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Lavoro

  • Dario Consonni1

  1. Clinica del lavoro, Milano
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Ricerca bibliografica periodo dal 1 luglio 2014 al 15 settembre 2014


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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 epidemiol*[All fields] AND ("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2014/06/01"[PDAT] : "2014/09/15"[PDAT])

Breve commento a cura di Dario Consonni
In questo numero segnaliamo 6 articoli sui linfomi non-Hodgkin. I primi 5 sono apparsi in una monografia sul Journal of National Cancer Institute Monographs e riguardano diversi sottotipi indagati nel progetto InterLymph: 1) micosi fungoide e sindrome di Sézary; 2) linfomi della zona marginale; 3) leucemia linfatica cronica e linfomi a piccole cellule linfocitiche; 4) linfoma follicolare; 5) linfoma diffuso a grandi cellule B. Il sesto articolo, di Kelly e Vineis, è una rassegna sui biomarcatori di suscettibilità a cancerogeni, e utilizza come esempio proprio i linfomi non-Hodgkin. Gli autori suggeriscono che le interazioni gene-ambiente (peraltro da confermare) potrebbero spiegare le difficoltà nell’identificare con sufficiente certezza i fattori di rischio chimici nell’eziologia di queste patologie e auspicano l’utilizzo di nuovi metodi standardizzati per lo studio della suscettibilità.

1 Aschebrook-Kilfoy B(1), Cocco P(1), La Vecchia C(1), Chang ET(1), Vajdic CM(1), Kadin ME(1), Spinelli JJ(1), Morton LM(1), Kane EV(1), Sampson JN(1), Kasten C(1), Feldman AL(1), Wang SS(1), Zhang Y(2) Medical history, lifestyle, family history, and occupational risk factors for mycosis fungoides and Sezary syndrome: the InterLymph Non-Hodgkin Lymphoma Subtypes Project. J Natl Cancer Inst Monogr. 2014 Aug;2014(48):98-105. doi: 10.1093/jncimonographs/lgu008.
Author information: (1)Department of Health Studies, University of Chicago, Chicago, IL (BA-K); Department of Public Health, Clinical and Molecular Medicine, Occupational Health Section, University of Cagliari, Cagliari, Italy (PC); Dipartimento di Epidimologia, IRCCS- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy, Community Health, University of Milan, Milan, Italy (CLV); Health Sciences Practice, Exponent, Inc., Menlo Park, CA, Department of Health Research and Policy, Stanford University, Stanford, CA (ETC); Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Department of Dermatology, Boston University, Boston, MA, Roger Williams Medical Center, Providence, RI (MEK); Cancer Control Research, BC Cancer Agency, Vancouver, BC, Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (JJS); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health Bethesda, MD (LMM, JNS); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK (EVK); Biostatistics Center, Massachusetts General Hospital, Boston, MA (CK); Department of Laboratory Medicine and Pathology, Mayo Clinic Cancer Center, Rochester, MN (ALF); Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute of the City of Hope, Duarte, CA (SSW); Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT (YZ). (2)Department of Health Studies, University of Chicago, Chicago, IL (BA-K); Department of Public Health, Clinical and Molecular Medicine, Occupational Health Section, University of Cagliari, Cagliari, Italy (PC); Dipartimento di Epidimologia, IRCCS- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy, Community Health, University of Milan, Milan, Italy (CLV); Health Sciences Practice, Exponent, Inc., Menlo Park, CA, Department of Health Research and Policy, Stanford University, Stanford, CA (ETC); Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Department of Dermatology, Boston University, Boston, MA, Roger Williams Medical Center, Providence, RI (MEK); Cancer Control Research, BC Cancer Agency, Vancouver, BC, Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (JJS); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health Bethesda, MD (LMM, JNS); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK (EVK); Biostatistics Center, Massachusetts General Hospital, Boston, MA (CK); Department of Laboratory Medicine and Pathology, Mayo Clinic Cancer Center, Rochester, MN (ALF); Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute of the City of Hope, Duarte, CA (SSW); Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT (YZ). yawei.zhang@yale.edu.

Abstract
BACKGROUND: Mycosis fungoides and Sézary syndrome (MF/SS) are rare cutaneous T-cell lymphomas. Their etiology is poorly understood. METHODS: A pooled analysis of 324 MF/SS cases and 17217 controls from 14 case-control studies from Europe, North America, and Australia, as part of the International Lymphoma Epidemiology Consortium (InterLymph) Non-Hodgkin Lymphoma (NHL) Subtypes Project, was carried out to investigate associations with lifestyle, medical history, family history, and occupational risk factors. Multivariate logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: We found an increased risk of MF/SS associated with body mass index equal to or larger than 30 kg/m(2) (OR = 1.57, 95% CI = 1.03 to 2.40), cigarette smoking for 40 years or more (OR = 1.55, 95% CI = 1.04 to 2.31), eczema (OR = 2.38, 95% CI = 1.73 to 3.29), family history of multiple myeloma (OR = 8.49, 95% CI = 3.31 to 21.80), and occupation as crop and vegetable farmers (OR = 2.37, 95% CI = 1.14 to 4.92), painters (OR = 3.71, 95% CI = 1.94 to 7.07), woodworkers (OR = 2.20, 95% CI = 1.18 to 4.08), and general carpenters (OR = 4.07, 95% CI = 1.54 to 10.75). We also found a reduced risk of MF/SS associated with moderate leisure time physical activity (OR = 0.46, 95% CI = 0.22 to 0.97). CONCLUSIONS: Our study provided the first detailed analysis of risk factors for MF/SS and further investigation is needed to confirm these findings in prospective data and in other populations.

2. Bracci PM, Benavente Y, Turner JJ, Paltiel O, Slager SL, Vajdic CM, Norman AD, Cerhan JR, Chiu BC, Becker N, Cocco P, Dogan A, Nieters A, Holly EA, Kane EV, Smedby KE, Maynadié M, Spinelli JJ, Roman E, Glimelius B, Wang SS, Sampson JN, Morton LM, de Sanjosé S. Medical history, lifestyle, family history, and occupational risk factors for marginal zone lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project. J Natl Cancer Inst Monogr. 2014 Aug;2014(48):52-65. doi: 10.1093/jncimonographs/lgu011.
Author information: Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (PMB, EAH); Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d'Oncologia, IDIBELL, Barcelona, Spain, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (YB, SdS); Department of Histopathology, Douglass Hanly Moir Pathology, Sydney, Australia, The Australian School of Advanced Medicine, Macquarie University, Sydney, Australia (JJT); Department of Entomology, The Robert H. Smith Faculty of Agriculture, Koret School of Veterinary Medicine Veterinary Teaching Hospital, Hebrew University of Jerusalem, Rehovot, Israel (OP); Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN (SLS, ADN, JRC); Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany (NB); Department of Health Studies, University of Chicago, Chicago, IL (BCHC); Department of Public Health, Clinical and Molecular Medicine, Occupational Health Section, University of Cagliari, Cagliari, Italy (PC); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (AD); Center for Chronic Immunodeficiency (CCI), University Medical Center Freiburg, Freiburg, Germany (AN); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK (EVK, ER); Unit of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (KES); Biological Hematology Unit, CRB Ferdinand Cabanne, University Hospital of Dijon and University of Burgundy, Dijon, France (MM); Cancer Control Research, BC Cancer Agency, Vancouver, BC, Canada (JJS); Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden, Department of Oncology and Pathology, Karolinska Institutet, Stockhol

Abstract
BACKGROUND: Marginal zone lymphoma (MZL), comprised of nodal, extranodal, and splenic subtypes, accounts for 5%-10% of non-Hodgkin lymphoma cases. A detailed evaluation of the independent effects of risk factors for MZL and its subtypes has not been conducted. METHODS: Data were pooled from 1052 MZL cases (extranodal [EMZL] = 633, nodal [NMZL] = 157, splenic [SMZL] = 140) and 13766 controls from 12 case-control studies. Adjusted unconditional logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Novel findings for MZL subtypes include increased risk for B-cell activating autoimmune conditions (EMZL OR = 6.40, 95% CI = 4.24 to 9.68; NMZL OR = 7.80, 95% CI = 3.32 to 18.33; SMZL OR = 4.25, 95% CI = 1.49 to 12.14), hepatitis C virus seropositivity (EMZL OR = 5.29, 95% CI = 2.48 to 11.28), self-reported peptic ulcers (EMZL OR = 1.83, 95% CI = 1.35 to 2.49), asthma without other atopy (SMZL OR = 2.28, 95% CI = 1.23 to 4.23), family history of hematologic cancer (EMZL OR = 1.90, 95% CI = 1.37 to 2.62) and of non-Hodgkin lymphoma (NMZL OR = 2.82, 95% CI = 1.33 to 5.98), permanent hairdye use (SMZL OR = 6.59, 95% CI = 1.54 to 28.17), and occupation as a metalworker (NMZL OR = 3.56, 95% CI = 1.67 to 7.58). Reduced risks were observed with consumption of any alcohol (EMZL fourth quartile OR = 0.48, 95% CI = 0.28 to 0.82) and lower consumption of wine (NMZL first to third quartile ORs < 0.45) compared with nondrinkers, and occupation as a teacher (EMZL OR = 0.58, 95% CI = 0.37 to 0.88). CONCLUSION: Our results provide new data suggesting etiologic heterogeneity across MZL subtypes although a common risk of MZL associated with B-cell activating autoimmune conditions was found.

3. Slager SL(1), Benavente Y(2), Blair A(2), Vermeulen R(2), Cerhan JR(2), Costantini AS(2), Monnereau A(2), Nieters A(2), Clavel J(2), Call TG(2), Maynadié M(2), Lan Q(2), Clarke CA(2), Lightfoot T(2), Norman AD(2), Sampson JN(2), Casabonne D(2), Cocco P(2), de Sanjosé S(2) Medical history, lifestyle, family history, and occupational risk factors for chronic lymphocytic leukemia/small lymphocytic lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project. J Natl Cancer Inst Monogr. 2014 Aug;2014(48):41-51. doi: 10.1093/jncimonographs/lgu001.
Author information: (1)Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN (SLS, JRC, TGC, ADN); Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Institut Català d' Oncologia, IDIBELL, L'Hospitalet de Llobregat, Spain, CIBER de Epidemiología y Salud Pública, Barcelona, Spain (YB, DC, SdS); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (AB, QL, JNS); Institute for Risk Assessment Sciences, Utrecht University, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (RV); Unit of Occupational and Environmental Epidemiology, Cancer Prevention and Research Institute ISPO, Florence, Italy (ASC); Inserm, Centre for Research in Epidemiology and Population Health, Environmental Epidemiology of Cancer Group, Univ Paris Sud, Villejuif, France (AM, JC); Registry of Hematological Malignancies, Gironde and Bergonié Institute, Bordeaux, France (AM); Center for Chronic Immunodeficiency (CCI), University Medical Center Freiburg, Freiburg, Germany (AN); Biological Hematology Unit; CRB Ferdinand Cabanne, University Hospital of Dijon, University of Burgundy, France (MM); Cancer Prevention Institute of California, Fremont, CA (CAC); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK (TL); Department of Public Health, Clinical and Molecular Medicine, Occupational Health Section, University of Cagliari, Cagliari, Italy (PC). slager@mayo.edu. (2)Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN (SLS, JRC, TGC, ADN); Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Institut Català d' Oncologia, IDIBELL, L'Hospitalet de Llobregat, Spain, CIBER de Epidemiología y Salud Pública, Barcelona, Spain (YB, DC, SdS); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (AB, QL, JNS); Institute for Risk Assessment Sciences, Utrecht University, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (RV); Unit of Occupational and Environmental Epidemiology, Cancer Prevention and Research Institute ISPO, Florence, Italy (ASC); Inserm, Centre for Research in Epidemiology and Population Health, Environmental Epidemiology of Cancer Group, Univ Paris Sud, Villejuif, France (AM, JC); Registry of Hematological Malignancies, Gironde and Bergonié Institute, Bordeaux, France (AM); Center for Chronic Immunodeficiency (CCI), University Medical Center Freiburg, Freiburg, Germany (AN); Biological Hematology Unit; CRB Ferdinand Cabanne, University Hospital of Dijon, University of Burgundy, France (MM); Cancer Prevention Institute of California, Fremont, CA (CAC); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK (TL); Department of Public Health, Clinical and Molecular Medicine, Occupational Health Section, University of Cagliari, Cagliari, Italy (PC).

Abstract
BACKGROUND: Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are two subtypes of non-Hodgkin lymphoma. A number of studies have evaluated associations between risk factors and CLL/SLL risk. However, these associations remain inconsistent or lacked confirmation. This may be due, in part, to the inadequate sample size of CLL/SLL cases. METHODS: We performed a pooled analysis of 2440 CLL/SLL cases and 15186 controls from 13 case-control studies from Europe, North America, and Australia. We evaluated associations of medical history, family history, lifestyle, and occupational risk factors with CLL/SLL risk. Multivariate logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: We confirmed prior inverse associations with any atopic condition and recreational sun exposure. We also confirmed prior elevated associations with usual adult height, hepatitis C virus seropositivity, living or working on a farm, and family history of any hematological malignancy. Novel associations were identified with hairdresser occupation (OR = 1.77, 95% CI = 1.05 to 2.98) and blood transfusion history (OR = 0.79, 95% CI = 0.66 to 0.94). We also found smoking to have modest protective effect (OR = 0.9, 95% CI = 0.81 to 0.99). All exposures showed evidence of independent effects. CONCLUSIONS: We have identified or confirmed several independent risk factors for CLL/SLL supporting a role for genetics (through family history), immune function (through allergy and sun), infection (through hepatitis C virus), and height, and other pathways of immune response. Given that CLL/SLL has more than 30 susceptibility loci identified to date, studies evaluating the interaction among genetic and nongenetic factors are warranted.

4. Linet MS(1), Vajdic CM(2), Morton LM(2), de Roos AJ(2), Skibola CF(2), Boffetta P(2), Cerhan JR(2), Flowers CR(2), de Sanjosé S(2), Monnereau A(2), Cocco P(2), Kelly JL(2), Smith AG(2), Weisenburger DD(2), Clarke CA(2), Blair A(2), Bernstein L(2), Zheng T(2), Miligi L(2), Clavel J(2), Benavente Y(2), Chiu BC(2). Medical history, lifestyle, family history, and occupational risk factors for follicular lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project. J Natl Cancer Inst Monogr. 2014 Aug;2014(48):26-40. doi: 10.1093/jncimonographs/lgu006.
Author information: (1)Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health Bethesda, MD (MSL, LMM, AB); Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (AJdR); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL (CFS); Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY (PB); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (JRC); Winship Cancer Institute, Emory University, Atlanta, GA (CRF); Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d'Oncologia, IDIBELL, Barcelona, Spain, CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain (SdS, YB); INSERM, Centre for Research in Epidemiology and Population Health (CESP), Environmental Epidemiology of Cancer Group and Univ Paris Sud, Villejuif, France (AM, JC); Registry of Hematological Malignancies in Gironde, Bergonié Institute, Bordeaux, France (AM); Department of Public Health, Clinical and Molecular Medicine, Occupational Health Section, University of Cagliari, Cagliari, Italy (PC); School of Medicine and Dentistry, University of Rochester, Rochester, NY (JLK); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK (AGS); Department of Pathology, City of Hope National Medical Center, Duarte, CA (DDW); Cancer Prevention Institute of California, Fremont, CA (CAC); Department of Cancer Etiology, City of Hope Beckman Research Institute, Duarte, CA (LB); Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT (TZ); Unit of Occupational and Environmental Epidemiology, Cancer Prevention and Research Institute ISPO, Florence, Italy (LM); Department of Health Studies, University of Chicago, Chicago, IL (BCHC). linetm@mail.nih.gov. (2)Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health Bethesda, MD (MSL, LMM, AB); Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (AJdR); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL (CFS); Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY (PB); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (JRC); Winship Cancer Institute, Emory University, Atlanta, GA (CRF); Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d'Oncologia, IDIBELL, Barcelona, Spain, CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain (SdS, YB); INSERM, Centre for Research in Epidemiology and Population Health (CESP), Environmental Epidemiology of Cancer Group and Univ Paris Sud, Villejuif, France (AM, JC); Registry of Hematological Malignancies in Gironde, Bergonié Institute, Bordeaux, France (AM); Department of Public Health, Clinical and Molecular Medicine, Occupational Health Section, University of Cagliari, Cagliari, Italy (PC); School of Medicine and Dentistry, University of Rochester, Rochester, NY (JLK); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK (AGS); Department of Pathology, City of Hope National Medical Center, Duarte, CA (DDW); Cancer Prevention Institute of California, Fremont, CA (CAC); Department of Cancer Etiology, City of Hope Beckman Research Institute, Duarte, CA (LB); Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT (TZ); Unit of Occupational and Environmental Epidemiology, Cancer Prevention and Research Institute ISPO, Florence, Italy (LM); Department of Health Studies, University of Chicago, Chicago, IL (BCHC).

Abstract
BACKGROUND: Follicular lymphoma (FL) has been linked with cigarette smoking and, inconsistently, with other risk factors. METHODS: We assessed associations of medical, hormonal, family history, lifestyle, and occupational factors with FL risk in 3530 cases and 22639 controls from 19 case-control studies in the InterLymph consortium. Age-, race/ethnicity-, sex- and study-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression. RESULTS: Most risk factors that were evaluated showed no association, except for a few modest or sex-specific relationships. FL risk was increased in persons: with a first-degree relative with non-Hodgkin lymphoma (OR = 1.99; 95% CI = 1.55 to 2.54); with greater body mass index as a young adult (OR = 1.15; 95% CI = 1.04 to 1.27 per 5 kg/m(2) increase); who worked as spray painters (OR = 2.66; 95% CI = 1.36 to 5.24); and among women with Sjögren syndrome (OR = 3.37; 95% CI = 1.23 to 9.19). Lower FL risks were observed in persons: with asthma, hay fever, and food allergy (ORs = 0.79-0.85); blood transfusions (OR = 0.78; 95% CI = 0.68 to 0.89); high recreational sun exposure (OR = 0.74; 95% CI = 0.65 to 0.86, fourth vs first quartile); who worked as bakers or millers (OR = 0.51; 95% CI = 0.28 to 0.93) or university/higher education teachers (OR = 0.58; 95% CI = 0.41 to 0.83). Elevated risks specific to women included current and longer duration of cigarette use, whereas reduced risks included current alcohol use, hay fever, and food allergies. Other factors, including other autoimmune diseases, eczema, hepatitis C virus seropositivity, hormonal drugs, hair dye use, sun exposure, and farming, were not associated with FL risk. CONCLUSIONS: The few relationships observed provide clues suggesting a multifactorial etiology of FL but are limited in the extent to which they explain FL occurrence.

5. Cerhan JR(1), Kricker A(2), Paltiel O(2), Flowers CR(2), Wang SS(2), Monnereau A(2), Blair A(2), Dal Maso L(2), Kane EV(2), Nieters A(2), Foran JM(2), Miligi L(2), Clavel J(2), Bernstein L(2), Rothman N(2), Slager SL(2), Sampson JN(2), Morton LM(2), Skibola CF(2). Medical history, lifestyle, family history, and occupational risk factors for diffuse large B-cell lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project. J Natl Cancer Inst Monogr. 2014 Aug;2014(48):15-25. doi: 10.1093/jncimonographs/lgu010.
Author information: (1)Department of Health Sciences Research, Mayo Clinic, Rochester, MN (JRC, SLS); Sydney School of Public Health, The University of Sydney, Sydney, Australia (AK); Department of Entomology, The Robert H. Smith Faculty of Agriculture, Koret School of Veterinary Medicine Veterinary Teaching Hospital, Hebrew University of Jerusalem, Jerusalem, Israel (OP); Winship Cancer Institute, Emory University, Atlanta, GA (CRF); Department of Cancer Etiology, Beckman Research Institute of the City of Hope, Duarte, CA (SSW, LB); Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Environmental Epidemiology of Cancer Group, F-94805, and Univ Paris Sud, UMRS 1018, F-94805, Villejuif, France (AM, JC); Registry of Hematological Malignancies in Gironde, Bergonié Institute, Bordeaux, France (AM); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (AB, NR, JNS, LMM); Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy (LDM); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK (EVK); Center for Chronic Immunodeficiency (CCI), University Medical Center Freiburg, Freiburg, Germany (AN); Department of Cancer Biology, Mayo Clinic Cancer Center, Jacksonville, FL (JMF); Unit of Occupational and Environmental Epidemiology, Cancer Prevention and Research Institute ISPO Florence, Florence, Italy (LM); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL (CFS). cerhan.james@mayo.edu. (2)Department of Health Sciences Research, Mayo Clinic, Rochester, MN (JRC, SLS); Sydney School of Public Health, The University of Sydney, Sydney, Australia (AK); Department of Entomology, The Robert H. Smith Faculty of Agriculture, Koret School of Veterinary Medicine Veterinary Teaching Hospital, Hebrew University of Jerusalem, Jerusalem, Israel (OP); Winship Cancer Institute, Emory University, Atlanta, GA (CRF); Department of Cancer Etiology, Beckman Research Institute of the City of Hope, Duarte, CA (SSW, LB); Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Environmental Epidemiology of Cancer Group, F-94805, and Univ Paris Sud, UMRS 1018, F-94805, Villejuif, France (AM, JC); Registry of Hematological Malignancies in Gironde, Bergonié Institute, Bordeaux, France (AM); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (AB, NR, JNS, LMM); Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy (LDM); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK (EVK); Center for Chronic Immunodeficiency (CCI), University Medical Center Freiburg, Freiburg, Germany (AN); Department of Cancer Biology, Mayo Clinic Cancer Center, Jacksonville, FL (JMF); Unit of Occupational and Environmental Epidemiology, Cancer Prevention and Research Institute ISPO Florence, Florence, Italy (LM); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL (CFS).

Abstract
BACKGROUND: Although risk factors for diffuse large B-cell lymphoma (DLBCL) have been suggested, their independent effects, modification by sex, and association with anatomical sites are largely unknown. METHODS: In a pooled analysis of 4667 cases and 22639 controls from 19 studies, we used stepwise logistic regression to identify the most parsimonious multivariate models for DLBCL overall, by sex, and for selected anatomical sites. RESULTS: DLBCL was associated with B-cell activating autoimmune diseases (odds ratio [OR] = 2.36, 95% confidence interval [CI] = 1.80 to 3.09), hepatitis C virus seropositivity (OR = 2.02, 95% CI = 1.47 to 2.76), family history of non-Hodgkin lymphoma (OR = 1.95, 95% CI = 1.54 to 2.47), higher young adult body mass index (OR = 1.58, 95% CI = 1.12 to 2.23, for 35+ vs 18.5 to 22.4 kg/m(2)), higher recreational sun exposure (OR = 0.78, 95% CI = 0.69 to 0.89), any atopic disorder (OR = 0.82, 95% CI = 0.76 to 0.89), and higher socioeconomic status (OR = 0.86, 95% CI = 0.79 to 0.94). Additional risk factors for women were occupation as field crop/vegetable farm worker (OR = 1.78, 95% CI = 1.22 to 2.60), hairdresser (OR = 1.65, 95% CI = 1.12 to 2.41), and seamstress/embroider (OR = 1.49, 95% CI = 1.13 to 1.97), low adult body mass index (OR = 0.46, 95% CI = 0.29 to 0.74, for <18.5 vs 18.5 to 22.4 kg/m(2)), hormone replacement therapy started age at least 50 years (OR = 0.68, 95% CI = 0.52 to 0.88), and oral contraceptive use before 1970 (OR = 0.78, 95% CI = 0.62 to 1.00); and for men were occupation as material handling equipment operator (OR = 1.58, 95% CI = 1.02 to 2.44), lifetime alcohol consumption (OR = 0.57, 95% CI = 0.44 to 0.75, for >400 kg vs nondrinker), and previous blood transfusion (OR = 0.69, 95% CI = 0.57 to 0.83). Autoimmune disease, atopy, and family history of non-Hodgkin lymphoma showed similar associations across selected anatomical sites, whereas smoking was associated with central nervous system, testicular and cutaneous DLBCLs; inflammatory bowel disease was associated with gastrointestinal DLBCL; and farming and hair dye use were associated with mediastinal DLBCL. CONCLUSION: Our results support a complex and multifactorial etiology for DLBCL with some variation in risk observed by sex and anatomical site.

6. Kelly RS(1), Vineis P(2). Biomarkers of susceptibility to chemical carcinogens: the example of non-Hodgkin lymphomas. Br Med Bull. 2014 Sep;111(1):89-100. doi: 10.1093/bmb/ldu015. Epub 2014 Aug 11.
Author information: (1)Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA MRC-PHE Center for Environment and Health, School of Public Health, Imperial College London, London, UK. (2)MRC-PHE Center for Environment and Health, School of Public Health, Imperial College London, London, UK HuGef Foundation, Torino, Italy p.vineis@imperial.ac.uk.

Abstract
BACKGROUND: Genetic susceptibly to suspected chemical and environmental carcinogens may modify the response to exposure. The aim of this review was to explore the issues involved in the study of gene-environment interactions, and to consider the use of susceptibility biomarkers in cancer epidemiology, using non-Hodgkin lymphoma (NHL) as an example. SOURCES OF DATA: PubMed, EMBASE and Web of Science were searched for peer-reviewed articles considering biomarkers of susceptibility to chemical, agricultural and industrial carcinogens in the aetiology of NHL. AREAS OF AGREEMENT: The results suggest a modifying role for genetic susceptibility to a number of occupational and environmental exposures including organochlorines, chlorinated solvents, chlordanes and benzene in the aetiology of NHL. The potential importance of these gene-environment interactions in NHL may help to explain the lack of definitive carcinogens identified to date for this malignancy. AREAS OF CONTROVERSY: Although a large number of genetic variants and gene-environment interactions have been explored for NHL, to date replication is lacking and therefore the findings remain to be validated. GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH: These findings highlight the need for novel standardized methodologies in the study of genetic susceptibility to chemical carcinogens.

7. Sanlorenzo M(1), Wehner MR(2), Linos E(3), Kornak J(4), Kainz W(5), Posch C(6), Vujic I(6), Johnston K(3), Gho D(3), Monico G(3), McGrath JT(3), Osella-Abate S(7), Quaglino P(7), Cleaver JE(3), Ortiz-Urda S(3). The Risk of Melanoma in Airline Pilots and Cabin Crew: A Meta-analysis. JAMA Dermatol. 2014 Sep 3. doi: 10.1001/jamadermatol.2014.1077. [Epub ahead of print]
Author information: (1)Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco2Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy. (2)Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco3School of Medicine, Stanford University, Stanford, California. (3)Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco. (4)Department of Epidemiology and Biostatistics, University of California, San Francisco. (5)Center for Devices and Radiological Health, Division of Physics, US Food and Drug Administration, Silver Spring, Maryland. (6)Mount Zion Cancer Research Center, Department of Dermatology, University of California, San Francisco6Department of Dermatology,The Rudolfstiftung Hospital, Vienna, Austria. (7)Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy.

Abstract
Importance: Airline pilots and cabin crew are occupationally exposed to higher levels of cosmic and UV radiation than the general population, but their risk of developing melanoma is not yet established. Objective: To assess the risk of melanoma in pilots and airline crew. Data Sources: PubMed (1966 to October 30, 2013), Web of Science (1898 to January 27, 2014), and Scopus (1823 to January 27, 2014). Study Selection: All studies were included that reported a standardized incidence ratio (SIR), standardized mortality ratio (SMR), or data on expected and observed cases of melanoma or death caused by melanoma that could be used to calculate an SIR or SMR in any flight-based occupation. Data Extraction and Synthesis: Primary random-effect meta-analyses were used to summarize SIR and SMR for melanoma in any flight-based occupation. Heterogeneity was assessed using the χ2 test and I2 statistic. To assess the potential bias of small studies, we used funnel plots, the Begg rank correlation test, and the Egger weighted linear regression test. Main Outcomes and Measures: Summary SIR and SMR of melanoma in pilots and cabin crew. Results: Of the 3527 citations retrieved, 19 studies were included, with more than 266 431 participants. The overall summary SIR of participants in any flight-based occupation was 2.21 (95% CI, 1.76-2.77; P < .001; 14 records). The summary SIR for pilots was 2.22 (95% CI, 1.67-2.93; P = .001; 12 records). The summary SIR for cabin crew was 2.09 (95% CI, 1.67-2.62; P = .45; 2 records). The overall summary SMR of participants in any flight-based occupation was 1.42 (95% CI, 0.89-2.26; P = .002; 6 records). The summary SMR for pilots was 1.83 (95% CI, 1.27-2.63, P = .33; 4 records). The summary SMR for cabin crew was 0.90 (95% CI, 0.80-1.01; P = .97; 2 records). Conclusions and Relevance: Pilots and cabin crew have approximately twice the incidence of melanoma compared with the general population. Further research on mechanisms and optimal occupational protection is needed.

8. Fortunato F(1), Tafuri S(2), Cozza V(3), Martinelli D(1), Prato R(1). Low vaccination coverage among italian healthcare workers in 2013: Contributing to the voluntary vs. mandatory vaccination debate. Hum Vaccin Immunother. 2014 Aug 19;11(1). [Epub ahead of print]
Author information: (1)Department of Medical and Surgical Sciences; University of Foggia; Foggia, Italy. (2)Department of Biomedical Sciences and Human Oncology; University of Bari Aldo Moro; Bari, Italy. (3)Department of Medical and Surgical Sciences; University of Foggia; Foggia, Italy; European Programme for Intervention Epidemiology Training (EPIET); European Centre for Disease Prevention and Control (ECDC); Stockholm, Sweden.

Abstract
Vaccination of healthcare workers (HCWs) reduces the risk of occupational infections, prevents nosocomial transmission and maintains healthcare delivery during outbreaks. Despite the European directive and national legislation on workers' protection, immunization coverage among HCWs has often been very low. In light of Italian National Vaccination Plan 2012-2014 recommendations, the aim of this study was to assess levels of immunization and factors influencing adherence to vaccinations needed for HCWs in Puglia region, South Italy. The study was conducted using an interview-based standardized anonymous questionnaire administered to hospital employees in the period November 2009-March 2011. A total of 2198 health professionals responded in 51/69 Apulian hospitals (median age: 45 years; 65.2% nurses, 22.6% doctors and 12.2% other hospital personnel). Vaccination coverage was 24.8% for influenza, 70.1% for hepatitis B, 9.7% for MMR, 3.6% for varicella, and 15.5% for Td booster. Receiving counselling from occupational health physicians (OHPs) was associated with influenza (OR = 1.8; 95%CI = 1.5-2.2; P<0.001), hepatitis B (OR = 4.9; 95%CI = 3.9-6.3; P<0.001), varicella (OR = 43.7; 95%CI = 18.9-101.7; P<0.001), MMR (OR = 8.8; 95%CI = 4.1-18.6; P<0.001) and tetanus (OR = 50.5; 95%CI = 30.1-88.3; P<0.001) vaccine uptake. OHPs should be trained with standard guidelines specific for healthcare settings and HCWs' risk groups to facilitate their crucial role in improving vaccine coverage among HCWs and increase awareness on the duty to protect both employees and patients.

9. Verlato G(1), Accordini S, Nguyen G, Marchetti P, Cazzoletti L, Ferrari M, Antonicelli L, Attena F, Bellisario V, Bono R, Briziarelli L, Casali L, Corsico AG, Fois A, Panico M, Piccioni P, Pirina P, Villani S, Nicolini G, de Marco R. Socioeconomic inequalities in smoking habits are still increasing in Italy. BMC Public Health. 2014 Aug 27;14:879. doi: 10.1186/1471-2458-14-879.
Author information: (1)Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy. giuseppe.verlato@univr.it.

Abstract
BACKGROUND: Socioeconomic inequalities in smoking habits have stabilized in many Western countries. This study aimed at evaluating whether socioeconomic disparities in smoking habits are still enlarging in Italy and at comparing the impact of education and occupation. METHODS: In the frame of the GEIRD study (Gene Environment Interactions in Respiratory Diseases) 10,494 subjects, randomly selected from the general population aged 20-44 years in seven Italian centres, answered a screening questionnaire between 2007 and 2010 (response percentage = 57.2%). In four centres a repeated cross-sectional survey was performed: smoking prevalence recorded in GEIRD was compared with prevalence recorded between 1998 and 2000 in the Italian Study of Asthma in Young Adults (ISAYA). RESULTS: Current smoking was twice as prevalent in people with a primary/secondary school certificate (40-43%) compared with people with an academic degree (20%), and among unemployed and workmen (39%) compared with managers and clerks (20-22%). In multivariable analysis smoking habits were more affected by education level than by occupation. From the first to the second survey the prevalence of ever smokers markedly decreased among housewives, managers, businessmen and free-lancers, while ever smoking became even more common among unemployed (time-occupation interaction: p = 0.047). At variance, the increasing trend in smoking cessation was not modified by occupation. CONCLUSION: Smoking prevalence has declined in Italy during the last decade among the higher socioeconomic classes, but not among the lower. This enlarging socioeconomic inequality mainly reflects a different trend in smoking initiation.

10. Farioli A(1), Yang J(2), Teehan D(2), Baur DM(3), Smith DL(4), Kales SN(5). Duty-related risk of sudden cardiac death among young US firefighters. Occup Med (Lond). 2014 Sep;64(6):428-35. doi: 10.1093/occmed/kqu102. Epub 2014 Aug 7.
Author information: (1)Department of Environmental Health(Environmental & Occupational Medicine & Epidemiology), Harvard School of Public Health, Boston, MA 02115, USA, The Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02139, USA, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy. (2)Department of Environmental Health(Environmental & Occupational Medicine & Epidemiology), Harvard School of Public Health, Boston, MA 02115, USA, The Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02139, USA. (3)Department of Environmental Health(Environmental & Occupational Medicine & Epidemiology), Harvard School of Public Health, Boston, MA 02115, USA, Interdisciplinary for Hormone and Metabolic Disorders, Endokrinologikum ULM, 89073 Ulm, Germany. (4)Department of Health and Exercise Sciences, Skidmore College, Saratoga Springs, New York, NY 12866, USA. (5)Department of Environmental Health(Environmental & Occupational Medicine & Epidemiology), Harvard School of Public Health, Boston, MA 02115, USA, The Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02139, USA, skales@hsph.harvard.edu.

Abstract
BACKGROUND: Little is known regarding duty-related risks for sudden cardiac death (SCD) among young firefighters. AIMS: To investigate duty-related SCD among US firefighters aged 45 or younger. METHODS: We collected data on duty-related SCD from the US Fire Administration (USFA) and the US National Institute for Occupational Safety and Health (NIOSH). Two physicians independently reviewed each record. The proportions of time spent by firefighters performing specific duties were estimated from a municipal department, 17 large metropolitan departments and a national database. We estimated the duty-specific relative risks (RRs) and 95% confidence intervals (95% CI) of SCD relative to non-emergency duties based on the observed deaths and the expected average proportions of time per duty. RESULTS: The USFA recorded 205 age-eligible on-duty SCDs between 1996 and 2012; 86 (42%) of these deaths and one additional SCD were investigated by NIOSH (total n = 206). NIOSH was more likely (P < 0.001) to report on SCD associated with physical training (69% of cases were investigated) and fire suppression (57%). Compared with non-emergency duties, the risk of SCD was increased for fire suppression (RR 22.1, 95% CI 14.8-32.9), alarm response (RR 2.6, 95% CI 1.5-4.6), alarm return (RR 4.1, 95% CI 2.7-6.2) and physical training (RR 4.8, 95% CI 3.2-7.2). RRs for SCD were higher among firefighters with a pre-existing history of a cardiac condition. All 16 SCDs associated with alarm response occurred among volunteer firefighters. CONCLUSIONS: The performance of strenuous emergency duties is strongly associated with an increased risk of SCD among young firefighters, particularly among those with a history of cardiovascular disease.

11. Paolocci G(1), Folletti I(1), Torén K(2), Muzi G(1), Murgia N(2). Hymenoptera venom allergy: work disability and occupational impact of venom immunotherapy. BMJ Open. 2014 Aug 6;4(8):e005593. doi: 10.1136/bmjopen-2014-005593.
Author information: (1)Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy. (2)Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.

Abstract
OBJECTIVES: Little is known about the Hymenoptera venom allergy impact on work ability and the effect of venom immunotherapy (VIT) on work. The objective of this study was to evaluate the prevalence and predictors of work disability in patients treated with VIT and the effects of VIT on occupational functioning. METHODS: 181 patients, aged 18-71 years, treated with VIT while working, were investigated by questionnaire. Participants were classified into employed and self-employed and, based on work exposure to Hymenoptera, into three risk categories: high risk, occasionally high risk and low risk. Work disability was defined as having to have changed jobs/tasks and/or suffered economic loss because of Hymenoptera venom allergy. Predictors of work disability were assessed in logistic regression models. RESULTS: 31 (17%) patients reported work disability. Being self-employed and having the severe reaction at work were associated with work disability (p<0.01). Having a high-risk job for exposure to Hymenoptera was a significant predictor of work disability (OR 2.66, 95% CI 1.04 to 6.75). 24% of patients referred a positive effect of VIT on work. Determinants of the positive effect of VIT on work were having a high-risk job for exposure to hymenoptera (OR 3.60, 95% CI 1.52 to 8.51) and having already concluded VIT (OR 2.82, 95% CI 1.30 to 6.14). CONCLUSIONS: Hymenoptera venom allergy could determine work disability. Patients with Hymenoptera venom allergy having a high-risk job for exposure to Hymenoptera seem to have higher risk of work disability and refer more frequently a positive effect of VIT on work.

12. Farioli A(1), Mattioli S(2), Curti S(2), Violante FS(2). Comment on 'The latency period of mesothelioma among a cohort of British asbestos workers (1978-2005)': the effect of left censoring. Br J Cancer. 2014 Aug 5. doi: 10.1038/bjc.2014.440. [Epub ahead of print]
Author information: (1)1] Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Palagi 9, 40138 Bologna, Italy [2] Department of Environmental Health (Environmental & Occupational Medicine & Epidemiology), Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA [3] The Cambridge Health Alliance, Harvard Medical School, 1493 Cambridge St, Cambridge, MA 02139, USA. (2)Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Palagi 9, 40138 Bologna, Italy.

Breve commento a cura di Dario Consonni
Abbiamo già recentemente segnalato altre due lettere di commento allo stesso studio. Ricordiamo brevemente il contesto: un recente studio inglese (Frost G. 2014) ha valutato la latenza del mesotelioma nei soli casi, trascurando l’intera coorte. Ma è errato trarre inferenze su età alla diagnosi o latenza da una serie di soli casi, tracurando la popolazione da cui provengono. A beneficio dei lettori, affinché un giorno non siano tentati di incorrere nello stesso errore, riportiamo di nuovo qui sotto la serie dei contributi: 1. Frost G. The latency period of mesothelioma among a cohort of British asbestos workers (1978-2005). Br J Cancer 2013;109:1965-1973. doi: 10.1038/bjc.2013.514 2. Mirabelli D, Zugna D. Comment on 'The latency period of mesothelioma among a cohort of British asbestos workers (1978-2005)'. Br J Cancer 2014. doi: 10.1038/bjc.2014.111 3. Consonni D, Barone-Adesi F, Mensi C. Comment on 'The latency period of mesothelioma among a cohort of British asbestos workers (1978-2005)': methodological problems with case-only survival analysis. Br J Cancer 2014. doi: 10.1038/bjc.2013.823 4. Farioli A, Mattioli S, Curti S, Violante FS. Comment on 'The latency period of mesothelioma among a cohort of British asbestos workers (1978-2005)': the effect of left censoring. Br J Cancer 2014. doi: 10.1038/bjc.2014.440 5. Frost G. Response to comment on 'The latency period of mesothelioma among a cohort of British asbestos workers (1978-2005)' Br J Cancer. 2014. doi: 10.1038/bjc.2014.441 Si segnala anche un articolo pertinente all’argomento, apparso nella rubrica “Con Metodo” di E&P: • Consonni D. Manca qualcosa: cosa c’è di sbagliato nell’usare l’età alla diagnosi/decesso o la latenza nei casi. Epidemiol Prev 2013;37(1):85-88

13. Rosati MV(1), Casale T(1), Ciarrocca M(1), Weiderpass E(2), Capozzella A(1), Schifano MP(1), Tomei F(1), Nieto HA(3), Marrocco M(1), Tomei G(4), Caciari T(1), Sancini A(1). Nickel and blood counts in workers exposed to urban stressors. Toxicol Ind Health. 2014 Jul 7. pii: 0748233714540225. [Epub ahead of print]
Author information: (1)Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, Sapienza University of Rome, Rome, Italy. (2)Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden Cancer Registry of Norway, Oslo, Norway Department of Community Medicine, University of Tromsø-The Arctic University of Norway, Tromsø, Norway Samfundet Folkhalsan, Helsinki, Finland. (3)National University of Buenos Aires, Catedra Libre de Salud y Seguridad en el Trabajo, Buenos Aires, Argentina. (4)Department of Psychiatric and Psychological Science, Sapienza University of Rome, Rome, Italy franc.tomei@alice.it.

Abstract
Nickel (Ni) and Ni compounds are widely present in the urban air. The purpose of this study is to estimate exposure of individuals to Ni and the correlation between this exposure and the values of blood counts in outdoor workers. This study focused on a sample of 101 outdoor workers (55 male and 46 female; 65 nonsmokers and 36 smokers), all employed in the municipal police in a large Italian city. The personal levels of exposure to Ni were assessed through (a) environmental monitoring of Ni present in the urban air obtained from individual samples and (b) biological monitoring of urinary and blood Ni. The blood count parameters were obtained from the hemochromocytometric tests. Pearson correlation coefficients (r) were calculated to assess the association between the blood and urinary Ni and the complete blood count. Multiple linear regression models were used to examine the associations between the complete blood count and the independent variables (age, gender, years of work for current tasks, cigarette smoking habit (current and never smoker), values of airborne Ni, and blood and urinary Ni). Multiple linear regression analysis performed on the total group of 101 subjects confirms the association among the red blood cells count, the hematocrit, and the urinary Ni (R (2) = 0.520, p = 0.025 and R (2) = 0.530, p = 0.030). These results should lead to further studies on the effects of Ni in working populations exposed to urban pollutants. The possibility that the associations found in our study may be partially explained by other urban pollutants (such as benzene, toluene, and other heavy metals) not taken into consideration in this study cannot be ruled out.

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