public and occupational health were queried to find publications and documents on work-related respiratory diseases, asthma, rhinitis, chronic obstructive pulmonary disease (COPD), pneumoconiosis and allergic alveolitis in association with climate change.RESULTS: Most of the retrieved articles concerned asthma (75 in Scopus), while the other topics were less frequently covered in the scientific literature, with a maximum of 29 papers for rhinitis and 23 for COPD. The most important terms highlighted by the word clouds were 'health', 'air', 'pollution', and, only for asthma and rhinitis, 'pollen' and 'allergic/allergy'. Website data on public and occupational health, and climate change were reported.CONCLUSIONS: Assessment and management of respiratory diseases that recognise occupational exposures should be improved, and more research into integrated approaches should be favoured. Health surveillance practices for workers exposed to agents that cause respiratory diseases should be implemented. The development of biomarkers of exposure, effect and susceptibility needs further study.

Climate change and occupational allergies: an overview on biological pollution, exposure and prevention

INTRODUCTION

Climate change, air pollution, temperature increase and other environmental variables are modifying air quality, contributing to the increase of prevalence of allergic respiratory diseases. Allergies are complex diseases characterized by multilevel interactions between individual susceptibility, response to immune modulation and environmental exposures to physical, chemical and biological agents. Occupational allergies introduce a further complexity to these relationships by adding occupational exposure to both the indoor and outdoor ones in the living environment.

OBJECTIVE

The aim of this paper is to overview climate-related allergy affecting environmental and occupational health, as literature data are scanty in this regard, and to suggest a management model of this risk based on a multidisciplinary approach, taking the case of biological pollution, with details on exposure and prevention.

CONCLUSIONS

The management of climate-related occupational allergy should take into account preventive health strategies, environmental, public and occupational interventions, as well as to develop, implement, evaluate, and improve guidelines and standards protecting workers health under changing climatic conditions; new tools and strategies based on local conditions will have to be developed. Experimental studies and acquisition of environmental and personal data have to be matched to derive useful information for the scope of occupational health and safety.

Climate change, vector-borne diseases and working population

INTRODUCTION

Risks associated with climate change are increasing worldwide and the global effects include altered weather and precipitation patterns, rising temperatures and others; human health can be affected directly and indirectly. This paper is an overview of literature regarding climate changes, their interaction with vector-borne diseases and impact on working population.

MATERIALS AND METHODS

Articles regarding climate changes as drivers of vector-borne diseases and evidences of occupational cases have been picked up by public databank. Technical documents were also included in the study.

RESULTS

Evidences regarding the impact of climate changes on vector-borne diseases in Europe, provided by the analysis of the literature, are presented.

DISCUSSION

Climate-sensitive vector-borne diseases are likely to be emerging due to climate modifications, with impacts on public and occupational health. However, other environmental and anthropogenic drivers such as increasing travelling and trade, deforestation and reforestation, altered land use and urbanization can influence their spread. Further studies are necessary to better understand the phenomenon and implementation of adaptation strategies to protect human health should be accelerated and strengthened.

[The simple measure of handwashing to prevent the risk from biological agents: what has changed since the theories of Semmelweis]

In this manuscript, we consider the importance of hand hygiene as the chief measure of prevention and protection in the occupational context. In particular, we remember the physician who lived in the middle of the 19th century, Ignazio Semmelweis, genius but not understood creator of the theory for infection control, based on hand hygiene. Subsequent studies have clearly demonstrated the validity of Semmelweis' research, through scientific publications and the establishment of international guidelines, such as by the World Health Organization (WHO). It is important to remember the initial work and then, sharpen this tool, resulting in the adoption of simple, but effective behavioural practices, that should be spread by several means and tools of information, education and communication, addressed at all involved, for the reduction of exposure to the occupational biological risk.

Airway inflammation in professional divers: FeNO as a marker

PURPOSE OF THE RESEARCH

The aim of this present study is examine the airway inflammation using the fractional exhaled nitric oxide (FeNO), to detect differences in FeNO measurements in comparison with spirometry and evaluate the use of this technique in health surveillance programs, also in order to determine the suitability to the specific task.

WHAT WAS DONE

Between November 2009 and February 2010 we recruited 74 volunteers, all professional divers from the Italian National Fire Services Department. A clinical-medical history questionnaire was administered, with guidance; then the study protocol was applied. Spirometry was conducted to measure respiratory function, and FeNO was assayed.

WHAT WAS FOUND

Neither age nor body mass index (BMI) influenced FeNO, but there were significant differences related to smoking, particularly among ex-smokers (p < 0.05). A FeNO value higher than the threshold of 35 ppb was related to the spirometry results and questionnaire answers.

WHAT WAS CONCLUDED

This non-invasive method is useful in checking for respiratory disease; divers with high FeNO should be scheduled for further clinical-instrumental investigation and laboratory tests to make sure they have no diving contraindications.

[A brief update on avian influenza and the protection of workers in view of the implementation of the new EU directive]

Influenza virus A(H5N1), since its first appearance in Hong Kong in 1997 killing six people, has continuously recorder by 2003 both new cases and deaths between these. Although the media and social attention received in the years between 2006 and 2008, mainly in Italy is not currently present, the same is not true for the avian flu that still exists in some countries. At the regulatory level, at the beginning of 2006 the Ministry of Health indicated the measures to be taken in the national preparedness and response to a pandemic flu, and the national Legislative Decree 25 January 2010, n. 9 makes implementing the EU Directive 2005/94/CE on Community measures to combat avian flu. Moreover, an article published in June 2010 show a new route of transmission of avian viruses by birds. The topic on avian flu, especially aimed at the protection of workers potentially exposed, has been long the subject of studies, and in particular for operators belonging to the Corpo Nazionale dei Vigili del Fuoco (C.N.VV.F.). In particular, in the context of the measures taken to address any outbreak of avian flu, were carried out one manual addressed to operators by C.N.VV.F. and to so-called managers/operators of the emergency public service workers represented by the operators of the C.N.VVF. and of Police, Civil Protection, and Voluntary Organisations of rescue enclosed in Civil Protection Service. It is necessary to reiterate the importance of continued and growing of the preparation and information for workers, brought to the operators themselves useful about the adoption of preventive and protective measures by the workers belonging to groups at risk of potential exposure to avian influenza viruses.

Risk assessment of aggression toward emergency health care workers

BACKGROUND

Health care and social service workers face a significant risk of job-related violence.

AIMS

To develop a method for quantitative evaluation of the risk of violence, as required by Italian and European regulations, against extra-hospital emergency health care workers employed by the Regional Emergency Healthcare Service (ARES 118) in the Lazio Region in Italy.

METHODS

Violence to the ARES 118 workers during working hours was examined by analysing injuries reported by them between 2005 and 2007. The assessment method proposed should give a numerical indicator of the risk of violence for each homogeneous group. The quantitative risk was evaluated on the basis of variables such as the days off work for each episode, the total number of aggressive attacks, the type of health intervention involved, etc.

RESULTS

The rate of accidents related to aggression during working hours at the ARES unit was 6.3%, which is significantly higher than the figure of 2% reported for the entire health care sector.

CONCLUSIONS

The present evaluation is largely based on analysis of the Injury Register. To increase the sensitivity of the method so that it closely reflects active reporting of events, it would be necessary to implement a procedure for reporting events in a 'company register of acts of violence' and to make workers more aware of the need to report all such episodes.

[Value of the microarray for the study of Laboratory Animal Allergy (LAA)]

Since 1989, the National Institute for Occupational Safety and Health (NIOSH) considers the Laboratory Animal Allergy - LAA a risk for workers and in 1998 the LAA has been recognized as occupational risk in the USA. Rat and mouse are the most source of allergens, not so much for the higher power of allergy respect to the other animals, but because represent the more utilized species in the research. Most of the allergens are members of the lipocalin superfamily, small extracellular proteins represented by at least 50 proteins that mainly bind or carry small hydrophobic molecules. The recent and innovative molecular techniques, as the microarray, have allow the characterization of numerous allergens. The protein microarray gives the possibility to study of IgE profile for each individual, simultaneos analysis of a wide number of parameters concerning the allergy, giving new diagnostic and therapeutic opportunities for the allergies. In the study of occupational allergy--as LAA--the protein microarray could improve: the identification and characterization of new allergens; the individuation of susceptible workers; the study of immunological responses in exposed workers; the strategies of prevention and protection; the environmental and housing conditions. The participation, formation and information of the workers could improve the behavioural and occupational practices, the use of personal and collective protective devices in order to reduce the exposure to LAA in occupational context.

[Contribution of ISPESL (National Institute for Occupational Safety and Prevention) for protecting workers from exposure to avian influenza]

Influenza virus A/H5N1 occurs mainly in birds, in which is highly contagious and deadly, and does not usually infect people. Most of the cases occurred in humans resulted from people having direct or close contact with H5N1 infected poultry or contaminated surfaces. The circulation of influenza viruses in birds, humans and other hosts represents a public and animal health threat, with important economic consequences. Controlling avian influenza in poultry, in particular with biosecurity measures, is the primary method to reduce human risk from infection. Enhanced surveillance both in poultry and in wild birds proved effective for the early detection of the infection. Worldwide most countries developed strategic plans, guidelines and recommendations for effective disease prevention and control. Moreover documents were specifically prepared to keep specific categories of workers adequately informed on how to avoid or minimize exposure to the viruses. In accordance with the Italian Decree 626/94, recently amended by the Decree 81/08, regarding the protection of workers from risks related to exposure to biological agents at work, the Department of Occupational Medicine of ISPESL prepared one booklet directed to people working with poultry and, together with Corpo Nazionale Vigili del Fuoco, two booklets addressed to fire brigade who could be at various levels involved in outbreak disease control and eradication activities. In fact information and training are essential aspects of a global preventive and protective strategy.

[HCV genotyping in health professionals: controversies and perspectives]

Healthcare workers (HCW) are at risk of acquiring blood-borne infections, including HCV Although current evidence does not suggest an increased prevalence of HCV infection among HCW, transmission of infection following occupational exposure has been demonstrated. Moreover, HCV can establish a persistent, chronic infection contributing to progressive liver disease, and post-exposure prophylaxis against HCV infection is not currently available. Problems still arise in the health surveillance of healthcare workers HCV infected. The use of virologic assays has become essential in the management of hepatitis C virus (HCV) infection, in order to improve the diagnosis of the infection, to guide the treatment decisions, and to assess the virologic response to antiviral therapy. Although several studies have specifically evaluated the role of HCV genotypes, many questions have not been answered. It is thought that HCV genotypes are important epidemiological markers, but more investigations are needed to elucidate their role regarding the progression and the pathogenesis of liver disease. The clinical implication of HCV genome heterogeneity, the different genotyping methods and the possible role of HCV genotypes as a parameter that could help health surveillance of infected HCW are described in this paper.

[New tools for the study of occupational allergies related to animals]

Animal laboratory workers are exposed at the Laboratory Animal Allergy (LAA). About 10% of them develop asthma. Currently, by the use of innovative methodologies, numerous allergens from the laboratory animals have been sequenced and analyzed. Between them, the allergens by rats and mouse, the experimental models more utilized. Proteomic approach or protein microarray permit the study of several allergens, belonging to the proteins known as lipocalins, and of immunological response in susceptible individuals. Moreover, availability of on-line data banks permit a knowledge more and more detailed and up-to-date regarding the allergens of the interest. Between the advantage of the proteomic there is the use of small amount of biological fluids, as the serum, in association with the possibility to studied a great number of allergens on a single support. The study of LAA by the use of proteomic will permit to identify the animal allergens more accurately, providing also a valid tool at the methodologies traditionally used, and for the planning of the preventive and protective measures.

[The need to improve the quality of laboratory results in the study of biological occupational risk]

In the field of occupational medicine, the laboratory medicine gives fundamental contribution not only to evaluate the risk connected to different environmental, biologic, chemical and physical factors, but also to manage the quality of the work condition. For this purpose, it's fundamental that the finalized health efficiency measures and the individuation of interventions partially or totally based on laboratory results, have to be correlated to reliable analytical results, to be validated by internal and external quality controls. During the last years, a new and in some way innovative interest in occupational exposition to biological agents increased. Although, in this sphere, the immunoenzimatic methods are widely used, standardization and quality controls are often absent. For the molecular investigation that is widely used in occupational medicine, adequate quality control systems should be promoted. The work medicine, as the laboratory medicine, should develop "Quality Assurance" programmes not only referred to different occupational infections study, but also to the use of different laboratory methodologies, including immunochemical, cellular, molecular or the ones ending by ... omic as proteomic, genomic, transcriptomic, etc.. The carrying out of such programmes is necessary to aim to support the integration in the involved different professional positions, to guarantee higher comprehension, transparency and reliability on analytical results.

[Use of the comet test in occupational medicine and industrial toxicology: considerations and prospects]

The comet test (Single Cell Gel Electrophoresis or SCGE) is an easy to perform, rapid and highly sensitive genotoxicity assay; it requires small amounts of biological substrate and is applicable in vivo and in vitro to a wide variety of cells and tissues. Modified versions of the comet test able to detect oxidative damage or the effects of agents inducing DNA-DNA or DNA-protein crosslinks are available. Similarly to other genotoxicity assays, the comet test is not predictive far individual cancer risk. Limitations and critical features presently linked to comet test applications, with particular regard to the biomonitoring of individuals exposed to genotoxic agents, include: lack of sensitivity with respect to aneugens (agents inducing numerical chromosomal aberrations), possible underestimation of genotoxic potency of agents with mixed action mechanisms, sensitivity depending on the genotoxic agent itself, dependence an biological substrate with regard to the influence of cytotoxicity on the assay results, influence of age, tobacco smoke, alcohol and drug consumption, diet, kinetics of DNA adducts and DNA repair mechanisms. Consequently, a routine use of the comet test in biological monitoring of individuals that are occupationally and environmentally exposed to genotoxic agents is submitted to its validation by multicentric studies on large population samples with different exposure patterns, with a suitable characterisation of the role played by the above mentioned factors. Human studies should also be increasingly focused on the direct cellular targets of exposure to genotoxicants (e.g. epithelial cells of oral cavity and airways).

Prevalence and incidence of antibodies to Borrelia burgdorferi and to tick-borne encephalitis virus in agricultural and forestry workers from Tuscany, Italy

The ticks Ixodes persulcatus and Ixodes ricinus are the main vectors of both Borrelia burgdorferi sensu lato and tick-borne encephalitis (TBE) virus in Eurasia. Borrelia burgdorferi is the cause of Lyme borreliosis, and TBE is a biphasic meningoencephalitis induced by an arbovirus belonging to the flavivirus family. The principal aims of the current investigation were (i) to determine the frequency of serological evidence of Borrelia burgdorferi sensu lato and TBE infections in healthy agricultural and forestry workers, (ii) to determine the incidence of seroconversion for antibodies against Borrelia burgdorferi sensu lato and TBE virus in Tuscan workers during a 1-year survey; and (iii) to assess the occupational risk for agricultural and forestry activities in a defined area (Tuscany, Italy). A total of 412 blood samples were taken from agricultural and forestry workers, and information on age, duration of employment, and history of tick bites was collected in a questionnaire to establish the risk factors for the diseases. Three hundred sixty-five blood donors from the same region served as controls. To estimate the rate of seroconversion, 176 of the agricultural and forestry workers were tested 1 year later. IgG and IgM antibodies against Borrelia burgdorferi sensu lato and TBE virus were detected in serum by an enzyme-linked immunosorbent assay and confirmed by Western blot analysis for Borrelia burgdorferi and by a test for inhibition of hemagglutination for TBE. Antibodies against Borrelia burgdorferi were more frequent among the workers than in the control group (7.8% vs. 4.9% in the IgG-IgM enzyme-linked immunosorbent assay and 7.03% vs. 3.56% in the confirmatory test). No seropositivity was observed for TBE virus. Eighteen of 176 subjects who underwent a second blood test developed specific antibodies against Borrelia burgdorferi within 1 year.

Intratumoral microvessel density and expression of ED-A/ED-B sequences of fibronectin in breast carcinoma

The aim of this study was to examine the correlation between intratumoral microvessel density (iMVD) and the presence of cellular fibronectin isoforms, ED-A and ED-B, in order to identify those tumours with a prominent angiogenic phenotype. 91 cases of invasive ductal breast carcinoma were evaluated for TNM, histological grading, percentage of Ki-67+ cells and receptor hormonal status. iMVD was determined as a single microvessel count in a 200 x microscope field from the region of the tumour that appeared to be most densely vascular. When the mean values of iMVD of the various groups were compared, no significant difference was noted (Mann-Whitney test). When tumours were classified as high or low iMVD, based on a cut-off value (99 vessels/0.74 mm2), cases with high iMVD were significantly more numerous in poorly differentiated G3 tumours (P = 0.01, Chi-square test), and in tumours with lymph node metastasis (N0 versus N1 + N2; P = 0.002). The possibility that high iMVD was the expression of prominent vascular neoformation was explored using ED-A and ED-B isoforms of fibronectin as markers of neoformed vessels. ED-A + and/or ED-B + blood vessels were < 10% of total vessels, were detected in approximately 50% of cases independently of iMVD values, and were not more numerous in tumour areas with hot spot vascularisation. Our findings indicate that iMVD and expression of ED-A/ED-B reflect different aspects of tumour-associated angiogenesis.

Role of delivery on serum iron-related parameters in Macaca fascicularis females

Few data exist on the iron status and metabolism in macaques, which are considered optimal models for the study of reproductive biology and anemia. The delivery influence on the hematological parameters of iron metabolism was investigated in adult Macaca fascicularis females during late pregnancy and at 6 weeks postpartum follow-up. No significant differences were detected for each parameter by one-way analysis of variance. A decrease of all parameters was observed at delivery. During the following weeks, however, the hematological values progressively came back to normal. In conclusion, notwithstanding the increased need of iron faced during pregnancy, a balanced diet, including iron, does not allow the development of either iron deficiency or sideropenic anemia.

Serum kappa and lambda light immunoglobulin chains in cynomolgus macaques (Macaca fascicularis) during the first twenty months of age

Growth is coupled to physiological modifications of the immune system which reaches the functional capabilities according to age-related milestones. Few data are available on the circulating immunoglobulin levels and no data exist on total immunoglobulin light chains in infant macaques. Therefore we studied by a nephelometric assay, the age-dependent variations of kappa and lambda serum light chains in the experimental animal model Macaca fascicularis during the first 20 months of age. Both kappa and lambda showed a marked increase in their concentrations during the first 7-8 months of life. Infants' light chain levels were anyhow significantly lower than those of the nursing dams and of the control group, never attaining, even at the 20th month, the same concentration as the adult, although the value of the kappa/lambda ratio was apparently the same.

Humoral immunity factors in cynomolgus macaques (Macaca fascicularis) serum: immunoglobulins and total light chains in nursing dams

This study was aimed at the identification of variations in humoral immunity parameters during the lactation period in macaque females, a recognized model in reproductive physiology and pathology. The importance of such evaluation is evidenced in particular by the central role played by the maternally transferred immunity to the progeny. The trends of serum immunoglobulins and light chains were characterized by immunonephelometry during the 6-months of lactation. The levels attained by nursing females were evaluated against a control group. The main modifications induced by lactation were in the IgM class, whose levels remained constantly lower than in the control group; the other Igs, even if showing different trends, returned to levels comparable to the control group by the end of the sixth month. Light chains quantification evidenced a significant decrease in Kappa levels; Lambda chains showed a similar trend. The variation of the Kappa/Lambda ratio was therefore minimal.

Changes in serum protein fractions and specific alpha and beta concentrations during lactation in Macaca fascicularis

Physiologic variations are known to develop in milk and serum proteins of women during lactation. This study was intended to evaluate whether modifications of the major serum proteins and alpha, beta, and gamma fractions occur during lactation in Macaca fascicularis. The alpha 1 and gamma globulins decreased and the alpha 2 and beta globulins increased; results of specific protein determinations indicated a decrease in almost all globulins. The protein trends during lactation in M. fascicularis are probably modified by estrogen and progesterone variations after delivery. Estrogen trends are similar in women and cynomolgus monkey females, whereas progesterone patterns between women and female macaques are different during the postpartum period.