Preventive oral kefir supplementation protects mice from ovariectomy-induced exacerbated allergic airway inflammation

Asthma is an inflammatory lung disease that affects more women than men in adulthood. Clinical evidence shows that hormonal fluctuation during the menstrual cycle and menopause are related to increased asthma severity in women. Considering that life expectancy has increased and that most women now undergo menopause, strategies to prevent the worsening of asthma symptoms are particularly important. A recent study from our group showed that re-exposure of ovariectomised allergic mice to antigen (ovalbumin) leads to an exacerbation of lung inflammation that is similar to clinical conditions. However, little is known about the role of probiotics in the prevention of asthma exacerbations during the menstrual cycle or menopause. Thus, our objective was to evaluate the effects of supplementation with kefir, a popular fermented dairy beverage, as a preventive strategy for modulating allergic disease. The results show that the preventive kefir administration decreases the influx of inflammatory cells in the airways and exacerbates the production of mucus and the interleukin 13 cytokine. Additionally, kefir changes macrophage polarisation by decreasing the number of M2 macrophages, as shown by RT-PCR assay. Thus, kefir is a functional food that potentially prevents allergic airway inflammation exacerbations in ovariectomised mice.

Personal solar ultraviolet radiation dosimetry in an occupational setting across Europe

BACKGROUND

Work-related solar ultraviolet radiation (UVR) is an important factor in the pathogenesis of non-melanoma skin cancer (NMSC). The World Health Organization, through the International Agency for Research on Cancer, has classified solar UVR as a group 1 carcinogen since 2012. The main problems encountered so far in the study of occupationally induced skin cancer include the lack of accurate occupational UVR dosimetry as well as insufficient distinction between occupational and leisure UVR exposure and underreporting of NMSC.

OBJECTIVES

The aim of this study was to collect long-term individual UVR measurements in outdoor workers across European countries.

METHODS

A prospective study was initiated through the European Academy of Dermatology and Venereology, Healthy Skin@Work Campaign, measuring UVR exposure doses at occupational settings of masons from five European countries. Measurements were performed for several consecutive months using the GENESIS-UV measurement system.

RESULTS

The results identified alarming UVR exposure data. Average daily UVR doses ranged 148.40-680.48 J/m² in Romania, 342.4-640.8 J/m² in Italy, 165.5-466.2 J/m² in Croatia, 41.8-473.8 J/m² in Denmark and 88.15-400.22 J/m² in Germany. Results showed an expected latitude dependence with increasing UVR yearly dosage from the north to the south of Europe.

CONCLUSIONS

This study shows that outdoor workers from EU countries included in this study are exposed to high levels of occupational solar UVR, vastly exceeding the occupational exposure limits for solar UVR exposure, considered to be 1-1.33 SED/day in the period from May to September. This finding may serve as an evidence-based recommendation to authorities on implementing occupational skin cancer prevention strategies.

Polycyclic Aromatic Hydrocarbons Exposure Assessment in a Refractory Brick Production

In a refractory brick manufacturing company a qualitative and quantitative determination of the sources of occupational exposure to polycyclic aromatic hydrocarbons (PAHs) was obtained in order to validate targeted hygiene measurements. The study included the assessment of PAHs contamination of work surfaces by wipe-sampling, cutaneous exposure by hand washing, contamination of personal protective equipments (gloves) by extraction in solvent, and airborne PAHs concentration in atmospheric samples. Biomonitoring was also carried out by measurement of urinary 1-hydroxypyrene (1-OHPU) in three groups of workers (packaging, production, and controls). The surface contamination sampling was performed in production, packaging, and in other departments (external area) in theory less contaminated by PAHs. Two different areas were identified within the production, one included surfaces that were regularly cleaned (A area) and one included data from non-cleaned surfaces (B area). To confirm the source of exposure, a clear correspondence was observed between the percentage of the single compounds in the binder and those measured in wipes and air samples. As far as the wipes are concerned, the concentrations of phenanthrene, anthracene, fluoranthene, pyrene, benzo(a)pyrene (BaP), and the total PAHs mixture were higher in the B area than the A area of production. The same happened between the A area and the other two departments. According to results of the statistical analysis, these differences were significant. These results were confirmed by the hand washing data and the analysis of PPE. On the other hand, a marked difference does not exist between the packaging department and the external area. In air samples, the differences were much less evident with only higher concentrations of anthracene and total PAHs between production as a whole and the other two departments. Biological monitoring showed 1-OHPU values significantly higher in production workers than in packaging workers. In conclusion, the analysis of the wipes demonstrated that the production B area has a higher surface contamination compared to the production A area and the packaging department. In the absence of a significant difference in air concentrations of PAHs between A and B areas, this is attributable to surfaces not subject to cleaning. Results confirm that the measurement of surface contamination represents a valid tool for the assessment of sources of exposure to PAHs in the workplace.

Skin photoaging in farmers occupationally exposed to ultraviolet radiation

BACKGROUND

Most personal exposures to UV radiations occur from outdoor activities and several studies detected a significant association between skin cancer and outdoor occupation.

OBJECTIVE

The aim of the study was to ascertain the prevalence of photoaging signs in a population of Italian farmers and in a population of indoor workers taking account of confounding factors.

METHODS

169 farmers and 198 indoor workers were classified for skin phototype and for skin photoaging, moreover 13 variables were taken into account. Marginal permutation tests were adopted for statistical analysis.

RESULTS

Farmers were significantly older than the indoor workers. In workers occupationally exposed to UV photoaging increased with increasing age and years of occupational exposure to sunlight The distribution of skin phototype did not show significant differences in the two populations, while farmer showed a higher degree of photoaging than indoor workers.

CONCLUSIONS

Even if farmers were older than the in door workers it seems that outdoor work produces a higher degree of photoaging.

[Dose and effect biomarkers in the diagnosis of asbestos-related diseases and health surveillance of exposed workers]

The aim of the study was to assess the reliability of the indicators of dose and effect in the health monitoring of asbestos exposed workers. In 49 cases out of 158 studied workers (31%) asbestos-related diseases were diagnosed following ATS criteria (2004). Using nonparametric statistical methods (permutation tests) 6 variables were analyzed with respect to asbestos-related diseases and working sectors, demonstrating a difference in the concentration of amphiboles (p < 0.01), greater in patients with asbestosis and workers involved in asbestos removal from railway carriages. There was not a correlation between mesothelin and amphiboles, chrysotile and total fibers concentrations (Spearman test).

[Prevention of occupational dermatitis in an international perspective]

Occupational dermatitis (OD) have always been a significant part of the occupational disease with huge social and economic costs. Traditionally, the standard program of OD prevention takes place in the three phases of protection, cleansing and use of emollient creams and other products able to improve the cutaneous trophism (skincare) at the end of the shiftwork. However, in countries like Germany where protection measures and skincare were widespread, there was not a simultaneous decrease in the OD. In recent years pilot programs for the prevention of OD have been implemented with positive results. In particular the integrated approach that includes three steps of primary, secondary and tertiary prevention (Osnabrueck model) is of great interest. Primary prevention is represented by introduction of technical regulations, pre-employment counselling and specific initiatives to promote health (healthy skin campaign). In the case of initial/minor OD, secondary prevention is accomplished through the dermatological treatment of the patient and 1-2 days outpatient education initiatives/skin protection training. In severe cases of individual OD, tertiary prevention involves the hospitalization of the patient in a dermatology department. In 2009 the European network EPOS (European Initiative for the Prevention of Occupational Skin Diseases) of preventive dermatology has been organized basing on the integrated approach of primary, secondary and tertiary prevention.

[Chemical risk assessment in the leather goods producers: a comparison of the results obtained by measurements air concentration and algorithm ARChiMEDE]

The Italian legislation on chemical agents has undergone significant changes. The aim of the study was to compare the results obatained from an environmental investigation and the use of the ARChi.MEDE model The results of the survey were treated with the UNI EN 689/1997 that showed an acceptable result, while according to the use A.R.Chi.M.E.D.E. a significant risk was obtained. Actually the mathematical model assess workers exposure without considering in the calculation the specific preventive measures (personal protective equipment, training, uptake of pollutants at the source) as contemplated by law. So the mathematical model showed the need of preventive measures in the studied work place.

[Leather bags production: organization study, general identification of hazards, biomechanical overload risk pre-evaluation using an easily applied evaluation tool]

BACKGROUND

Craft industries are the backbone of the Italian manufacturing system and in this sector the leather trade plays a crucial role.

OBJECTIVE AND METHODS

The aim of the study was to experiment with a risk pre-mapping data sheet in leather bag manufacture by analyzing the production cycle.

RESULTS

The prevalence of biomechanical, organizational and physical factors was demonstrated in tanneries. With regard to chemical agents the lack of any priority of intervention could be due to the lack of information on the chemicals used. In the 2 enterprises that used mechanical processes the results showed different priorities for intervention and a different level of the extent of such intervention. In particular in the first enterprise biomechanical overload was a top priority, while in the second the results were very similar to those of the tannery. The analysis showed in both companies that there was a high prevalence of risk of upper limb biomechanical overload in leather bag manufacture. Chemical risk assessment was not shown as a priority because the list of chemicals used was neither complete nor sufficient.

CONCLUSIONS

The risk pre-mapping data sheet allowed us to obtain a preliminary overview of all the major existing risks in the leather industry. Therefore the method can prove a useful tool for employers as it permits instant identification of priorities for intervention for the different risks.

Prevention of occupational dermatitis

Occupational dermatitis is among the most frequent occupational diseases. Dermal exposure risk affects many professional categories such as healthcare workers, hairdressers, bakers, cleaning and kitchen employees. The economical burden of occupational dermatitis (OD) is huge (greater than 5 billion Euro per year in Europe), comprising direct costs (treatment, compensation), as well as indirect costs due to sick leave and lack of productivity. A scientifically based preventive program consisting of skin protection during work, cleaning and skin care after work has generally been recommended to prevent occupational contact dermatitis. However the rate of reported occupational skin diseases seems unchanged in the recent years. In cases of impaired skin condition the secondary prevention (i.e. therapeutic treatment by dermatologists and health-educational intervention seminars) is fundamental. For cases of occupational dermatoses in which these outpatient prevention measures are not successful, interdisciplinary inpatient rehabilitation measures have been developed (tertiary individual prevention). In the past years, various pilot-concepts to improve occupational dermatitis prevention have been successfully put into practice focussing on interdisciplinary (dermatological and educational) skin protection training programmes for high-risk professions. Currently a multi-step intervention approach is implemented which is aiming at offering quick preventive help at all levels of severity of occupational contact dermatitis. Recent data reveals that there are reliable evidence-based options for multidisciplinary prevention and patient management of occupational dermatitis using a combined approach by a network of clinics, practices and statutory social insurance bodies. At this stage, it seemed reasonable to form a European joint initiative for skin prevention. Recently a European network of preventive dermatology (European Initiative for the Prevention of Occupational Skin Diseases-EPOS) has been organized based on the German experience in the specific field.

[Diagnosis of occupational skin diseases]

Occupational skin diseases (mainly irritative and allergic contact dermatitis) are a significant part of occupational diseases. The economical burden of occupational skin diseases (OSD) is huge comprising direct costs (treatment, compensation) as well as indirect costs due to sick leave and lack of productivity. The management of a case of OSD is complex requiring different steps ranging from diagnosis to prevention, through interpretation of patch tests and outpatient treatment and involving an interdisciplinary approach. Patch tests alone cannot prove the allergic origin of OSD because positive results can be referred to a previous contact dermatitis and negative ones may simply be apparent.

[SIMLII guidelines on workplace health promotion]

Interventions of health promotion (HP) with the best evidence of effectiveness are reported in literature. However nothing is said about how to apply these interventions in the local specific situations. On the other hand in literature the role of the occupational physician in workplace HP is not highlighted. Currently there is a substantial amount of knowledge on effective HP interventions that meets internationally accepted criteria, but at least in our country it is not systematically applied. While several databases provide useful information on different HP programs, the Cochrane Collaboration systematic reviews should be considered the most reliable source.

[Acute inorganic lead poisoning in workers employed on building renovation]

BACKGROUND

Occupationally, there are a number of work processes that constitute a long-term risk as sources of exposure to lead. In these processes the presence of lead is not evident but represents a hidden risk of poisoning.

OBJECTIVES

Study of two cases of hidden exposure to lead that were discovered during renovation work on a historical building.

METHODS

Acute lead poisoning symptoms appeared in the 2 workers. The current protocol for treatment of lead poisoning was applied, which consisted in administration of a chelating agent (EDTA), with subsequent monitoring of indicators of dose (PbB. blood lead level, PbU: urinary lead level) and indicators of effect (erythrocyte Protoporphyrin IX, urinary delta-aminolevulinic acid (ALA-U), urinary coproporphyrins).

RESULTS

The lead colic and anaemia appeared at PbB values (102 microg/dl e 104 microg/dl) that were higher than the PbB action value (40 microg/dl) and higher than the limit value (60 microg/dl).

CONCLUSIONS

The gravity of the symptoms, the high number of persons potentially involved, the difficulty of reclamation and probable urban contamination, with relative consequences concerning particularly infants and women infertile age, are sufficient grounds to require effective legislative action and improvement in the services available at the hospitals involved.

[Asthma induced by chloramine T in nurses: case report]

BACKGROUND

Chloramine T is used in hospitals as a disinfectant and for sterilization of endoscopy instruments.

OBJECTIVES

A case of a nurse suffering from asthma due to Chloramine T is presented in order to focus attention on this occupational disease.

METHODS AND RESULTS

The patient (male, 43 years) had been a nurse since 1993, working in various departments and operating rooms where he was exposed to glutaraldehyde and Chloramine T to disinfect surgical and endoscopy instruments. In 2007 he noticed the beginning of asthmatic reactions after exposure to the disinfectant. Skin tests with common allergens gave positive reactions and a skin test with Chloramine T gave a positive result. An inhalation test with glutaraldehyde gave negative results for both asthma and rhinitis. During the inhalation test with Chloramine T 0.5%, a significant biphasic decrease in FEVI was observed. The score of subjective symptoms for rhinitis was negative,

CONCLUSIONS

The case confirms the current difficulty in diagnosing occupational asthma due to Chloramine T in health care workers, which is due to the frequent presence of late reactions and to exposure to several respiratory allergens and irritants in the workplace. The specific inhalation challenge is thus confirmed as the gold standard for the diagnosis of asthma induced by Chloramine T and in occupational asthma in general. It may very well be that the frequency of occupational asthma due to sensitization to Chloramine T in nurses is underestimated.

The 2008 ICOH Workshop on Skin Notation

BACKGROUND

On 29 March 2008 the International Commission on Occupational Health (ICOH) Scientific Committee on Occupational and Environmental Dermatoses organized a Skin Notation Workshop hosted by the 11th International Percutaneous Penetration Perspectives Conference (La Grande Motte, France). Skin notation (S) was chosen as a topic for discussion because this is the only example of existing regulation in the field of dermal risk assessment. The issue was discussed in a previous workshop held in Siena, Italy in 2006 with the objective of focussing on the problems related to S, the different assignment criteria and the attempts to improve the S system made by various international and governmental agencies. A position paper was subsequently published.

OBJECTIVES

The workshop in France was a continuation of this activity with the aim of evaluating how the different strategies can improve S.

METHODS AND DISCUSSION

The Workshop was divided into two sessions. The first was dedicated to lectures focused on different aspects of S. In the second session participants discussed key issues with the aim of exploring the actions needed to improve international S. systems.

[Working hypothesis of simplified techniques for the first mapping of occupational hazards in handicrafts. Part two: physical and chemical risks]

Craft features a strong link with tradition which preserves and perpetuates techniques created and consolidated over time, in a particular historical, cultural and geographical situation. Italy is home to excellent craftsmanship: fashion, furniture, giftware, design. The framework law for the craft n. 433/1985 defines the craft business carried on by the craftsman for a predominant objective of producing goods, including semi-finished or services. The D.L.gs 81/2008 defines the manner in which the employer must conduct risk assessment in the workplace and process the risk assessment document. The aim of the study is to provide employers with a simple methodology that allows the drafting of the first mapping of hazards/dangers identificating risk sources in the working process. The developed methodology is expressed as a model of information gathering, which brings to a first overview of all major risk indicators that may arise in the craftsmanship.

[Consensus Document. Update on latex exposure and use of gloves in Italian health care settings]

This consensus document was prepared by an Italian working group including occupational health professionals involved for many years in the management of glove- and latex-related problems in health care settings. The aim of this document was to address the most significant technical, epidemiological, clinical, environmental and prevention problems related to the use of gloves and latex. The group's recommendations are based on scientific evidence and practical experience but they cannot be considered as final. These topics need to be periodically revised. The following points should be taken into account: glove quality seems to have improved considerably but the information on glove features provided by the manufacturers is often still inaccurate or incomplete; the regulations in force provide that the manufacturers perform tests to supply evidence for the quality of the products but they do not indicate which analytical method should be used and they do not require that the results be reported in the technical data sheets. Thus the manufacturers have only to declare that their products are "in accordance with the rules"; therefore, purchasers should require the manufacturing companies to supply detailed information and verify their reliability. Moreover, the rules should be adapted to higher quality standards; occupational physicians must be involved for the correct choice and purchase of protective gloves; the use of gloves (in particular latex gloves) and latex devices in health care settings should be based on specific criteria: procedures must be available stating which kind of gloves are suitable for specific tasks. When exposure to latex cannot be avoided it is necessary to choose products that have good biocompatibility (e.g., powder free-gloves with low allergen content); once and for all latex powdered gloves should no longer be commercially available! labels for latex devices (including gloves) should report the extractable latex allergen content. Limit values for extractable latex allergens should be established; the use of synthetic rubber gloves should be encouraged since some materials (e.g., neoprene and nitrile rubber) appear to have physical properties and protective efficacy similar to latex, plus good biocompatibility; more studies should be promoted to verify the protective efficacy of new synthetic materials; health care workers should be informed about the advisability and usefulness of using materials other than latex; health care services should not cause additional risks but rather highlight the advantages for workers and patients if the use of latex gloves and devices is minimized.

[Medical and risk records]

Aim of this report is to outline the importance of personal medical records collected from the occupational health surveillance practice. The Italian law D.Lgs. 81/08 puts a great emphasis on a national information system built up by health monitoring results in workplace as far as individual and general prevention is concerned. Private and public roles and duties are discussed.

[The occupational and active research, diagnosis and reporting of occupational diseases]

The Occupational Doctor plays a key role on the protection of workers safety and prevention of occupational and work-related disease. His training and his need of updating, due to the constant transformation of work, the evolution of technology and the medical progress, set him in the center of all activities carried out to protect health in workplaces. The Occupational Doctor should devote special attention to the working anamnesis as well as to the pathological anamnesis both close and remote. He should also pay attention to semeiotics. Another important element is the relationship between the Occupational Doctor and the Doctor of General Medicine (MMG); this synergy is of vital importance in protecting health and in investigating diseases whether occupational or not. D.Lgs. 81/08 emphasizes this synergy, in fact name and phone number of Doctor of General Medicine is compulsory in Case History. Major source of information for all form of prevention is the survey of occupational disease which is a tool for epidemiological control. The use of a systematic collection of data, of protocols, of guidelines and of scientific evidence is the basis for identifying occupational diseases, their diagnosis and subsequent denunciations. This is the line suggested in MAL PROF informative system, made for registration of work-related diseases, and which is important, with other instruments, in realizing an integrated informative system for prevention in workplace. The Covenant for the Protection of Health and Prevention in Workplaces (DPCM 17/12/2007) indicates the strategic objectives of the National Health System for the consolidation and development of the existing system and of the programs promoting health and safety. These include the growth of the culture of prevention and of the epidemiological control of occupational diseases. The Occupational Doctor has an important role because he can identify the early onset of diseases during the working age and start all forms of prevention and health promotion. In the case of diagnosis of a suspected professional disease the Occupational Doctor has three distinct obligations. The first is to report to the legal authority (C.P.P. art. 365). The second requirement is the declaration of the occupational disease (D.P.R. 1124/65 art. 139) and the third is to issue the first certificate of occupational disease for compensation insurance (D.P.R. 1124/65 artt. 53, 251).

[Chemical resistance of latex gloves]

Dermal chemical risk is represented by the chemicals with irritant, caustic and sensitization properties or that can produce toxic effects after penetration through the skin. During the last few years the interest for the effective protecting ability of gloves progressively is increased in parallel with their use. Penetration of chemicals through the protecting material does not always turn out visible. That has led to the development of test standardizes. In 1989 the EC adopted two Directives in the field of the characteristics of protection devices defining certification procedures (89/686/EEC) and characteristics demanded for the use of protection devices at the workplace (89/656/EEC). When the European Standards are accepted from the CEN they exist in rough draft shape (prEN), losing the prefixed one pr- when they are approved by all the EC member Countries. A number of EN for protection gloves have been proposed by CEN/TC 162 regarding methods for testing the resistance to penetration/permeation of chemicals and other characteristics. However in these protocols some limitations were found, since not necessarily they represent the real using conditions. In general an ideal protecting material against the chemicals does not exist because what is effective to a specific compound does not effectively protect from an other. Latex is not commonly considered a very chemical resistant material and therefore its use in such sense is limited However the low cost and the spread of latex gloves in particular in Public Health often make them easy available at workplace and therefore used in several situations.

Advanced glycation end products and sorbitol in blood from differently compensated diabetic dogs

Canine diabetes mellitus (DM) is a common metabolic disorder with long term complications, most of which are caused by glycosylation of structural proteins, decreases in antioxidant concentrations, altered osmotic balance and hypoxia due to impaired oxygen transport. Previous studies have demonstrated that under hyperglycemic conditions canine erythrocytes undergo swelling, probably due to activation of the polyol pathway. The present work aimed to assess the plasma concentration of advanced glycation end (AGE) products, stable Amadori-products generated by non-enzymatic glycosylation of proteins and the intracellular concentration of sorbitol, produced by the activation of polyol pathway in 34 blood samples from diabetic dogs and in 14 controls. AGE products were significantly higher (p<0.01) in plasma from diabetic dogs compared with control animals. The sorbitol concentration in erythrocytes was also significantly higher in diabetic dogs and, in particular, in poorly compensated animals and in dogs with ketonuria. In five cases that were analysed before and after clinical improvement, sorbitol concentration was found to correlate with improvement. These results suggest that non-specific glycosylation is increased and that the polyol pathway is activated in diabetic dogs in a manner that is proportionate to the severity of disease. Moreover, the concentration of AGE products and sorbitol may be useful for monitoring the onset of diabetic complications and assessing the most appropriate therapeutic approaches for management of canine DM.

[Work related mesothelioma: analysis of cases discovered at the Section for Occupational Medicine and Toxicology of Siena University during the years 2000-2007]

This study focuses on the spread of mesothelioma in Siena. The population consisted of 30 patients. The diagnosis was made through histopathological and immunoistochemical or cytological and immunoistochemical analysis. The association between malignant masothelioma and exposure to asbestos was deduced by the occupational history. The mesothelioma was noted both in traditional industries and other jobs such as the chain of manifacture, plumbers, electricians, carpenters, installers of asbestos insulation and construction workers. Thus it is possible to find other malignant and nonmalignant asbestos-related diseases more frequently than mesothelioma. There is an evident risk in rebuilding, so the development of new cases due to these exposures is expected.

[Estimate of the previous exposure to asbestos through mineralogical examination of the bronchoalveolar lavage (BAL) fluid in a population working in a sugar industry]

In this study the past professional exposure and the health state of sugar refinery workers in Arezzo (Italy) are reviewed. The medical examinations, confirmed by chest CT, showed asbestos pleural thickening and one asbestosis case. Mineralogical analysis of bronchoalveolar lavage fluid (BALF) was carried out in this population to measure the pulmonary burden. Total fiber's concentration was not different in either subjects with or without asbestos-related disease. Notably, comparison between total fiber's concentration in sugar refinery workers and subjects employed in other industries, revealed a lower professional exposure of the former with respect to shipyard workers and electric plants. In other groups of Italian sugar refinery workers, a concentration of asbestos fibers higher than in the studied population was found. Thus, the study highlights the necessity to develop standardized methodologies to carry out health intervention programmes in workers previously exposed to asbestos.

Measurement of asbestos fibre concentrations in fluid of repeated bro-choalveolar lavages of exposed workers

OBJECTIVES

The aim of this study was to assess the reliability of asbestos fibre concentration in bronchoalveolar lavage fluid (BALF) by carrying out the mineralogical analysis of BALF at different times in the same patient and comparing the results.

METHODS

Twenty two patients underwent diagnostic fibreoptic bronchoscopy twice: the first was to assess the past asbestos exposure and the second for different clinical reasons. Mineralogical analysis of BALF was carried out.

RESULTS

In 16 patients (72.7%), a reduction of concentration in BALF of all asbestos fibres was observed. The concentrations of both chrysotile and amphiboles in the first bronchoalveolar lavage (BAL) were related to their concentrations in the second BAL and the observed differences were not statistically significant. A significant decrease in asbestos body concentration between the first and the second BAL was found (Wilcoxon test, P < 0.01).

CONCLUSIONS

The reliability of the fibre concentration in BALF as a marker of past asbestos exposure seems quite good. In most cases, it allows us to distinguish workers in different classes of exposure and gives useful information on the pattern of exposure. Uncertainties related in general to lung residues and in particular to mineralogical analysis of BALF (mainly due to the high coefficient of variation (CV) at low fibre concentrations and the results of the statistical analysis on total fibres) suggest that this biomarker is more likely suitable for a qualitative/categorical approach to exposure assessment than a quantitative one.

Biological monitoring of exposure to chlorpyrifos-methyl by assay of urinary alkylphosphates and 3,5,6-trichloro-2-pyridinol

The results of biological monitoring by assay of urinary 3,5,6-trichloro-2-pyridinol and alkylphosphates (DMP, DMTP) in groups of 9 and 2 workers exposed to chlorpyrifos-methyl during vine spraying and manual leaf thinning 5-11 d after spraying, respectively, are reported. The results are compared with those of a control group of 46 subjects not occupationally exposed to organophosphate insecticides. Significantly higher urinary excretion of metabolites (Mann-Whitney U-test) was found in both groups than in controls. Levels of 3,5,6-trichloro-2-pyridinol (mean +/- SD) were 15.9 + 10.6 nmol/g creatinine (n = 33) for controls, 92.4 + 162.5 nmol/g creatinine (n = 20) for manual workers, and 675.5 + 1110.8 nmol/g creatinine (n = 48) for workers spraying and mixing the insecticide. Levels of DMP (mean +/- SD) were 63.8 + 100.1 nmol/g creatinine (n = 42), 123.0 + 79.0 nmol/g creatinine (n = 20), and 577.2 + 1003.2 nmol/g creatinine (n = 61), respectively, for the same 3 groups. Levels of DMTP (mean +/- SD) were 153.4 + 164.4 nmol/g creatinine (n = 43), 489.3 + 288.3 nmol/g creatinine (n = 20), and 297.6 + 215.4 nmol/g creatinine (n = 61), respectively, for the same 3 groups. Good correlations were found between urinary excretion of 3,5,6-trichloro-2-pyridinol and DMP (r = .776 for manual workers; r = .775 for workers mixing and spraying the insecticide) or DMTP (r = .558 and r = .746, respectively for the same 2 groups). The peak of excretion of the three metabolites was found in urine samples collected the night after the spraying or leaf thinning operations.

[Methodology for assessing occupational dermal exposure]

BACKGROUND

Dermal risk assessment of exposure to chemicals is difficult due to the lack of standardisation of the methods used in exposure quantification; further limits concern the extent of skin contamination and especially dermal absorption of different substances. To solve these problems many authors proposed conceptual models founded on theoretical assumptions and experimental data, but their use in occupational settings revealed many difficulties. A possible alternative is the use of a check-list that permits evaluation of occupational dermal contamination hazards.

AIMS

To propose a simplified method for dermal risk assessment.

METHODS

Dermal contamination risk evaluation, chemical hazard quantification and duration of exposure are the basic features of the method. The first step assesses working conditions, use of protective devices, skin contamination directly observed, personal hygiene of workers: all information, collected by a trained observer, is scored according to literature data and/or to authors'personal experience. Chemical hazard quantfication is obtained from safety data sheet evaluation (R phrases classification and chemical-physical characteristics of the chemical in use). The method allows a preliminary dermal exposure assessment to be made, subdivided on hazard bands.

RESULTS

The method permits a rapid dermal exposure assessment to be made and suggests intervention measures to decrease dermal risk.

CONCLUSIONS

A check-list is proposed that can be a useful and easy method to assess dermal exposure to chemicals, particularly in small- and medium-sized enterprises.

[Echinococcosis: a persistent endemic]

Echinococcosis seems to be still endemic in Italy. Data from epidemiological studies in middle- south Italy indicates that this parasitosis is often a work- related disease. Our survey concerning findings among patients from surgical departments in Tuscany confirms the rsults of the studies. Echinococcosis is still endemic and dairy farming seems to be a risk factor.

In vitro predictions of skin absorption of caffeine, testosterone, and benzoic acid: a multi-centre comparison study

To obtain better insight into the robustness of in vitro percutaneous absorption methodology, the intra- and inter-laboratory variation in this type of study was investigated in 10 European laboratories. To this purpose, the in vitro absorption of three compounds through human skin (9 laboratories) and rat skin (1 laboratory) was determined. The test materials were benzoic acid, caffeine, and testosterone, representing a range of different physico-chemical properties. All laboratories performed their studies according to a detailed protocol in which all experimental details were described and each laboratory performed at least three independent experiments for each test chemical. All laboratories assigned the absorption of benzoic acid through human skin, the highest ranking of the three compounds (overall mean flux of 16.54+/-11.87 microg/cm(2)/h). The absorption of caffeine and testosterone through human skin was similar, having overall mean maximum absorption rates of 2.24+/-1.43 microg/cm(2)/h and 1.63+/-1.94 microg/cm(2)/h, respectively. In 7 out of 9 laboratories, the maximum absorption rates of caffeine were ranked higher than testosterone. No differences were observed between the mean absorption through human skin and the one rat study for benzoic acid and testosterone. For caffeine the maximum absorption rate and the total penetration through rat skin were clearly higher than the mean value for human skin. When evaluating all data, it appeared that no consistent relation existed between the diffusion cell type and the absorption of the test compounds. Skin thickness only slightly influenced the absorption of benzoic acid and caffeine. In contrast, the maximum absorption rate of testosterone was clearly higher in the laboratories using thin, dermatomed skin membranes. Testosterone is the most lipophilic compound and showed also a higher presence in the skin membrane after 24 h than the two other compounds. The results of this study indicate that the in vitro methodology for assessing skin absorption is relatively robust. A major effort was made to standardize the study performance, but, unlike in a formal validation study, not all variables were controlled. The variation observed may be largely attributed to human variability in dermal absorption and the skin source. For the most lipophilic compound, testosterone, skin thickness proved to be a critical variable.

Seasonal changes in serum metabolites in free-ranging alpine marmots (Marmota marmota)

Circannual changes in serum parameters and body mass were studied in free-ranging Marmota marmota that had been shot in Switzerland (Grisons) for management reasons in May, July, and September of 1995, 1996, and 1997; and in April 1996. Markers of lipid (triglycerides, cholesterol), protein (total protein, urea-nitrogen) and mineral (calcium, inorganic phosphate) metabolism were evaluated in 111 haemolysis-free serum samples; the effects of sex, age, reproductive status, season and year were tested. Mean body mass was higher in adult males than in adult females in July and September, and serum cholesterol concentrations were lower in adult males in May. Pregnant females had lower concentrations of total protein than non-pregnant females, and triglyceride concentrations were negatively correlated with the number of uterine ampullae. Inorganic phosphate decreased and total protein increased with age. In adults, triglycerides, cholesterol and urea-nitrogen increased mainly from May to July and decreased between September and May. Total protein, calcium and phosphate did not change throughout the year. This suggests that, during the active season, ingested lipids and amino acids were utilised for metabolic needs or lipid storage, while in winter, lipids were catabolised and protein was spared. Quantitative differences between years, observed for triglycerides and total protein during the active season, were probably due to different climatic conditions in each year.

[Assessment of asbestos exposure via mineralogical analysis of bronchoalveolar lavage fluid]

BACKGROUND

Mineralogical analysis of bronchoalveolar lavage fluid (BALF) by electron microscopy could be the most suitable method for assessing asbestos exposure. However, it has been claimed that there is not a standardized or systematic approach to the subject of mineralogical analysis.

OBJECTIVES

The aim of the study was to evaluate mineralogical analysis of BALF by transmission electron microscopy (TEM) as biomarker of asbestos fibre load.

METHODS

BALF was examined in 193 exposed workers (189 men and 4 women) and in 84 patients (65 men and 19 women) who underwent diagnostic fibreoptic bronchoscopy for various clinical purposes. Asbestos bodies (AB) in BALF were counted with a phase contrast microscope, while fibres were counted and analysed by TEM.

RESULTS

Fibre counting by TEM showed a significant difference in the two populations (two tailed Mann-Whitney U test, p=0.0044), since it was positive in all exposed subjects. Only 75.1% of the exposed population was positive for asbestos bodies (AB). Subjects who had been exposed over a long time period had higher concentrations of fibres than subjects who had been exposed more recently probably because of higher exposure in the past.

CONCLUSIONS

The study confirms the results of a previous study on a limited number of subjects. Fibre concentrations in BALF can be considered as a reliable biomarker of past asbestos exposure even after many years after cessation of exposure.

[Assessment of occupational skin exposure: proposal of a check-list]

The dermal risk assessment requires simplified methodologies to understand the role played by the skin. The conceptual models proposed to this aim are founded on theoretical assumptions and experimental data, but their use in occupational settings shows many difficulties. For this end we have drawn up a check-list that includes six sessions and allows to obtain a preliminary dermal exposure evaluation subdivided on hazard bands.

[Skin and respiratory allergic disease caused by polyfunctional aziridine]

BACKGROUND

Polyfunctional aziridine (PFA) hardener is increasingly used in water-based paints and inks as a replacement for organic solvents. Allergic contact dermatitis, contact urticaria, respiratory allergy in occupationally exposed patients with hypersensitivity to PFA are reported.

OBJECTIVES

The aim was to study a population of adhesive tape printers for occupational respiratory and skin sensitisation to PFA hardener. Also 2 cases of occupational asthma in workers exposed to PFA in tanneries are reported.

METHODS

A standard series prick and patch tests was carried out on 15 workers with skin symptoms out of 36 adhesive tape printers exposed to PFA. Prick tests with a 1% PFA water solution and patch tests with a dilution series (0.1-0.32-0.5-1%) of PFA in petrolatum were performed. Lung and nasal provocation tests with PFA hardener were also carried out on 4 subjects with skin and respiratory symptoms.

RESULTS

Skin sensitivity to PFA prick tests was demonstrated in 8.3% of the exposed population; 22.2% of the exposed workers suffered from allergic contact dermatitis due to PFA with positive patch tests for this compound. One case of occupational rhinitis due to PFA was diagnosed.

CONCLUSIONS

PFA is a strong sensitizer and the use of gloves and protective clothing appears to be insufficient to prevent occupational allergic diseases. Elimination of PFA from production processes is desirable.

[Evaluation of sources of mercury absorption through studying urinary mercury levels in the general population]

OBJECTIVES

The number of instances where mercury exposure is possible outside the workplace are numerous, with the main source being amalgam dental fillings and diet. It is also possible to envisage environmental exposure in subjects resident in areas where there is existing environmental contamination. This is probably what happened in Tuscany where past mining activity in the Monte Amiata area may have been the cause. This study estimated the concentration of urinary mercury (HgU) in non-occupationally exposed subjects from southern Tuscany, with the aim of evaluating the sources of mercury absorption in the general population.

METHODS

A questionnaire aimed at collecting specific information on factors which might influence the uptake of mercury was used. 164 subjects were studied: 82 subjects (41 males, 41 females) came from the Monte Amiata area and the other 82 (41 males, 41 females) from the Province of Siena. In this way it was possible to evaluate the elements associated with everyday life which may have influenced the presence of the metal in the urine. Since the distribution of the variables cannot be assumed multivariate normal as usual, a recently-proposed method based on a permutation procedure was adopted that allows the analysis of the variables as well as the single marginal analyses, without assuming any model for the distribution of variables.

RESULTS AND CONCLUSIONS

The results showed significantly lower levels of HgU in the subjects from the Monte Amiata area. Highly significant differences were demonstrated in the population which was sub-divided according to number and surfaces of amalgam fillings, use of contact lenses and type of water drunk (p < 0.001). Correlations between the levels of HgU and the investigated variables were not observed. It was confirmed that mercury uptake is simultaneously influenced by many factors. Probably the presence of higher levels of mercury in the environment in the Monte Amiata area is a factor of minor importance compared to others, especially the number of amalgam fillings, in determining mercury absorption in the general population.

[In vitro study of transcutaneous inorganic mercury absorption from solid soil]

OBJECTIVES

Skin is such an important route of absorption of mercury compounds that the ACGIH has assigned them a skin notation. Soil has been recognised as a potential source of exposure to chemical contaminants. It therefore seems advisable to establish maximum daily exposure levels for mercury in soil. In the past, areas adjacent to certain industries and smelters were heavily contaminated by mercury. For example, on Monte Amiata in Tuscany, which was an important mercury mining and production centre in the past, several areas have been polluted. To understand the dermal uptake of chemicals bound to soil and dust, information on the pure substance is helpful but does not seem sufficient. Other factors must be accounted for, that can easily be reproduced and controlled in in vitro experiments.

METHODS

Using an in vitro diffusion cell system and human skin, we studied percutaneous penetration of mercury chloride (HgCl2) at different concentrations, with particular emphasis on skin absorption from soil. The test apparatus consisted of a flow-through diffusion cell system. Dermotomed human cadaver skin was used as the membrane, while the receiving liquid was a saline solution with 6% PEG-20 oleyl-ether and gentamycin sulphate. Mercury chloride was applied at two different concentrations using a buffered solution and soil as vehicles.

RESULTS AND CONCLUSIONS

Increments of percentage of absorption at the different hours were found to be significantly lower in the cells where the higher concentration of mercury chloride was applied. In the receiving fluid of cells where soil was used as vehicle, the concentration of mercury was always below the detection limit. Skin contamination with soil containing inorganic mercury does not seem to be a dermal risk.

Dermal exposure assessment in occupational medicine

The importance of dermal exposure has increased during the last few years, mainly because of the reduction of respiratory exposure to toxicants. Pesticides, aromatic amines and polycyclic aromatic hydrocarbons are considered to be the chemicals at highest dermal risk. In the occupational exposure limit lists of the American Conference of Governmental Industrial Hygienists (ACGIH) and of many countries, compounds that can be absorbed through the skin are identified by a skin notation. However, a generally accepted criterion for assigning skin notation does not exist. The recent attempts to develop health-based dermal occupational exposure limits (DOELs) have not been accepted, thus in practice their use has remained limited. To predict the systemic risk associated with dermal exposure and to enable agencies to set safety standards, penetration data are needed. Moreover, there is a need for a practical risk assessment model, particularly for small and medium-sized enterprises.

[RISKOFDERM: European research project for assessment of occupational skin exposure to chemicals]

OBJECTIVES

RISKOFDERM is a research project whose aim is to develop instruments to assess and manage occupational dermal exposure to chemical substances.

METHODS

The research, funded by the European Commission, involves 15 Institutes from 10 member countries; it is a continuation of the Dermal Exposure Network experience and consists of four interrelated parts. The first phase (Qualitative survey) assumed that dermal exposure can be extrapolated from one compound to another when it is task-based: therefore six Dermal Exposure Operation units (DEOu) were defined that lead back to the variety of occupational dermal exposure conditions and an extensive Questionnaire was developed for on-site surveys to perform standard observations in selected working situations (scenarios).

RESULTS

The Italian group, participating in the research, obtained a set of observations relating to two "scenarios" in different working sectors: asphalt, ceramic and pottery workers, spectacle decorators and paint production: the aim was to verify the validity of the methodology in assessing the risk of percutaneous absorption, time, frequency and extension of skin exposure.

CONCLUSIONS

From the observations made it was shown that the perception of risk was poor; it is necessary to rationalise work organization, and train and inform the employees on the correct use of personal protection devices.