• Dario Consonni1

  1. Clinica del lavoro, Milano

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Ricerca bibliografica periodo 2 giugno – 2 agosto 2011

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Database: Pubmed/MEDline
(Occupational Exposure [MESH] or Occupational Diseases [MESH] or Occupational Health [MESH] or Workplace [MESH] or Accidents, Occupational [MESH] or Employment [MESH] or Occupation (titolo/abstract) or Occupational (titolo/abstract) or Worker (titolo/abstract) or job (titolo/ abstract) and italy (tutti i campi).

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1.Corradi M, Gergelova P, Di Pilato E, Folesani G, Goldoni M, Andreoli R, Selis L, Mutti A.

Effect of exposure to detergents and other chemicals on biomarkers of pulmonary response in exhaled breath from hospital cleaners: a pilot study.
Int Arch Occup Environ Health. 2011 Jul 22. [Epub ahead of print]

Laboratory of Industrial Toxicology, Department of Clinical Medicine, Nephrology and Health Sciences, University of Parma, Via Gramsci 14, 431 00, Parma, Italy,

PURPOSE: The main aim of the study was to provide evidence whether professional cleaning was associated with biomarkers of lung damage in non-invasively collected biological fluids (exhaled air and exhaled breath condensate-EBC).
MATERIALS AND METHODS: This cross-sectional study involved 40 cleaners regularly exposed to cleaning detergents and 40 controls. The subjects completed a standard questionnaire from European Community Respiratory Health Survey (ECRHS II) and underwent a spirometry. Fractional exhaled nitric oxide (F(E)NO) was measured online, and pH, ammonium (NH(4) (+)), H(2)O(2) and 4-hydroxynonenal (4-HNE) were assayed in EBC.
RESULTS: Among the cleaners, the frequency of asthma and rhinitis was, respectively, 2.5 and 20%. The most frequently reported symptoms were sneezing (27.5%), nasal and/or pharyngeal pruritus (25%), ocular pruritus (22.5%) and cough (22.5%). There were no significant differences in comparison with the control group. Median F(E)NO levels were higher in African than in Caucasian cleaners (21.5 [16.5-30.0] ppb and 18.0 [13.5-20.5] ppb; p < 0.05). H(2)O(2)-EBC (0.26 [0.09-0.53] μM vs. 0.07 [0.04-0.15] μM; p < 0.01), NH(4) (+)-EBC (857 [493-1,305] μM vs. 541 [306-907] μM; p < 0.01) and pH-EBC (8.17 [8.09-8.24] vs. 8.06 [7.81-8.10]; p < 0.01) were higher in the cleaners than in the controls. Finally, the cleaners showed significant correlations between pH-EBC and NH(4) (+)-EBC (r = 0.33, p < 0.05) and a weak correlation between 4-HNE-EBC and H(2)O(2)-EBC (r = 0.37, p < 0.05).
CONCLUSIONS: The promising role of EBC analysis in biomonitoring of exposed workers was confirmed. It was also possible to identify the potential biomarkers of exposure to alkaline products (increased ammonium-EBC and pH-EBC levels) and potential biomarkers of oxidative stress (increased H(2)O(2)-EBC levels correlated with 4-HNE-EBC levels) in workers with no signs of airway diseases.

Breve commento a cura di Dario Consonni
Un metodo non invasivo di potenziale utilità nel biomonitoraggio dei lavoratori esposti a prodotti detergenti per la pulizia.

2. Petracci E, Decarli A, Schairer C, Pfeiffer RM, Pee D, Masala G, Palli D, Gail MH.
Risk factor modification and projections of absolute breast cancer risk.
J Natl Cancer Inst. 2011 Jul 6;103(13):1037-48. Epub 2011 Jun 24.
National Cancer Institute, 6120 Executive Plaza South, EPS 8049, Bethesda, MD 20892-7244.
Background:: Although modifiable risk factors have been included in previous models that estimate or project breast cancer risk, there remains a need to estimate the effects of changes in modifiable risk factors on the absolute risk of breast cancer.
Methods: Using data from a case-control study of women in Italy (2569 case patients and 2588 control subjects studied from June 1, 1991, to April 1, 1994) and incidence and mortality data from the Florence Registries, we developed a model to predict the absolute risk of breast cancer that included five non-modifiable risk factors (reproductive characteristics, education, occupational activity, family history, and biopsy history) and three modifiable risk factors (alcohol consumption, leisure physical activity, and body mass index). The model was validated using independent data, and the percent risk reduction was calculated in high-risk subgroups identified by use of the Lorenz curve.
RESULTS: The model was reasonably well calibrated (ratio of expected to observed cancers = 1.10, 95% confidence interval [CI] = 0.96 to 1.26), but the discriminatory accuracy was modest. The absolute risk reduction from exposure modifications was nearly proportional to the risk before modifying the risk factors and increased with age and risk projection time span. Mean 20-year reductions in absolute risk among women aged 65 years were 1.6% (95% CI = 0.9% to 2.3%) in the entire population, 3.2% (95% CI = 1.8% to 4.8%) among women with a positive family history of breast cancer, and 4.1% (95% CI = 2.5% to 6.8%) among women who accounted for the highest 10% of the total population risk, as determined from the Lorenz curve.
CONCLUSIONS: These data give perspective on the potential reductions in absolute breast cancer risk from preventative strategies based on lifestyle changes. Our methods are also useful for calculating sample sizes required for trials to test lifestyle interventions.

Breve commento a cura di Dario Consonni
Descrizione di un modello statistico per valutare l’impatto dei cambiamenti di alcuni stili di vita sul rischio di tumore alla mammella.

3. Garbarino S, Magnavita N, Elovainio M, Heponiemi T, Ciprani F, Cuomo G, Bergamaschi A.
Police job strain during routine activities and a major event.
. Occup Med (Lond). 2011 Jun 3. [Epub ahead of print]
State Police Health Service Department, Ministry of the Interior, Italy.

BACKGROUND: Special police forces are exposed to periods of intense work stress in ensuring public order.
AIM: To explore the relationship between the work context (routine work or special event) of special force policemen and psychological measures of job strain (demand-control) and effort-reward imbalance.
METHODS: . All policemen assigned to the G8 meeting in L'Aquila, Italy, in July 2009 were invited to complete a questionnaire while engaged in routine work in January 2009 (Time A) and in June 2009 (Time B), while preparing for the special event.
RESULTS: Participation rate in the questionnaire study was 292/294 (99%) members of the special police force. Measures of job strain (-0.39, P < 0.001) and effort-reward imbalance (-0.37, P < 0.001) decreased significantly from Time A to Time B. On average, demand decreased from 14.2 ± 1.9 to 12.6 ± 2.7 (P < 0.001), control increased from 11.8 ± 2.5 to 14.4 ± 3.4 (P < 0.001) and social support increased from 17.8 ± 2.9 to 19.0 ± 3.1 (P < 0.001). At the same time, effort decreased from 17.4 ± 3.2 to 11.8 ± 3.8 (P < 0.001), reward grew from 37.6 ± 5.5 to 45.5 ± 7.4 (P < 0.001) and overcommitment dropped from 7.1 ± 2.1 to 6.6 ± 1.7 (P < 0.001).
CONCLUSIONS: In special police forces, routine work may be significantly more stressful than a single critical event.

Breve commento a cura di Dario Consonni
Basso stress nei corpi speciali di polizia ai tempi del G8 dell’Aquila (2009).

4. Giordano F, Dell'orco V, Fantini F, Grippo F, Perretta V, Testa A, Figà-Talamanca I.
Mortality in a cohort of cement workers in a plant of Central Italy.
Int Arch Occup Environ Health. 2011 Jul 16. [Epub ahead of print]
Department of Public Health and Infectious Diseases, University of Rome "Sapienza", P.le Aldo Moro, 5, 00185, Rome, Italy,


PURPOSE: Workers of cement production are exposed to alkaline dust with irritant effects on the respiratory system. Most previous studies have examined workers in cement/asbestos factories, but there is limited information of the effects of exposures to Portland cement alone. The present study examines the effects of cement dust in a cohort of Portland cement workers through the analyses of their mortality records.
METHODS: Using the records of a cement plant, we reconstructed the work history of all 748 male employees between 1956 and 2006. SMRs were computed for overall mortality and for specific causes of death for the cohort compared with the reference population. The analysis was also performed by subdividing the cohort in low- and high-exposure groups on the basis of the task of the worker and the length of his exposure.
RESULTS: The overall mortality of the cohort (SMR = 0.87) as well as the mortality from all cancers (SMR = 0.64) and from cancers of the respiratory system (SMR = 0.56) was significantly lower compared to the reference population. Workers of the cement plant with higher exposures did not have an increased mortality risk from any cause. The only significantly elevated risk observed among these workers was for cancer of the respiratory system (SMR = 2.86), exclusively in the small subgroup of 39 workers with previous exposure to a cement/asbestos plant.
Portland cement workers had a statistically significant reduced risk of overall mortality and of all cancers mortality probably due to the healthy workers effect. The study confirmed an increased risk of respiratory system cancer only in the subgroup with previous work exposure in a cement/asbestos plant.

5. Bonassi S, Coskun E, Ceppi M, Lando C, Bolognesi C, Burgaz S, Holland N, Kirsh-Volders M, Knasmueller S, Zeiger E, Carnesoltas D, Cavallo D, da Silva J, de Andrade VM, Demircigil GC, Odio AD, Donmez-Altuntas H, Gattas G, Giri A, Giri S, Gómez-Meda B, Gómez-Arroyo S, Hadjidekova V, Haveric A, Kamboj M, Kurteshi K, Martino-Roth MG, Montoya RM, Nersesyan A, Pastor-Benito S, Salvadori DM, Shaposhnikova A, Stopper H, Thomas P, Torres-Bugarín O, Yadav AS, González GZ, Fenech M.
The HUman MicroNucleus project on eXfoLiated buccal cells (HUMN(XL)): The role of life-style, host factors, occupational exposures, health status, and assay protocol.
Mutat Res. 2011 Jul 8. [Epub ahead of print]
Unit of Clinical and Molecular Epidemiology IRCCS San Raffaele Pisana, Via di Val Cannuta, Roma, Italy.


The human buccal micronucleus cytome assay (BMCyt) is one of the most widely used techniques to measure genetic damage in human population studies. Reducing protocol variability, assessing the role of confounders, and estimating a range of reference values are research priorities that will be addressed by the HUMN(XL) collaborative study. The HUMN(XL) project evaluates the impact of host factors, occupation, life-style, disease status, and protocol features on the occurrence of MN in exfoliated buccal cells. In addition, the study will provide a range of reference values for all cytome endpoints. A database of 5424 subjects with buccal MN values obtained from 30 laboratories worldwide was compiled and analyzed to investigate the influence of several conditions affecting MN frequency. Random effects models were mostly used to investigate MN predictors. The estimated spontaneous MN frequency was 0.74‰ (95% CI 0.52-1.05). Only staining among technical features influenced MN frequency, with an abnormal increase for non-DNA-specific stains. No effect of gender was evident, while the trend for age was highly significant (p<0.001). Most occupational exposures and a diagnosis of cancer significantly increased MN and other endpoints frequencies. MN frequency increased in heavy smoking (≥40cig/day, FR=1.37; 95% CI 1.03-.82) and decreased with daily fruit consumption (FR=0.68; 95% CI 0.50-0.91). The results of the HUMN(XL) project identified priorities for validation studies, increased the basic knowledge of the assay, and contributed to the creation of a laboratory network which in perspective may allow the evaluation of disease risk associated with MN frequency.

6. La Torre G, Mannocci A, Ursillo P, Bontempi C, Firenze A, Panico MG, Sferrazza A, Ronga C, D'Anna A, Amodio E, Romano N, Boccia A.
Prevalence of influenza vaccination among nurses and ancillary workers in Italy: Systematic review and meta analysis. Hum Vaccin. 2011 Jul 1;7(7). [Epub ahead of print]
Sapienza University of Rome; Department of Public Health and Infectious Diseases; Sapienza University of Rome;Rome, Italy.

Introduction:: Italian Ministry of Health, recommends vaccination for seasonal influenza to all healthcare workers (HCW), particularly to nurses who have an important interaction with patients. The aim of this study is to conduct a systematic review in order to estimate the pooled prevalence of influenza vaccinations among nurses and ancillary workers in Italy and analyse the enhancing and hindering factors.

RESULTS: The review was performed using 15 articles, six containing the prevalence of vaccination for nurses and ancillary workers, while the others qualitative analysis. In all the selected articles the score calculation has been carried out by using a protocol for observational studies. The nurses and ancillary workers pooled proportion of influenza vaccination was respectively 13,47% (95%CI 9,58-17,90%) and 12,52% (95%CI 9,97-15,31%).
The Italian mean of influenza vaccination prevalence appear low if compared to other European countries, ranging from 15% to 29% in Countries such as UK, Germany, France. This situation of weakness should be seen as an opportunity to improve the vaccination rate for seasonal influenza significantly This should be done by intervening on the category which affirms caring less. In fact, this category has a priority to receive vaccination, due to their numbers and closer contact to patients

Methods: Research was conducted using medical database Scopus, PubMed, the search engine Google Scholar and ISI web of knowledge, and was concluded February 1st 2011.
Scarselli A, Binazzi A, Forastiere F, Cavariani F, Marinaccio A.
Industry and job-specific mortality after occupational exposure to silica dust.
Occup Med (Lond). 2011 Jun 17. [Epub ahead of print]
. Occupational Medicine Department, ex ISPESL research area, Italian Workers' Compensation Authority (INAIL), Via Alessandria 220/E, 00198 Rome, Italy.

BACKGROUND: Occupational exposure to silica dust occurs in many workplaces and is well known to cause silicosis. However, the link between silica exposure, silicosis and other diseases is still disputed.
AIMS To evaluate cause-specific mortality in a cohort of Italian silicotics.
METHODS: The cohort included 2034 male compensated for silicosis between 1943 and 1986, alive on 1 January 1987 and resident in the Latium region (Italy). Mortality follow-up was from 1987 to 2006. Vital status and death causes were ascertained from the regional mortality archive. Standardized mortality ratios (SMRs) were computed assuming a Poisson distribution of observed deaths.
RESULTS: Significant excess mortality was observed from all causes (SMR: 1.17, 95% CI: 1.11-1.24), cancer of trachea, bronchus and lung (SMR: 1.39, 95% CI: 1.17-1.64), cancer of larynx (SMR: 2.18, 95% CI: 1.32-3.60) and tuberculosis (SMR: 5.85, 95% CI: 3.03-11.30). Higher risks were observed for masons (lung cancer, SMR: 2.46, 95% CI: 1.65-3.66) and miners (larynx cancer, SMR: 5.31, 95% CI: 1.88-15.03). In a Poisson regression analysis, the relative risk of death from lung cancer and silicosis increased with silicosis severity and decreased in more recent compensation periods.
CONCLUSION: The excess mortality from respiratory tract cancers and other diseases detected among Italian workers compensated for silicosis confirms previous epidemiological findings.
Nardo D, Högberg G, Flumeri F, Jacobsson H, Larsson SA, Hällström T, Pagani M.
Self-rating scales assessing subjective well-being and distress correlate with rCBF in PTSD-sensitive regions. Psychol Med. 2011 Jun 15:1-13. [Epub ahead of print]
Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy.

BACKGROUND: The aim of this study was to investigate the distribution of the regional cerebral blood flow (rCBF) in occupational-related post-traumatic stress disorder (PTSD) subjects and to seek possible correlations between brain perfusion and self-rating scales (SRS) in order to cross-check their diagnostic value and to look for their neural correlates.
METHODS: A total of 13 traumatized underground and long-distance train drivers developing (S) and 17 not developing (NS) PTSD who had experienced a 'person under train' accident or who had been assaulted at work underwent clinical assessment and 99mTc-HMPAO SPECT imaging during autobiographical trauma scripts. Statistical parametric mapping was applied to analyse rCBF changes in S as compared with NS and to search for correlations between rCBF and the administered SRS scores, modelling age, months to SPECT and the ratio 'grey matter/intra-cranial volume' as nuisance variables.
RESULTS: Significantly higher activity was observed during trauma script in left posterior and anterior insula, posterior cingulate, inferior parietal lobule, precuneus, caudate and putamen in PTSD subjects as compared with the trauma-exposed control group. Impact of Event Scale and World Health Organisation (10) Well-Being Index scores highly correlated with tracer uptake to a great extent in the same regions in which rCBF differences between S and NS were found.
CONCLUSIONS: These findings support the involvement of insular, cingulate and parietal cortices (as well as the basal ganglia) in the pathogenesis of PTSD and in the processing of related subjective well-being and distress.

Richiardi L, Corbin M, Marron M, Ahrens W, Pohlabeln H, Lagiou P, Minaki P, Agudo A, Castellsague X, Slamova A, Schejbalova M, Kjaerhiem K, Barzan L, Talamini R, Macfarlane GJ, Macfarlane TV, Canova C, Simonato L, Conway DI, A McKinney P, Sneddon L, Thomson P, Znoar A, Healy CM, McCartan BE, Benhamou S, Bouchardy C, Hashibe M, Brennan P, Merletti F.
Occupation and risk of upper aerodigestive tract cancer: The ARCAGE study.
Int J Cancer. 2011 Jun 13. doi: 10.1002/ijc.26237. [Epub ahead of print]
Unit of Cancer Epidemiology, CeRMS and CPO Piemonte, University of Turin, Italy; Centre for Public Health Research, Massey University, Wellington, New Zealand.

We investigated the association between occupational history and upper aerodigestive tract (UADT) cancer risk in the ARCAGE European case-control study. The study included 1851 patients with incident cancer of the oral cavity, oropharynx, hypopharynx, larynx or oesophagus and 1949 controls. We estimated odds ratios (OR) and 95% confidence intervals (CI) for ever employment in 283 occupations and 172 industries, adjusting for smoking and alcohol. Men (1457 cases) and women (394 cases) were analysed separately and we incorporated a semi-Bayes adjustment approach for multiple comparisons. Among men, we found increased risks for occupational categories previously reported to be associated with at least one type of UADT cancer, including painters (OR=1.74, 95% CI: 1.01-3.00), bricklayers (1.58, 1.05-2.37), workers employed in the erection of roofs and frames (2.62, 1.08-6.36), reinforced concreters (3.46, 1.11-10.8), dockers (2.91, 1.05-8.05) and workers employed in the construction of roads (3.03, 1.23-7.46), general construction of buildings (1.44, 1.12-1.85) and cargo handling (2.60, 1.17-5.25). With the exception of the first three categories, risks both increased when restricting to long duration of employment and remained elevated after semi-Bayes adjustment. Increased risks were also found for loggers (3.56, 1.20-10.5) and cattle and dairy farming (3.60, 1.15-11.2). Among women, there was no clear evidence of increased risks of UADT cancer in association with occupations or industrial activities. This study provides evidence of an association between some occupational categories and UADT cancer risk among men. The most consistent findings, also supported by previous studies, were obtained for specific workers employed in the construction industry.

Marinaccio A, Binazzi A, Marzio DD, Scarselli A, Verardo M, Mirabelli D, Gennaro V, Mensi C, Riboldi L, Merler E, De Zotti R, Romanelli A, Chellini E, Silvestri S, Pascucci C, Romeo E, Menegozzo S, Musti M, Cavone D, Cauzillo G, Tumino R, Nicita C, Melis M, Iavicoli S; ReNaM Working Group.
Pleural malignant mesothelioma epidemic. Incidence, modalities of asbestos exposure and occupations involved from the italian national register.
Int J Cancer. 2011 Jun 6. doi: 10.1002/ijc.26229. [Epub ahead of print]
Workers Compensation Authority (INAIL), Research area ex ISPESL, Occupational Medicine Department, Epidemiology Unit, Rome, Italy.

Due to the large scale use of asbestos (more than 3.5 million tons produced or imported until its definitive banning in 1992) a specific national surveillance system of mesothelioma incident cases is active in Italy, with direct and individual anamnestic etiological investigation. In the period between 1993 and 2004 a case-list of 8,868 pleural MM was recorded by the Italian National Register (ReNaM) and the modalities of exposure to asbestos fibres have been investigated for 6,603 of them. Standardised incidence rates are 3.49 (per 100,000 inhabitants) for men and 1.25 for women, with a wide regional variability. Occupational asbestos exposure was in 69.3% of interviewed subjects (N = 4,577 cases), while 4.4% was due to cohabitation with someone (generally the husband) occupationally exposed, 4.7% by environmental exposure from living near a contamination source and 1.6% during a leisure activity. In the male group 81.5% of interviewed subjects exhibit an occupational exposure. In the exposed workers the median year of first exposure was 1957 and mean latency was 43.7 years. The analysis of exposures by industrial sector focuses on a decreasing trend for those traditionally signalled as "at risk" (asbestos-cement industry, shipbuilding and repair, railway carriages maintenance) and an increasing trend for the building construction sector. The systematic mesothelioma surveillance system is relevant for the prevention of the disease and for supporting an efficient compensation system. The existing experience on all-too-predictable asbestos effects should be transferred to developing countries where asbestos use is spreading.

Di Giampaolo L, Cavallucci E, Braga M, Renzetti A, Schiavone C, Quecchia C, Petrarca C, Di Gioacchino M.
The persistence of allergen exposure favors pulmonary function decline in workers with allergic occupational asthma.
Int Arch Occup Environ Health. 2011 Jun 4. [Epub ahead of print]
Allergy and Immunotoxicology Unit, CeSI, G. d'Annunzio University Foundation, Via Colle dell'Ara, 66100, Chieti, Italy.

BACKGROUND: In asthmatics, a rapid decline in pulmonary function is observed, likely as a consequence of airways remodeling. Persistence of allergen exposure in patients with occupational asthma (OA) maintains chronic bronchial inflammation, resulting in a more severe lung function decline. Few studies were performed on the effects of allergen exposure cessation.
OBJECTIVE: This study aims at evaluating the influence of allergen exposure cessation on respiratory decline in allergic asthmatic workers.
METHODS: Two groups of workers with allergic OA were selected. The first group (30 workers) changed job after the diagnosis and was no more exposed to sensitizing allergens, and the second group (28 subjects) did not and, as a consequence of preventive measures in the work place, was exposed to a lower level of allergens. All were treated with conventional therapy, according to GINA protocols. FEV1 changes during a 12-year period were evaluated.
RESULTS: Despite pharmacological therapy, the pulmonary function decay slope was steeper in workers continuously exposed to the sensitizing agent (even at reduced level) than in those with a complete cessation of exposure: final FEV1 loss was 512.5 ± 180 ml versus 332.5 ± 108 ml, respectively. The difference became significant after 4 years from the cessation of the exposure.
CONCLUSIONS: The study shows that the cessation of the exposure to allergen in the work place appears the most effective measure in limiting pulmonary function decline in asthmatic workers and underlines the importance of allergic risk assessment and control in the management of occupational asthma.

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