rubrica

Lavoro

  • Dario Consonni1

  1. Clinica del lavoro, Milano
Dario Consonni -

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Ricerca bibliografica periodo dal 31 agosto 2013 al 15 novembre 2013

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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 ("2013/08/31"[PDAT] : "2013/11/15"[PDAT])
1. Corrao CR, Del Cimmuto A, Marzuillo C, Paparo E, La Torre G. Association between Waste Management and HBV among Solid Municipal Waste Workers: A Systematic Review and Meta-Analysis of Observational Studies. ScientificWorldJournal. 2013 Oct 9;2013:692083.
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy.

Abstract
Aim. To conduct a systematic review of this relationship using available published observational studies in the field of solid municipal waste treatment. Methods. The review of the scientific literature was based on Medline and Scopus databases up to December 2012, using the keywords HBV, waste, solid, treatment, workers, disposal, and refuse in different combinations. Results. 160 studies were found and checked. Finally, 5 observational studies were considered suitable, all cross-sectional. The pooled proportion of HBs-Ag considering all the studies was 11% (95% CI: 5-21%), and considering the high quality studies only, this proportion was 14% (95% CI: 6-24%). The pooled proportion of HBs-Ab positivity among waste workers considering all the studies was 14.2% (95% CI: 1.4-37.2%), and considering the high quality studies only, this proportion was 24% (95% CI: 18-30%). The pooled proportion of HBc-Ab positivity among waste workers considering all the studies was 24% (95% CI: 6-49%). The pooled estimation of the risk of HBV positivity (HBsAg) among exposed was OR = 2.39 (95% CI: 0.88-6.52). Conclusion. In conclusion, waste workers need to be vaccinated against HBV infection since they are at risk of acquiring this infection through the exposure to potentially infected waste.

2. Pillastrini P, Bonfiglioli R, Banchelli F, Capra F, Resende Fde L, Villafane JH, Vanti C, Violante FS. The effect of a multimodal group programme in hospital workers with persistent low back pain: a prospective observational study. Med Lav. 2013 Sep-Oct;104(5):380-92.
Occupational Health Section, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.

Abstract
BACKGROUND: Low Back Pain (LBP) is a very common disorder in hospital workers. Several studies examined the efficacy of multimodal interventions for health care providers suffering from LBP; nevertheless their results did not appear to be consistent. OBJECTIVE: The aim of the study was to determine the effect of a multimodal group programme (MGP) on pain and disability in a sample of hospital workers with persistent LBP. METHODS: A prospective cohort study was conducted to compare baseline measurements with changes over an eight-month period. The study focused on 109 workers suffering from persistent LBP with or without radiating pain. 62 nurses and 47 blue collars not involved in health care. The MGP consisted of six group sessions including supervised exercises, an at-home programme and ergonomic advice. The primary outcome measurement was the level of disability recorded with the Roland & Morris Disability Questionnaire, while the secondary outcome measurement was the evaluation of lumbar physical discomfort with the Visual Analogue Scale. Data were analyzed using the Multiple Imputation method for dropouts. RESULTS: At the short-term follow-up participants showed a statistically significant reduction (from baseline) of all outcome measurements, particularly for the nurses group. Moreover, about a third of the subjects showed clinically significant improvement. No significant reduction in pain and disability (from baseline) was observed at the mid-term follow-up in either group. CONCLUSIONS: An MGP dedicated to hospital workers seems to be partially useful only for short-term follow-up, particularly for health care providers.

3. Mastrangelo G, Marangi G, Ballarin MN, Bellini E, De Marzo N, Eder M, Finchi A, Gioffrè F, Marcolina D, Tessadri G, Zannol F, Altafini I, Belluso E, Zaina S, Agnesi R, Scoizzato L, Fedeli U, Cegolon L, Valentini F, Marchiori L. Post-occupational health surveillance of asbestos workers. Med Lav. 2013 Sep-Oct;104(5):351-8.
Padua University, Department of Molecular Medicine, University of Padua, Padua, Italy.

Abstract
BACKGROUND: Italian law requires an extensive health surveillance of workers after cessation of their employment status in the case of occupational exposure to carcinogens, including asbestos. Nonetheless, Italian law does not specify the timeframe of these clinical checks, nor who has financial and organizational responsibility for this surveillance. A literature search confirmed a lack of consensus around the objectives and methods to follow up workers with past occupational exposure to asbestos. OBJECTIVES: To develop an updated evidence-based methodology for an appropriate health surveillance programme. METHODS: We present an overview of the field experience developed by the Veneto Region from 2000 to 2011, and new studies that could contribute to establishing a national policy for the medical surveillance of workers with past asbestos exposure. RESULTS: There were three specific topics: (1) definition of a reliable method to identify asbestos workers (through multiple sources and procedures that meet current confidentiality regulations); (2) detection of asbestos fibres in biological media (to support the etiological diagnosis of asbestos-related diseases); (3) creation of a national protocol of health surveillance (through the assessment of policies developed by other Regions in this field, and recruiting from these regions a cohort of past-exposed workers: the epidemiological study should offer relevant suggestions for specific surveillance approaches, based on either estimated cumulative asbestos exposure or detection of x-ray patterns of pleural plaques and/or asbestosis). CONCLUSIONS: These studies will support the Regions in setting up health care policies directed at workers with past asbestos exposure.

4. Casale T, Rosati MV, Ciarrocca M, Samperi I, Andreozzi G, Schifano MP, Capozzella A, Pimpinella B, Tomei G, Caciari T, Tomei F. Assessment of liver function in two groups of outdoor workers exposed to arsenic. Int Arch Occup Environ Health. 2013 Oct 29. [Epub ahead of print]
Unit of Occupational Medicine, Department of Anatomy, Histology, Legal Medicine and Orthopedics, University of Rome "Sapienza", Viale Regina Elena 336, 00161, Rome, Italy, info@spinoff-sipro.it.

Abstract
PURPOSE: To evaluate whether the exposure to arsenic (As) causes alterations of liver enzymes in two groups of outdoor workers. METHODS: Total urinary As and the levels of AST/GOT, ALT/GPT, and GGT were measured on 80 traffic policemen and 50 police drivers. Personal air samples were obtained for assessing the exposure to As on a subgroup of 20 traffic policemen and 20 police drivers. RESULTS: Mean values of personal exposure to As, urinary As, AST/GOT, and ALT/GPT were significantly higher in traffic policemen than in the police drivers. Multiple linear regression models showed associations between urinary As and airborne As, ALT/GPT and the job variables, and BMI and urinary As. CONCLUSIONS: These findings contribute toward the evaluation of the hepatic effects of exposure to As in the urban workers.

5. Magagnotti N, Picchi G, Sciarra G, Spinelli R. Exposure of Mobile Chipper Operators to Diesel Exhaust. Ann Occup Hyg. 2013 Oct 25. [Epub ahead of print]
CNR IVALSA, Via Biasi 75, 38010 San Michele all'Adige (TN), Italy;

Abstract
The current boom of forest biomass is making mobile chippers increasingly popular among forest operators. This motivates concern about the potential exposure of chipper operators to noxious chemicals derived from diesel fuel combustion. The objective of this study was to determine operator exposure to BTEX (benzene, toluene, ethylbenzene, and xylenes) and polycyclic aromatic hydrocarbons (PAHs) generated from diesel combustion. This study sampled 28 mobile chipping operations in the Italian mountains, in order to determine professional exposure to BTEX and PAHs among chipper operators. IOM, Radiello®, and XAD2 samplers were used for the purpose. Operations were divided into industrial and small scale, the former based on powerful chippers with enclosed cabs and the latter on smaller machines without enclosed cabs. We could not detect any measurable exposure to BTEX, while exposure levels for PAHs were very low, especially for what concerned recognized cancer agents. That is likely related to work environment and organization because mobile chippers work in the open-air forest environment and in the presence of very few other machines. PAH concentration was significantly higher inside cabs than outside. None of the operators involved in this research was exposed to BTEX or PAHs above occupational exposure limits.

6. Buschini A, Villarini M, Feretti D, Mussi F, Dominici L, Zerbini I, Moretti M, Ceretti E, Bonfiglioli R, Carrieri M, Gelatti U, Rossi C, Monarca S, Poli P. Multicentre study for the evaluation of mutagenic/carcinogenic risk in nurses exposed to antineoplastic drugs: assessment of DNA damage. Occup Environ Med. 2013 Nov;70(11):789-94. doi: 10.1136/oemed-2013-101475. Epub 2013 Aug 16.
Department of Life Sciences, University of Parma, Parma, Italy.

Abstract
OBJECTIVES: People who handle antineoplastic drugs, many of which classified as human carcinogens by International Agency for Research on Cancer, are exposed to low doses in comparison with patients; however, the long duration of exposure could lead to health effects. The aim of this work was to evaluate DNA damage in white blood cells from 63 nurses who handle antineoplastic drugs in five Italian hospitals and 74 control participants, using different versions of the Comet assay. METHODS: Primary DNA damage was assessed by using the alkaline version of the assay on leucocytes, whereas to detect DNA oxidative damage and cryptic lesions specifically, the Comet/ENDO III assay and the Comet/araC assay were performed on leucocytes and lymphocytes, respectively. RESULTS: In the present study, no significant DNA damage was correlated with the work shift. The exposed population did not differ significantly from the reference group with respect to DNA primary and oxidative damage in leucocytes. Strikingly, in isolated lymphocytes treated with araC, lower data dispersion as well as a significantly lower mean value for the percentage of DNA in the comet tail was observed in exposed participants as compared with the control group (p<0.05), suggesting a potential chronic exposure to crosslinking antineoplastic drugs. CONCLUSIONS: Although stringent rules were adopted at national and international levels to prevent occupational exposure to antineoplastic drugs, data reported in this study support the idea that a more efficient survey on long-lasting exposures at very low concentrations is needed.

7. Spinazzè A, Cattaneo A, Garramone G, Cavallo DM. Temporal variation of size-fractionated particulate matter and carbon monoxide in selected microenvironments of the milan urban area. J Occup Environ Hyg. 2013 Nov;10(11):652-62. doi: 10.1080/15459624.2013.831985.
a Dipartimento di Scienza e Alta Tecnologia , Università degli Studi dell'Insubria , Como , Italy.

Abstract
This article focuses on air pollution in specific urban microenvironments and conditions characterized by high relative concentration levels and by possible risk to human health. For this reason, monitoring of particle number concentration (PNC) with a wide, size-resolved particle-size range, and CO (an indicator of combustion sources, e.g., traffic), was performed in a variety of microenvironments. Concentrations of ultrafine particles (UFPs), size-fractionated particulate matter (PM), and carbon monoxide (CO) were measured in the central area of Milan over three-week-long periods, one each during summer, autumn, and winter, with three monitoring sessions per day. Experimental data were collected continuously during each monitoring period along an established urban pathway. To assess the relevance of time and spatial factors affecting atmospheric concentrations of UFPs, PM, and CO data were collected while walking or moving by different private and public means of transport. Measurements were divided on the basis of different microenvironments (MEs), seasons, days of the week, and periods of the day. Data analysis shows statistically significant differences across MEs and monitoring periods. The highest measured median concentrations and data variability were observed for busy streets, walking or moving by motorized vehicle (CO, UFP) and in metro trains (PM); the lowest concentrations were observed in park areas and in indoor environments. The highest concentrations were measured during working day morning monitoring sessions. Regarding seasonal variation, UFP, PM, and CO showed different patterns: the highest median concentrations were observed in summer for CO, and in autumn and winter for the UFP and PM. Appreciable differences among all MEs and monitoring periods were observed: concentration patterns and variations appear related to typical sources of urban pollutants (traffic), proximity to sources, and time of day. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: a file containing Table VI: Tau b (Kendall) index for non-parametric correlation tau test.].

8. Mensi C, Consonni D, Sieno C, De Matteis S, Riboldi L, Bertazzi PA. Sinonasal cancer and occupational exposure in a population-based registry. Int J Otolaryngol. 2013;2013:672621. doi: 10.1155/2013/672621. Epub 2013 Sep 4.
Department of Preventive Medicine, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via San Barnaba 8, 20122 Milan, Italy.

Abstract
We examined occupational exposures among subjects with sinonasal cancer (SNC) recorded in a population-based registry in the Lombardy Region, the most populated and industrialized Italian region. The registry collects complete clinical information and exposure to carcinogens regarding all SNC cases occurring in the population of the region. In the period 2008-2011, we recorded 210 SNC cases (137 men, 73 women). The most frequent occupational exposures were to wood (44 cases, 21.0%) and leather dust (29 cases, 13.8%), especially among men: 39 cases (28.5%) to wood and 23 cases (16.8%) to leather dust. Exposure to other agents was infrequent (<2%). Among 62 subjects with adenocarcinoma, 50% had been exposed to wood dust and 30.7% to leather dust. The proportions were around 10% in subjects with squamous cell carcinoma and about 20% for tumors with another histology. The age-standardized rates (×100,000 person-years) were 0.7 in men and 0.3 in women. Complete collection of cases and their occupational history through a specialized cancer registry is fundamental to accurately monitor SNC occurrence in a population and to uncover exposure to carcinogens in different industrial sectors, even those not considered as posing a high risk of SNC, and also in extraoccupational settings.

9. Caciari T, Rosati MV, Di Giorgio V, Casale T, Pimpinella B, Scala B, Giubilati R, Capozzella A, Tomei G, Tomei F. Urinary nickel and prolactin in workers exposed to urban stressors. Environ Sci Process Impacts. 2013 Oct 23;15(11):2096-103. doi: 10.1039/c3em00409k.
University of Rome "Sapienza" - Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, Rome, Italy.

Abstract
The aim of our study is to verify whether the exposure to low Ni doses in urban air may have some effects on the prolactin values of outdoor workers exposed to urban pollutants. 334 workers have been included in the study and divided on the basis of gender, job, age, length of service and smoking habits. Each worker underwent urinary Ni and prolactin sampling. The t-test for independent samples, the Mann-Whitney U test for two mode variables (gender, smoking habit), the univariate ANOVA test and the Kruskal Wallis test for the variables in more than two modes (age, length of service and job duties) were performed on the total sample. Pearson's correlation coefficient (p two-tailed) among the parameters was evaluated both in the total sample and after the stratification by gender, smoking habit and job. Multiple linear regression was performed after taking account of the major confounding factors on the total sample and on the subcategories. The statistical tests showed a significant correlation between urinary Ni and prolactin both in the total sample and in the subcategories. We believe that the occupational exposure to low doses of Ni present in urban pollution may influence the prolactin values in exposed workers.

10. Durando P, Sotgiu G, Spigno F, Piccinini M, Mazzarello G, Viscoli C, Copello F, Poli A, Ansaldi F, Icardi G. Latent tuberculosis infection and associated risk factors among undergraduate healthcare students in Italy: a cross-sectional study. BMC Infect Dis. 2013 Sep 23;13:443. doi: 10.1186/1471-2334-13-443.
Department of Health Sciences, Associate Professor of Hygiene, Preventive Medicine and Public Health, Hygiene Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Via Antonio Pastore 1, 16132, Genoa, Italy. durando@unige.it.

Abstract
BACKGROUND: The screening of both healthcare workers and students attending teaching hospitals for latent tuberculosis infection (LTBI) is recommended in hospitals of many countries with a low-incidence of TB, including Italy, as a fundamental tool of tuberculosis (TB) control programs. The aim of the study was to estimate the prevalence of LTBI and evaluate the main risk-factors associated with this condition in a cohort of healthcare Italian students. METHODS: In a cross-sectional study, performed between January and May 2012, 881 undergraduate students attending the Medical, Nursing, Pediatric Nursing and Midwifery Schools of the University of Genoa, trained at the IRCCS San Martino-IST Teaching Hospital of Genoa, were actively called to undergo the Tuberculin Skin Test (TST). All the TST positive cases were also tested with an Interferon-Gamma Release Assay (IGRA) to confirm the diagnosis of LTBI. A standardized questionnaire was collected for risk-assessment analysis. RESULTS: Seven hundred and thirty-three (83.2%) subjects underwent TST testing. The prevalence of TST positives was 1.4%, and in 4 (0.5%) out of 10 TST positive cases LTBI diagnosis was confirmed by IGRA. No difference in the prevalence of subjects who tested positive to TST emerged between pre-clinical (n = 138) and clinical (n = 595) students. No statistically significant association between TST positivity and age, gender, and BCG vaccination was observed. The main independent variable associated with TST positivity was to be born in a country with a high TB incidence (i.e., ≥20 cases per 100,000 population) (adjusted OR 102.80, 95% CI 18.09-584.04, p < 0.001). CONCLUSIONS: The prevalence of LTBI among healthcare students resulted very low. The only significant association between TST positivity and potential risk factors was to be born in high TB incidence areas. In countries with a low incidence of TB, the screening programs of healthcare students before clinical training can be useful for the early identification and treatment of the sporadic cases of LTBI.

11. Bena A, Giraudo M, Leombruni R, Costa G. Job tenure and work injuries: a multivariate analysis of the relation with previous experience and differences by age. BMC Public Health. 2013 Sep 22;13:869. doi: 10.1186/1471-2458-13-869.
Department of Epidemiology, Servizio di Epidemiologia - Settore rischi e danni da lavoro - ASL TO3 - Grugliasco, Via Sabaudia 164 Grugliasco, Turin 10095, Italy. antonella.bena@epi.piemonte.it.

Abstract
BACKGROUND: One of the consequences of the increasing flexibility in contemporary labour markets is that individuals change jobs more frequently than in the past. Indeed, in many cases, through collecting a lot of contracts, individuals work in the same economic sector or even in the same company, doing the same job in the same way as existing colleagues. A very long literature has established that newly hired workers - whatever the contract type - are more likely to be injured than those with longer job tenures. The objectives of this paper are: 1) to study the relationship between job tenure and injury risk taking into account past experience as a possible confounder; and 2) to evaluate how the effects of past experience and job tenure are modified by age. METHODS: Using a longitudinal national database, we considered only job contracts starting in 1998-2003 held by men working as blue collars or apprentices in the non-agricultural private sector. We calculated injury rates stratified by job tenure and age. Multivariate analyses were adjusted for background variables and previous experience accrued in the same economic sector of the current job. RESULTS: In the study period 58,271 workers who had experienced 10,260 injuries were observed. These people worked on 115,277 contracts in the six years observed (1.98 contracts per worker). Injury rates decrease with job tenure; the trend is the same in each age group; young workers have both the highest injury rate (9.20; CI 95%: 8.95-9.45) and the highest decrease with job tenure. Previous experience is associated with a decreasing injury rate in all age groups and for all job tenures. Multivariate analyses show that, even after checking for previous experience, workers with job tenure of less than 6 months show always higher relative risks compared with job tenure > 2 years: relative risk is 41% higher among under-thirty workers; it is 22% higher among people over forty. Previous experience is protective against injury risk in workers over thirty: after checking for all other variables, relative risk is lower in workers who have accumulated more than 5 years of experience. CONCLUSIONS: In a context in which career fragmentation is increasing, workers find themselves more and more in the "high risk" period and only individuals who are able to build their career with similar jobs may mitigate the higher risks thanks to their past experience. If institutions don't adopt appropriate prevention policies, injury risk is likely to increase, especially among young people.

Breve commento a cura di Dario Consonni
In questo studio longitudinale, condotto su scala nazionale su oltre 58.000 lavoratori, è stata valutata la relazione tra incidenza di infortuni lavorativi e lunghezza del rapporto di lavoro. E’ stato evidenziato un aumento di incidenza di infortuni tra i soggetti con contratti di lavoro brevi. Tale aumento era inoltre più marcato tra i giovani. Lo studio ha chiaramente documentato e quantificato uno dei numerosi effetti negativi della precarizzazione del lavoro.

12. Mattioli S, Gori D, Di Gregori V, Ricotta L, Baldasseroni A, Farioli A, Zanardi F, Galletti S, Colosio C, Curti S, Violante FS. PubMed search strings for the study of agricultural workers' diseases. Am J Ind Med. 2013 Sep 6. doi: 10.1002/ajim.22252. [Epub ahead of print]
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.

Abstract
BACKGROUND: Several optimized search strategies have been developed in Medicine, and more recently in Occupational Medicine. The aim of this study was to identify efficient PubMed search strategies to retrieve articles regarding putative occupational determinants of agricultural workers' diseases. METHODS: We selected the Medical Subjects Heading (MeSH) term agricultural workers' diseases and six MeSH terms describing farm work (agriculture, agrochemicals NOT pesticides, animal husbandry, pesticides, rural health, rural population) alongside 61 other promising terms. We estimated proportions of articles containing potentially pertinent information regarding occupational etiology to formulate two search strategies (one "more specific," one "more sensitive"). We applied these strategies to retrieve information on the possible occupational etiology among agricultural workers of kidney cancer, knee osteoarthritis, and multiple sclerosis. We evaluated the number of needed to read (NNR) abstracts to identify one potentially pertinent article in the context of these pathologies. RESULTS: The "more specific" search string was based on the combination of terms that yielded the highest proportion (40%) of potentially pertinent abstracts. The "more sensitive" string was based on use of broader search fields and additional coverage provided by other search terms under study. Using the "more specific" string, the NNR to find one potentially pertinent article were: 1.1 for kidney cancer; 1.4 for knee osteoarthritis; 1.2 for multiple sclerosis. Using the sensitive strategy, the NNR were 1.4, 3.6, and 6.3, respectively. CONCLUSION: The proposed strings could help health care professionals explore putative occupational etiology for agricultural workers' diseases (even if not generally thought to be work related).

13. Farioli A, Mattioli S, Quaglieri A, Curti S, Violante FS, Coggon D. Musculoskeletal pain in Europe: the role of personal, occupational, and social risk factors. Scand J Work Environ Health. 2013 Sep 5. pii: 3381. doi: 10.5271/sjweh.3381. [Epub ahead of print]
Occupational Health Unit, University of Bologna, Sant'Orsola Malpighi Hospital, via Palagi 9, IT-40138 Bologna, Italy. francesco.violante@unibo.it.

Abstract
OBJECTIVES: The prevalence of musculoskeletal pain in European countries varies considerably. We analyzed data from the fifth European Working Conditions Survey (EWCS) to explore the role of personal, occupational, and social risk factors in determining the national prevalence of musculoskeletal pain. METHODS: Over the course of 2010, 43 816 subjects from 34 countries were interviewed. We analyzed the one-year prevalence of back and neck/upper-limb pain. Individual-level risk factors studied included: sex; age; educational level; socioeconomic status; housework or cooking; gardening and repairs; somatizing tendency; job demand-control; six physical occupational exposures; and occupational group. Data on national socioeconomic variables were obtained from Eurostat and were available for 28 countries. We fitted Poisson regression models with random intercept by country. RESULTS: The main analysis comprised 35 550 workers. Among individual-level risk factors, somatizing tendency was the strongest predictor of the symptoms. Major differences were observed by country with back pain more than twice as common in Portugal (63.8%) than Ireland (25.7%), and prevalence rates of neck/upper-limb pain ranging from 26.6% in Ireland to 67.7% in Finland. Adjustment for individual-level risk factors slightly reduced the large variation in prevalence between countries. For back pain, the rates were more homogenous after adjustment for national socioeconomic variables. CONCLUSIONS: Our analysis indicates substantial variation between European countries in the prevalence of back and neck/upper-limb pain. This variation is unexplained by established individual risk factors. It may be attributable in part to socioeconomic differences between countries, with higher prevalence where there is less risk of poverty or social exclusion.

Breve commento a cura di Dario Consonni
Utilizzando I dati dell’ European Working Conditions Survey (EWCS) relativi a oltre 35.000 lavoratori, questo studio ha analizzato il ruolo di fattori personali, occupazionali e sociali nel determinare la prevalenza di disturbi muscolo-scheletrici. Sono state evidenziate ampie variazioni di prevalenza tra Stati Europei che risultavano attribuibili, più che a fattori individuali, a differenze socio-economiche tra paesi. In particolare, la prevalenza era più elevata in paesi con minore rischio di povertà o esclusione sociale).

14. Folletti I, Zock JP, Moscato G, Siracusa A. Asthma and rhinitis in cleaning workers: a systematic review of epidemiological studies. J Asthma. 2013 Sep 18. [Epub ahead of print]
Occupational Allergology Unit, Department of Clinical and Experimental Medicine, University of Perugia , Perugia , Italy .

Abstract
Abstract Objective: This article presents a systematic review of epidemiological studies linking cleaning work and risk of asthma and rhinitis. Methods: Published reports were identified from PubMed covering the years from 1976 through June 30, 2012. In total, we identified 24 papers for inclusion in the review. The quality of studies was evaluated using the Strengthening of the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist of 22 items for cross-sectional, cohort and case-control studies. Results: Increased risk of asthma or rhinitis has been shown in 79% of included epidemiological studies. In four studies the increased risk of asthma in cleaning workers was confirmed by objective tests, such as bronchial hyper-reactivity or airflow obstruction. Level of exposure to cleaning products, cleaning sprays, bleach, ammonia, mixing products and specific job tasks has been identified as specific causes of asthma and rhinitis. Conclusions: Possible preventive measures encompass the substitution of cleaning sprays, bleach and ammonia, avoidance of mixing products, the use of respiratory protective devices, worker education and medical surveillance.

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