• Dario Consonni1

  1. Clinica del lavoro, Milano

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Ricerca bibliografica periodo dal 16 gennaio 2013 al 31 marzo 2013

Per leggere le caratteristiche di questa ROUTINE di ricerca clicca qui

Stringa: ("occupational exposure"[MeSH Terms] OR "occupational diseases"[MeSH Terms]) OR "occupational health"[MeSH Terms]) OR "workplace"[MeSH Terms]) OR "accidents, occupational"[MeSH Terms]) OR "employment"[MeSH Terms]) OR occupation[Title/Abstract]) OR occupational[Title/Abstract]) OR worker[Title/Abstract]) OR workers[Title/Abstract]) AND ("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2013/01/15"[PDAT] : "2013/03/31"[PDAT])

Breve commento a cura di Dario Consonni relativo all'intera sezione
In questo numero segnaliamo tre interessanti studi effettuati utilizzando varie fonti di dati correnti. Il primo (Farina et al.), che ha utilizzato il “Work History Italian Panel-Salute integrated database”, documenta in modo rigoroso l’efficacia degli interventi di prevenzione conseguenti a disposizioni legislative (626/94 e 528/99) nel diminuire il tasso di infortuni lavorativi. Il secondo (Salvatore et al.), utilizzando i dati di sorveglianza ISTAT 2007, richiama l’attenzione sulla eterogeneità dei tassi infortunistici tra i lavoratori. In particolare viene evidenziata una più alta frequenza di infortuni tra i migranti, in particolare nel settore edile. Il terzo (Scarselli et al), condotto su banche dati INAIL (oltre 12.000 misurazioni ambientali nel periodo 1996-2010), ha stimato il numero di lavoratori esposti a idrocarburi policiclici aromatici in diversi settori lavorativi.

Di ogni articolo è disponibile l'abstract. Per visualizzarlo basta cliccare sul titolo.

1. Farina E, Bena A, Pasqualini O, Costa G. Are regulations effective in reducing construction injuries? An analysis of the Italian context. Occup Environ Med. 2013 Mar 15. [Epub ahead of print]
Department of Epidemiology, ASL TO3, , Grugliasco, Torino, Italy.

OBJECTIVES: At the end of the 1990s, as required by European Directive 92/57/EEC, two laws were enacted in Italy which laid down safety and health requirements for construction sites: Decree 494/96 and Decree 528/99. The aim is to evaluate the impact on injury rates due to actions performed by a group of eight regions that planned formalised programmes to enforce the laws around the year 2000. METHODS: Using the Work History Italian Panel-Salute integrated database, which extends from 1994 to 2005, total and serious injury rates were calculated for the construction sector. An interrupted time series analysis was applied to serious injury rates. RESULTS: During the 12 years under observation, at the national level the total and serious injury rates decreased while the number of employees increased. The results of the regression models indicate that in the period after the intervention the injury rates (×10 000 weeks worked) decreased by 0.21 per year more than in the period before the intervention (CI -0.41 to -0.01). The difference in pre-post trends is even larger after adjusting for external factors. CONCLUSIONS: The intervention plans developed to enforce the two Italian decrees had an effect on the reduction in injury rates. The results showed that there was a decrease in injury rates that could not be explained by external factors. These findings highlight the importance of concrete initiatives to have employers and workers comply with regulatory safety standards.

2. Salvatore MA, Baglio G, Cacciani L, Spagnolo A, Rosano A. Work-related injuries among immigrant workers in Italy. J Immigr Minor Health. 2013 Feb;15(1):182-7. doi: 10.1007/s10903-012-9673-8.
National Institute of Statistics, Rome, Italy.

In Italy, work-related injuries among immigrant workers are an emerging concern. In this study, we compared the occurrence of work-related injuries between legally residing immigrants from High Migration Pressure Countries and Italians and evaluated the associations with potential risk factors. Using data from the 2007 Labour Force Survey conducted by Italy's National Institute of Statistics, we examined the relationship between the occurrence of work-related injuries in the previous 12 months and being an immigrant among a nationally representative sample. The occurrence of work-related injuries was significantly higher among immigrant males compared to Italian males (adjusted OR = 1.82; 95 % CI 1.53-2.16), particularly in the construction sector, for which the results showed a U-shaped trend of the odds ratios of injuries for immigrants compared to Italians with increasing number of years of work in the same job. No associations were found among women. The findings suggest that prevention programs need to be implemented to limit the burden of work-related injuries among immigrants.

3. Scarselli A, Di Marzio D, Marinaccio A, Iavicoli S. Assessment of work-related exposure to polycyclic aromatic hydrocarbons in Italy. Am J Ind Med. 2013 Feb 28. doi: 10.1002/ajim.22172. [Epub ahead of print]
Epidemiology Unit, Occupational Medicine Department, Research Division, Italian Workers' Compensation Authority (INAIL), Rome, Italy.

BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs) are generally present in the workplace environment as complex mixtures and often difficult to identify a priori. OBJECTIVES: The aim of this study is to evaluate the level and coverage of occupational exposure to PAHs in Italy. METHODS: Data were collected from exposure registries of companies with mandatory reporting to the National Workers' Compensation Authority. Statistical analyses were carried out on the retrieved information and the number of workers potentially exposed was estimated for some industrial sectors. RESULTS: Overall 12,849 measurements of exposure levels to individual PAHs were selected from the database of registries in the period 1996-2010. Most exposures occurred in the manufacture of chemicals (N = 5,383, 51%), and the occupational group most frequently measured was chemical-processing-plant operator (N = 3,930, 31%). Measurements were associated to various PAHs, including benzo[a]pyrene, benzo[a]anthracene, benzo[b]fluoranthene, benzo[k]fluoranthene, dibenz[a,h]anthracene, and benzo[j]fluoranthene. Overall, 39,230 workers were estimated as potentially at risk of exposure to PAHs in the selected industrial sectors. CONCLUSIONS: This study summarized data recorded in the Italian occupational exposure database and identified specific exposure patterns to PAHs. The systematic recording of occupational exposures is a source of data that allows the recognition, control, and prevention of high-risk situations for workers' health.

4.Tarantini L, Bonzini M, Tripodi A, Angelici L, Nordio F, Cantone L, Apostoli P, Bertazzi PA, Baccarelli AA. Blood hypomethylation of inflammatory genes mediates the effects of metal-rich airborne pollutants on blood coagulation. Occup Environ Med. 2013 Mar 8. [Epub ahead of print]
Department of Clinical and Community Sciences, Università degli Studi di Milano and IRCCS Maggiore Hospital, Mangiagalli and Regina Elena Foundation, , Milan, Italy.

OBJECTIVES: Recent investigations have associated airborne particulate matter (PM) with increased coagulation and thrombosis, but underlying biological mechanisms are still incompletely characterised. DNA methylation is an environmentally sensitive mechanism of gene regulation that could potentially contribute to PM-induced hypercoagulability.We aimed to test whether altered methylation mediates environmental effects on coagulation. METHODS: We investigated 63 steel workers exposed to a wide range of PM levels, as a work-related condition with well-characterised prothrombotic exposure. We measured personal PM10 (PM≤10 µm in aerodynamic diameter), PM1 (≤1 µm) and air metal components. We determined leukocyte DNA methylation of NOS3 (nitric-oxide-synthase-3) and EDN1 (endothelin-1) through bisulfite-pyrosequencing and we measured ETP as a global coagulation-activation test after standardised triggers. RESULTS: ETP increased in association with PM10 (β=20.0, 95% CI 3.0 to 37.0), PM1 (β=80.8 95% CI 14.9 to 146.7) and zinc (β=51.3, 95% CI 0.01 to 111.1) exposures. NOS3 methylation was negatively associated with PM10 (β=-0.2, 95% CI -0.4 to -0.03), PM1 (β=-0.8, 95% CI -1.4 to -0.1), zinc (β=-0.9, 95% CI -1.4 to -0.3) and iron (β=-0.7, 95% CI -1.4 to -0.01) exposures. Zinc exposure was negatively associated with EDN1 (β=-0.3, 95% CI -0.8 to -0.1) methylation. Lower NOS3 (β=-42.3; p<0.001) and EDN1 (β=-14.5; p=0.05) were associated with higher ETP. Statistical mediation analysis formally confirmed NOS3 and EDN1 hypomethylation as intermediate mechanisms for PM-related coagulation effects. CONCLUSIONS: Our study showed for the first time, that gene hypomethylation contributes to environmentally induced hypercoagulability.

5. Caciari T, Casale T, Pimpinella B, Montuori L, Trove' L, Tomei G, Capozzella A, Schifano MP, Fiaschetti M, Scala B, Tomei F, Rosati MV. Exposure to solvents in health care workers: assessment of the hepatic effects. Ann Ig. 2013 Mar-Apr;25(2):125-36. doi: 10.7416/ai.2013.1914.
Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, Sapienza University of Rome, Italy. Department of Psychiatric and Psychological Science, Sapienza University of Rome, Italy.

Objectives: The use of organic solvents has been linked to pathologies of different apparatuses. The purpose of this study is to analyze the liver damage induced by organic solvents. Materials and Methods: We analyzed 556 workers, 278 exposed to organic solvents (group 1) and 278 not exposed to organic solvents (group 2). The exposed group was further divided into 2 subgroups: group 1A (139 workers exposed to considerable doses) and group 1B (139 workers exposed to negligible doses). Mean and standard deviation of some liver parameters was calculated. Statistically significant differences between the liver parameters in the different groups and subgroups were detected using the t-test. Multiple linear regression models were used to examine the associations between laboratory parameters and the independent variable. Results: The data so far obtained showed the existence of statistically significant differences with regard to the total protein, total bilirubin, transaminase GOT and GPT, Gamma Glutamyl Transferase (gamma-GT). Conclusions: Our results confirm that exposure to solvents can alter some liver parameters. The blood tests we used can be useful tool for the assessment of the actual occupational hazards and to verify the effectiveness of the measures taken for the prevention and protection.

6. De Marco MA, Porru S, Cordioli P, Cesana BM, Moreno A, Calzoletti L, Bonfanti L, Boni A, Di Carlo AS, Arici C, Carta A, Castrucci MR, Donatelli I, Tomao P, Peri VM, Di Trani L, Vonesch N. Evidence of cross-reactive immunity to 2009 pandemic influenza A virus in workers seropositive to swine H1N1 influenza viruses circulating in Italy. PLoS One. 2013;8(2):e57576. doi: 10.1371/journal.pone.0057576. Epub 2013 Feb 28.
Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.

BACKGROUND: Pigs play a key epidemiologic role in the ecology of influenza A viruses (IAVs) emerging from animal hosts and transmitted to humans. Between 2008 and 2010, we investigated the health risk of occupational exposure to swine influenza viruses (SIVs) in Italy, during the emergence and spread of the 2009 H1N1 pandemic (H1N1pdm) virus. METHODOLOGY/PRINCIPAL FINDINGS: Serum samples from 123 swine workers (SWs) and 379 control subjects (Cs), not exposed to pig herds, were tested by haemagglutination inhibition (HI) assay against selected SIVs belonging to H1N1 (swH1N1), H1N2 (swH1N2) and H3N2 (swH3N2) subtypes circulating in the study area. Potential cross-reactivity between swine and human IAVs was evaluated by testing sera against recent, pandemic and seasonal, human influenza viruses (H1N1 and H3N2 antigenic subtypes). Samples tested against swH1N1 and H1N1pdm viruses were categorized into sera collected before (n. 84 SWs; n. 234 Cs) and after (n. 39 SWs; n. 145 Cs) the pandemic peak. HI-antibody titers ≥10 were considered positive. In both pre-pandemic and post-pandemic peak subperiods, SWs showed significantly higher swH1N1 seroprevalences when compared with Cs (52.4% vs. 4.7% and 59% vs. 9.7%, respectively). Comparable HI results were obtained against H1N1pdm antigen (58.3% vs. 7.7% and 59% vs. 31.7%, respectively). No differences were found between HI seroreactivity detected in SWs and Cs against swH1N2 (33.3% vs. 40.4%) and swH3N2 (51.2 vs. 55.4%) viruses. These findings indicate the occurrence of swH1N1 transmission from pigs to Italian SWs. CONCLUSION/SIGNIFICANCE: A significant increase of H1N1pdm seroprevalences occurred in the post-pandemic peak subperiod in the Cs (p<0.001) whereas SWs showed no differences between the two subperiods, suggesting a possible occurrence of cross-protective immunity related to previous swH1N1 infections. These data underline the importance of risk assessment and occupational health surveillance activities aimed at early detection and control of SIVs with pandemic potential in humans.

7. Bonzini M, Battaglia P, Parassoni D, Casa M, Facchinetti N, Turri-Zanoni M, Borchini R, Castelnuovo P, Ferrario MM. Prevalence of occupational hazards in patients with different types of epithelial sinonasal cancers. Rhinology. 2013 Mar;51(1):31-6. doi: 10.4193/Rhin.
University of Insubria, Varese, Italy.

BACKGROUND: Occupational exposure to carcinogens contributes greatly to the etiology of sinonasal cancer (SNC), but the role of different risk factors in determining different histological subtypes is disputed. METHODOLOGY: All consecutive surgical epithelial SNC cases (case-series study) underwent a systematic occupational medicine examination to determine previous exposure to a wide range of work-related chemical hazards. RESULTS: We investigated 65 SNC cases including intestinal-type adenocarcinoma [ITAC] squamous-cell carcinoma [SCC], and others. Occupational exposure was recognized for 39 cases. Occupational exposures were sensibly more frequent among ITAC than among SCC or other histotypes. Occupational exposure in ITAC cases was to leather or wood dust only, while among non-ITAC cases, we recognised exposure to formaldehyde, solvents and metal fumes. A high proportion of SNC with occupational exposure originated in the ethmoidal epithelium. CONCLUSION: In our case-series of SNC, a very high frequency of previous occupational exposure to carcinogens was detected, suggesting that occupational hazards may be associated to the aetiopathogenesis, primarily for ITAC, but also for other histotypes. Besides leather or wood, other chemical agents must be recognized as occupational risk factors.

8. Brandi G, Di Girolamo S, Farioli A, de Rosa F, Curti S, Pinna AD, Ercolani G, Violante FS, Biasco G, Mattioli S. Asbestos: a hidden player behind the cholangiocarcinoma increase? Findings from a case-control analysis. Cancer Causes Control. 2013 Feb 14. [Epub ahead of print]
Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy,

PURPOSES: We conducted a case-control analysis to explore the association between occupational exposure to asbestos and cholangiocarcinoma (CC). METHODS: The study was based on historical data from 155 consecutive patients with CC [69 intrahepatic CC (ICC) and 86 extrahepatic CC (ECC)] referred to Sant'Orsola-Malpighi University Hospital between 2006 and 2010. The cases were individually matched by calendar period of birth, sex, and region of residence to historical hospital and population controls. Occupational exposure to asbestos was retrospectively assessed considering job titles obtained from work histories. Separate conditional logistic regression models were applied for ECC and ICC. Estimates were adjusted for smoking status and socioeconomic class. RESULTS: We matched 149 controls (median birth year: 1947; males: 56 %) to 41 cases of ICC (median birth year: 1946; males: 56 %) and 212 controls (median birth year: 1945; males: 48 %) to 59 cases of ECC (median birth year: 1945; males 51 %); 53 cases were not matched due to residence or birth year. We found an increased risk of ICC in workers exposed to asbestos (adjusted OR 4.81, 95 % CI 1.73-13.33); we also observed suggestive evidence that asbestos exposure might be associated with ECC (adjusted OR 2.09, 95 % CI 0.83-5.27). Sensitivity analysis restricted to patients from the Province of Bologna produced confirmatory figures. CONCLUSIONS: Our findings suggest that ICC could be associated with asbestos exposure; a chronic inflammatory pathway is hypothesized. Exposure to asbestos could be one of the determinants of the progressive rise in the incidence of ICC during the last 30 years.

9. Morrone A, Bordignon V, Barnabas GA, Dassoni F, Latini O, Padovese V, Ensoli F, Cristaudo A. Clinical-epidemiological features of contact dermatitis in rural and urban communities in northern Ethiopia: correlation with environmental or occupational exposure. Int J Dermatol. 2013 Jan 20. doi: 10.1111/j.1365-4632.2012.05777.x. [Epub ahead of print]
National Institute for Health, Migration and Poverty (NIHMP), Rome, Italy.

BACKGROUND: The widespread diffusion of low-quality products as well as the local cultural habits could be a relevant cause of allergic diseases in developing countries. In the present observational study, we explored the prevalence of allergic contact dermatitis in both rural and urban settings in northern Ethiopia, where skin diseases represent a frequent cause of morbidity. Clinical features and specific reactivities in association with environmental or occupational exposure were investigated. PATIENTS AND METHODS: We patch tested 480 consecutive patients, visited at the Mekele IDC, exhibiting symptoms of contact dermatitis. A detailed medical history of each patient was collected. RESULTS: A positive patch-test response was observed in 50% of subjects; nickel was the most frequent sensitizer (26.2%), followed by p-tert-butylphenol formaldehyde resin (10%), fragrance mix (7.1%), potassium dichromate (5.4%), cobalt chloride (4.6%), disperse blue (2.3%), and p-phenylenediamine (1.7%). Gender-related differences were analyzed for single allergen. Eczema represented the most common manifestation, affecting the head and neck as primary skin areas. While reactivity to nickel interested almost all the occupational categories, sensitization to other allergens could be ascribed to working habits or environmental exposure. CONCLUSIONS: The results gathered from this study, the first one conducted within the Tigray region in Ethiopia, confirm the need to take appropriate measures to limit the nickel rate in metal objects and may be useful to design allergenic series suitable for patch testing in those geographical settings.

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