• Dario Consonni1

  1. Clinica del lavoro, Milano

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Ricerca bibliografica periodo dal 1 gennaio 2012 al 15 marzo 2012

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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 ("2012/10 01/01"[PDAT] : "2012/03/15"[PDAT])
1.Lacquaniti A, Fenga C, Venuti VA, Pernice L, Catanzariti S, Sirna G, Pernice F, Arena A, Lupica R, Abbate C, Buemi M. Hydrocarbons and Kidney Damage: Potential Use of Neutrophil Gelatinase-Associated Lipocalin and Sister Chromatide Exchange.. Am J Nephrol. 2012 Feb 25;35(3):271-278. [Epub ahead of print]
Section of Nephrology, Department of Internal Medicine,University of Messina,Messina, Italy.

Background: Millions of workers are exposed to polycyclic aromatic hydrocarbons (PAHs) and it is known that the kidney is a target for toxic chemicals. We have evaluated neutrophil gelatinase-associated lipocalin (NGAL) as a potential marker of tubular damage and have used it, with sister chromatid exchange (SCE) analysis, to evaluate carcinogenic risk in a group of workers from an oil refinery. Methods: NGAL and SCE analysis were evaluated in 160 subjects. Exposed subjects were divided into three groups, according to levels of exposure to PAHs: 40 highly exposed workmen (WM), 40 less exposed office workers (OW), and 40 subjects (GE) living in Gela. The control group included 40 healthy subjects (HS). Results: WM, OW and GE showed higher NGAL levels than HS. WM had higher levels of NGAL than the OW and GE groups; in ROC analysis, serum NGAL showed a good diagnostic profile (sensitivity 87.5%; specificity 100.0%), as did urinary NGAL (sensitivity 90.0%; specificity 92.5%). Moreover, regarding SCE analysis, WM showed higher values than HS. A direct correlation between SCE and serum NGAL was found in WM, the group most exposed to PAHs. Conclusion: The high values of NGAL are an expression of damage to the renal tubule determined by exposure to PAHs. Compared to the other groups studied, chromosomal aberrations - expressed as SCE - were increased in WM, the group most exposed to PAHs, indicating genotoxic damage. NGAL may also play a role in the process of carcinogenesis having a direct correlation with the number of SCEs.

2. Santoro PE, Nardis ID, Fronterrè P, Felli M, Martello S, Bergamaschi A, Chiarotti M. A snapshot of workplace drug testing in Italy. Drug Test Anal. 2012 Feb;4(2):66-70. doi: 10.1002/dta.417.
Catholic University of the Sacred Heart, Rome,

The Italian Decree on Health and Safety at Work (81/08) prescribes mandatory drug tests for jobs which pose safety hazards to others. Workplace drug testing is performed in accordance with the Provision of the Government-Regions Conference, 2008. The aim of our survey was to examine the prevalence of drug use and the main drug findings in a sample of Italian workers performing hazardous jobs. From September 2009 to February 2011, 551 urine samples were collected in 42 Italian companies. Sample collection was carried out at the workplace by qualified laboratory personnel sent from the Institute of Occupational Medicine of the Catholic University (UCSC) of Rome. The workers to be tested were informed the day before, as the law requires. The samples were checked for adulteration, coded, and sent immediately to the laboratory of the UCSC Forensic Toxicology Analytical Unit. The screening test was an immunoassay. The positive samples proceeded to the confirmatory analysis with liquid chromatography-tandem mass spectrometry (LC-MS/MS). The urine samples were analyzed for cannabis, opiates, amphetamines, methamphetamines, cocaine, methadone, and MDMA. Out of 16 samples .9% screened positive; only 4 of them (0.7%) were confirmed with the LC-MS/MS. Confirmed results included cocaine (2 samples), cannabis (1 sample), both cocaine and cannabis (1 sample). The prevalence of positive samples was lower than expected. Such finding cannot be explained by a low reliability of the testing procedure but could be due to test scheduling. More positive cases might be found performing short-notice random testing.

3.Pira E, Pelucchi C, Romano C, Manzari M, Negri E, La Vecchia C. Mortality from cancer and other causes in an italian cohort of male rubber tire workers. J Occup Environ Med. 2012 Mar;54(3):345-9.
Dipartimento di Traumatologia (Drs Pira, Romano, and Manzari), Ortopedia e Medicina del Lavoro, Università degli Studi di Torino, Turin, Italy; Istituto di Ricerche Farmacologiche "Mario Negri" (Drs Pelucchi, Negri, and La Vecchia), Milan, Italy; and Sezione di Statistica Medica e Biometria, Dipartimento di Medicina del Lavoro (Dr La Vecchia), Università degli Studi di Milano, Milan, Italy.

OBJECTIVE: : To investigate mortality among workers of an Italian rubber tire factory employed between 1954 and 2008. METHODS: : This cohort study included 6246 men, totaling 190,512 man-years of observation. Employment data were obtained from personnel records, whereas vital status and causes of death were ascertained from local authorities. We computed standardized mortality ratios (SMRs) using national and regional death certification rates. RESULTS: : Mortality was significantly lower than expected for all cancers (SMR = 79) and all causes (SMR = 85). The SMRs were 99 for cancer of stomach, 78 for lung, 121 for urinary bladder, 116 for lymphoma, and 89 for leukemia, none being significant. Decreased mortality emerged for cancers of the oral cavity and pharynx (SMR = 45), esophagus (SMR = 29), colorectum (SMR = 71), liver (SMR = 57), and kidney (SMR = 33). CONCLUSIONS: : This study shows no excess cancer risk among male rubber tire workers employed after 1954..

4. Bena A, Leombruni R, Giraudo M, Costa G. A new Italian surveillance system for occupational injuries: Characteristics and initial results. Am J Ind Med. 2012 Feb 21. doi: 10.1002/ajim.22025. [Epub ahead of print]
Department of Epidemiology, ASL TO3 Grugliasco, Turin, Italy.

BACKGROUND: Occupational injuries research and surveillance is important for prevention and public health protection. A new occupational surveillance system based on linkage of work histories calculated from the Italian National Social Security Institute (INPS) and occupational injuries provided by the National Insurance Institute for Occupational Injuries (INAIL) was created and assessed. METHODS: It has been extracted a 1% sample of individuals from INPS. For each subject, a detailed description of the career has been compiled between 1985 and 2004, and matched on an individual basis to work injuries between 1994 and 2003. It has been calculated injury rates and risks by economic activity, gender, age, job tenure, country of birth, and firm size. RESULTS: The linkage success is very high both in engineering than in the construction sector. The comparison with Eurostat statistics is very positive. The injury risks calculated by job tenure, country of birth, and firm size are consistent with literature. The high injury rate for short work contracts remain unvaried also after controlling by age. CONCLUSIONS: It is finally possible to describe injuries based on some main characteristics of the recent changes in the labor market, such as precarization, ageing of workers, migration, that databases currently available in Italy do not allow. The sample is longitudinal and can contribute to describing the development of the phenomena over time. The Ministry of Health is completing procedures to extend the sample and to increase the health outcomes for which a follow-up is available.

Commento a cura di D. Consonni:
Interessante esempio di uso di dati correnti per la valutazione della frequenza di infortuni in funzione di diverse variabili demografiche e socio-occupazionali, che riflettono i recenti mutamenti del mercato del lavoro, in particolare l’aumento del precariato e della quota di lavoratori migranti.

5. Gagliardi D, Marinaccio A, Valenti A, Iavicoli S. Occupational safety and health in europe: lessons from the past, challenges and opportunities for the future. Ind Health. 2012;50(1):7-11.
Department of Occupational Medicine, Italian Workers' Compensation Authority -INAIL (formerly ISPESL), via Fontana Candida, Monteporzio Catone (Rome), Italy.

Europe has always played a key role in the field of Occupational Health and Safety (OHS) and can be considered the cradle of Occupational Health. The European policy framework has been set since the establishment of the European Union, but its strength lies in the enactment of the Framework Directive on Occupational Health and Safety (89/391/EC), which has had a strong positive impact on the assessment and management of occupational risk factors and has promoted the quick diffusion of common standards across Europe. Yet, some implementation issues still remain to be addressed, due to changes in the world of work, fragmentation, economic crisis and, more generally, to the impact of globalization. Therefore, actions need to be reviewed with respect to research plans and policy implementation so as to support the OHS social dimension fostering a broader concept of wellbeing at work.

6. Mensi C, Pellegatta M, Sieno C, Consonni D, Riboldi L, Bertazzi PA. Mesothelioma of tunica vaginalis testis and asbestos exposure. BJU Int. 2012 Feb 9. doi: 10.1111/j.1464-410X.2012.10932.x. [Epub ahead of print]
Clinica del Lavoro 'Luigi Devoto', Department of Preventive Medicine, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Inhaled Dust Biological Effects Centre Post-Graduate School of Occupational Medicine, Department of Occupational Health, Università degli Studi di Milano, Milan, Italy.

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Mesothelioma of the tunica vaginalis testis is a rare tumour. From 2000 to 2010, 13 mesothelioma of the tunica vaginalis testis cases were reported in the most populated and industrialized region in Italy. Asbestos exposure was documented in two-thirds of these cases. OBJECTIVE: •  To describe cases of mesothelioma of the tunica vaginalis testis (MTVT) recorded in the Lombardy Mesothelioma Registry between 2000 and 2010. METHODS: •  The Lombardy Mesothelioma Registry, established in 2000, collects data regarding all incident cases of mesothelioma of the pleura, peritoneum, pericardium and tunica vaginalis testis that have been diagnosed in the population of the Lombardy region. •  These data include a detailed clinical report and a complete occupational history for each MTVT patient, with the latter including details of the industrial sector involved, the patient's job, and the specific tasks performed. To address the potential for asbestos exposure outside the work environment, the residential history, lifestyle habits and hobbies of the patient, as well as job information for all subjects living with the patient, are also collected. •  Records were reviewed and discussed by a panel of experts. RESULTS: •  Thirteen cases of MTVT were reported between 2000 and 2010. •  The age-standardized incidence rate of MTVT for the Lombardy region of Italy is 0.2 cases per million individuals/year. •  Asbestos exposure was documented in 8 of the 12 (67%) interviewed cases. CONCLUSIONS: •  Asbestos exposure was associated with a higher proportion of MTVT cases than previously reported in the literature. These results confirm the aetiological role for asbestos in the pathogenesis of MTVT. •  The results of this study also highlight the importance of obtaining detailed occupational histories and lifestyle habits from patients, particularly by trained interviewers.

7. Berry G, Reid A, Aboagye-Sarfo P, de Klerk NH, Olsen NJ, Merler E, Franklin P, Musk AW. Malignant mesotheliomas in former miners and millers of crocidolite at Wittenoom (Western Australia) after more than 50 years follow-up. Br J Cancer. 2012 Feb 28;106(5):1016-20. doi: 10.1038/bjc.2012.23. Epub 2012 Feb
Sydney School of Public Health, University of Sydney, Sydney, New South Wales 2006, Australia.

Background: To report the number of malignant pleural and peritoneal mesotheliomas that have occurred in former Wittenoom crocidolite workers to the end of 2008, to compare this with earlier predictions, and to relate the mesothelioma rate to amount of exposure. Methods: A group of 6489 men and 419 women who had worked for the company operating the former Wittenoom crocidolite mine and mill at some time between 1943 and 1966 have been followed up throughout Australia and Italy to the end of 2008.Results:The cumulative number of mesotheliomas up to 2008 was 316 in men (268 pleural, 48 peritoneal) and 13 (all pleural) in women. There had been 302 deaths with mesothelioma in men and 13 in women, which was almost 10% of all known deaths. Mesothelioma rate, both pleural and peritoneal, increased with time since first exposure and appeared to reach a plateau after about 40 to 50 years. The mesothelioma rate increased with amount of exposure and the peritoneal mesotheliomas occurred preferentially in the highest exposure group, 37% compared with 15% overall. Conclusion: By the end of 2008, the number of mesothelioma deaths had reached 4.7% for all the male workers and 3.1% for the females. Over the past 8 years the numbers were higher than expected. It is predicted that about another 60 to 70 deaths with mesothelioma may occur in men by 2020.

8. La Vecchia C, Boffetta P. Role of stopping exposure and recent exposure to asbestos in the risk of mesothelioma. Eur J Cancer Prev. 2012 Feb 5. [Epub ahead of print]
A Department of Epidemiology, 'Mario Negri' Institute for Pharmacological Research B Department of Occupational Health, University of Milan, Milan, Italy cInternational Prevention Research Institute, Lyon, France dThe Tisch Cancer Institute, Mount Sinai School of Medicine, New York, New York, USA.

The model of asbestos-related mesothelioma implies that the time since first exposure (latency) is the key determinant of subsequent risk. The role of recent exposure or stopping asbestos exposure, if any, is, however, open to discussion. A literature review was conducted to the end of 2010. In a cohort of 1966 Italian textile workers, the standardized mortality ratio, on the basis of 68 deaths from mesothelioma, was 6627 for workers employed only under the age of 30 years, 8019 for those employed both under the age of 30 years and at the age of 30-39 years, and 5891 for those employed both under the age of 30 years and at the age of 40 years or more. In a cohort of Italian asbestos cement workers, including 135 deaths from pleural cancer, compared with workers who had stopped exposure for 3-15 years, the relative risk (RR) was similar for those still employed (RR=0.67) and for those who had stopped for 30 years or more (RR=0.65). In a British case-control study, including 622 cases of mesothelioma and 1420 population controls, the RR substantially increased with increasing duration of exposure under the age of 30 years, but not with exposure at the age of more than 30 years. In the Great Britain Asbestos Workers Survey, including 649 deaths from mesothelioma compared with workers who were still employed and or had stopped for less than 10 years, the multivariate RRs were 0.90 10-20 years after stopping exposure and 0.99 both 20-30 and more than 30 years after stopping. There is consistent evidence showing that, for workers exposed in the distant past, the risk of mesothelioma is not appreciably modified by subsequent exposures, and that stopping exposure does not materially modify the subsequent risk of mesothelioma.

9.Rubino FM, Mandic-Rajcevic S, Ariano E, Alegakis A, Bogni M, Brambilla G, De Paschale G, Firmi A, Minoia C, Micoli G, Savi S, Sottani C, Somaruga C, Turci R, Vellere F, Tsatsakis A, Colosio C. Farmers' exposure to herbicides in North Italy: Assessment under real-life conditions in small-size rice and corn farms. Toxicol Lett. 2012 Jan 28. [Epub ahead of print]
LaTMA Laboratory for Analytical Toxicology and Metabolomics, Department of Medicine, Surgery and Dental Sciences, University of Milan, San Paolo University Hospital, Via di Rudinì 8 20124 Milan, Italy; Department of Occupational and Environmental Health, University of Milan, San Paolo Hospital Unit, and International Centre for Rural Health, San Paolo University Hospital, Via di Rudinì 8 20124 Milan, Italy.

Although rice and corn are two main cash crops in Lombardy (North Italy) and their cultivation involves several thousands of farmers, risk assessment of pesticide exposure is rarely done, especially in small and medium sized enterprises. With the use of pads for environmental monitoring (OECD protocol), of pre- and post-exposure 24h urine collection for biological monitoring and of hand wash for hands' exposure, we measured the exposure of 28 agricultural workers to propanil and terbuthylazine in real-life working conditions. In propanil applicators, median daily exposure on the clothes was 73.5μmol per worker, while the exposure on the skin was 22.4μmol. For terbuthylazine, these exposures were 37.2μmol and 0.86μmol per worker, respectively. Median excretion of the propanil metabolite (3,4-dichloroaniline) after exposure was 84nmol in 24h urine, and 13nmol for the metabolite of terbuthylazine. Risk assessment performed by comparing to the AOELs of the applied active ingredients with an estimated internal dose, obtained based on the measured levels of skin and hand exposure and the percentage of dermal absorption of the active ingredients considered showed that 4 propanil workers, and no terbuthylazine workers, were overexposed. Our study helps define and confirm relationships between different exposure determinants, which can be used in the development of tools for risk assessment of exposure to pesticides in small and medium sized enterprises.

10.Damiani G, Federico B, Basso D, Ronconi A, Bianchi CB, Anzellotti GM, Nasi G, Sassi F, Ricciardi W. Socioeconomic disparities in the uptake of breast and cervical cancer screening in Italy: a cross sectional study. BMC Public Health. 2012 Feb 3;12(1):99. [Epub ahead of print]

BACKGROUND: Breast and cervical cancer screening are widely recognized as effective preventive procedures in reducing cancer mortality. The aim of this study was to evaluate the impact of socioeconomic disparities in the uptake of female screening in Italy, with a specific focus on different types of screening programs. METHODS: A cross-sectional study was conducted using data from the 2004-2005 national health interview survey. A sample of 15,486 women aged 50-69 years for mammography and one of 35,349 women aged 25-64 years for Pap smear were analysed. Logistic regression models were used to estimate the association between socioeconomic factors and female screening utilization. RESULTS: Education and occupation were positively associated with attendance to both screening. Women with higher levels of education were more likely to have a mammogram than those with a lower level (OR = 1.28; 95% CI = 1.10-1.49). Women of intermediate and high occupational classes were more likely to use breast cancer screening (OR = 1.77; 95% CI = 1.55-2.03, OR = 1.63; 95% CI = 1.40-1.91) compared to unemployed women. Women in the highest occupational class had a higher likelihood of cervical cancer screening compared to those in the lowest class (OR = 1.91; 95% CI = 1.72-2.13). Among women who attended screening, those with lower levels of education and lower occupational classes were more likely than more advantaged women to attend organized screening programs rather than being screened on the basis of their own initiative. CONCLUSIONS: Inequalities in the uptake of female screening widely exist in Italy. Organized screening programs may have an important role in increasing screening attendance and tackling inequalities.

11.Ciarrocca M, Tomei G, Fiaschetti M, Caciari T, Cetica C, Andreozzi G, Capozzella A, Schifano MP, Andre' JC, Tomei F, Sancini A. Assessment of occupational exposure to benzene, toluene and xylenes in urban and rural female workers. Chemosphere. 2012 Jan 30. [Epub ahead of print]
Department of Anatomy, Histology, Medical-Legal and the Orthopaedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy.

OBJECTIVES: This is the first research study to compare among female, non-smoker workers: (a) the exposure to benzene, toluene and xylenes (BTXs) in urban air during work in the street (traffic policewomen, TP) vs. work in vehicles (police drivers, PD); (b) the exposure to BTXs in urban environments (in street and in car) vs. rural environments (roadwomen, RW); (c) the values of blood benzene, urinary trans, trans muconic acid (t,t-MA) and urinary S-phenylmercapturic acid (S-PMA) in urban areas (in street and in car) vs. rural areas. METHODS: Passive personal samplings and data acquired using fixed monitoring stations located in different areas of the city were used to measure environmental and occupational exposure to BTXs during the work shift in 48 TP, 21 PD and 22 RW. In the same study subjects, blood benzene, t,t-MA and S-PMA were measured at the end of each work shift. RESULTS: Personal exposure of urban workers to benzene seemed to be higher than the exposure measured by the fixed monitoring stations. Personal exposure to benzene and toluene was (a) similar among TP and PD and (b) higher among urban workers compared to rural workers. Personal exposure to xylenes was (a) higher in TP than in PD and (b) higher among urban workers compared to rural workers. Blood benzene, t,t-MA and S-PMA levels were similar among TP and PD, although the blood benzene level was significantly higher in urban workers compared to rural workers. In urban workers, airborne benzene and blood benzene levels were significantly correlated. CONCLUSIONS: Benzene is a human carcinogen, and BTXs are potential reproductive toxins at low dose exposures. Biological and environmental monitoring to assess exposure to BTXs represents a preliminary and necessary tool for the implementation of preventive measures for female subjects working in outdoor environments.

12.Dolcetti R, Serraino D, Dognini G, Govi S, Crocchiolo R, Ghia P, Pasini E, Ponzoni M, Talamini R, De Paoli P, Doglioni C, Ferreri AJ. Exposure to animals and increased risk of marginal zone B-cell lymphomas of the ocular adnexae. Br J Cancer. 2012 Feb 28;106(5):966-9. doi: 10.1038/bjc.2012.2. Epub 2012 Jan 24.
Centro di Riferimento Oncologico - IRCCS, National Cancer Institute, 33081, Aviano, Italy.

Background: Ocular adnexal marginal zone B-cell lymphoma (OAMZL) has been associated with Chlamydophila psittaci, an infection that may be transmitted by carrier animals. However, it is still unclear whether exposure to animals affects the risk of OAMZL in comparison with other lymphoma histotypes. We therefore investigated the role of professional and/or domestic exposures to animals in the occurrence of OAMZL, as compared with other types of lymphoma. Methods: A hospital-based case-control study was carried out on 43 consecutive OAMZL patients (cases) and 87 consecutive patients with nodal non-Hodgkin's lymphomas (NHLs; controls). Multiple logistic regression (MLR) odds ratios (ORs), and 95% confidence intervals (CIs) were used to estimate the association between exposures to animals and OAMZL risk. Results: A higher proportion of cases reported a lifetime exposure to household animals (79.1% vs 64.4% among controls), with a non-statistical significant MLR-OR of 2.18 (95% CI: 0.85-5.62). The OAMZL cases more frequently reported a history of occupation in breeding and/or slaughtering than controls (34.9% vs 6.9%), with an overall increased risk of 7.69 (95%CI: 2.65-22.34).Conclusion: These results indicate that, compared with nodal NHLs, the risk of OAMZL is markedly increased by contact with animals, particularly by occupational exposures.

13.Mongini F, Evangelista A, Milani C, Ferrero L, Ciccone G, Ugolini A, Piedimonte A, Sigaudo M, Carlino E, Banzatti E, Galassi C. An educational and physical program to reduce headache, neck/shoulder pain in a working community: a cluster-randomized controlled trial. PLoS One. 2012;7(1):e29637. Epub 2012 Jan 9.
Section Headache-Facial Pain, Department of Clinical Pathophysiology, University of Turin, Turin, Italy.

BACKGROUND: Noninvasive physical management is often prescribed for headache and neck pain. Systematic reviews, however, indicate that the evidence of its efficacy is limited. Our aim was to evaluate the effectiveness of a workplace educational and physical program in reducing headache and neck/shoulder pain. METHODOLOGY/PRINCIPAL FINDINGS: Cluster-randomized controlled trial. All municipal workers of the City of Turin, Italy, were invited to participate. Those who agreed were randomly assigned, according to their departments, to the intervention group (IG) or to the control group and were given diaries for the daily recording of pain episodes for 1 month (baseline). Subsequently, only the IG (119 departments, 923 workers) began the physical and educational program, whereas the control group (117 departments, 990 workers) did not receive any intervention. All participants were again given diaries for the daily recording of pain episodes after 6 months of intervention. The primary outcome was the change in the frequency of headache (expressed as the proportion of subjects with a ≥50% reduction of frequency; responder rate); among the secondary outcomes there were the absolute reduction of the number of days per month with headache and neck/shoulder pain. Differences between the two groups were evaluated using mixed-effect regression models. The IG showed a higher responder rate [risk ratio, 95% confidence interval (CI)] for headache (1.58; 1.28 to 1.92) and for neck/shoulder pain (1.53; 1.27 to 1.82), and a larger reduction of the days per month (95% CI) with headache (-1.72; -2.40 to -1.04) and with neck/shoulder pain (-2.51; -3.56 to -1.47). CONCLUSIONS: The program effectively reduced headache and neck/shoulder pain in a large working community and appears to be easily transferable to primary-care settings. Further trials are needed to investigate the program effectiveness in a clinical setting, for highly selected patients suffering from specific headache types. TRIAL REGISTRATION: NCT00551980.

Commento a cura di D. Consonni:
Raro esempio di valutazione metodologicamente corretta della efficacia degli interventi preventivi in ambito occupazionale.

14.Salerno S, Livigni L, Magrini A, Talamanca IF. Gender and ergonomics: a case study on the 'non-formal' work of women nurses. Ergonomics. 2012;55(2):140-6.
ENEA, Agency for New Technology, Energy and the Environment, Division of Bio-Medicine, Rome, 00123, Italy.

Women's work activities are often characterised by 'non-formal actions' (such as giving support). Gender differences in ergonomics may be due to this peculiarity. We applied the method of organisational congruencies (MOC) to ascertain the 'non-formal' work portion of nurses employed in three hospital units (haematology, emergency room and general medicine) during the three work shifts in a major University Hospital in Rome, Italy. We recorded a total of 802 technical actions performed by nine nurses in 72 h of work. Twenty-six percent of the actions in direct patient's care were communicative actions (mainly giving psychological support) while providing physical care. These 'double actions' are often not considered to be a formal part of the job by hospital management. In our case study, the 'non-formal' work of nurses (psychological support) is mainly represented by double actions while taking physical care of the patients. The dual task paradigm in gender oriented research is discussed in terms of its implications in prevention in occupational health. PRACTITIONER SUMMARY: The main purpose of the study was to assess all the formal and non-formal activities of women in the nursing work setting. Offering psychological support to patients is often not considered to be a formal part of the job. Our case study found that nurses receive no explicit guidelines on this activity and no time is assigned to perform it. In measuring the burden of providing psychological support to patients, we found that this is often done while nurses are performing tasks of physical care for the patients (double actions). The article discusses the significance of non-formal psychological work load of women nurses through double actions from the ergonomic point view.

15.Barbieri PG, Mirabelli D, Somigliana A, Cavone D, Merler E. Asbestos Fibre Burden in the Lungs of Patients with Mesothelioma Who Lived Near Asbestos-Cement Factories. Ann Occup Hyg. 2012 Jan 12. [Epub ahead of print]
Mesothelioma Registry, Occupational Health Unit, Local Health Authority, 25128 Brescia, Italy.

Background Epidemics of malignant mesothelioma are occurring among inhabitants of Casale Monferrato and Bari never employed in the local asbestos-cement (AC) factories. The mesothelioma risk increased with proximity of residence to both plants. Objectives To provide information on the intensity of environmental asbestos exposure, in the general population living around these factories, through the evaluation of the lung fibre burden in mesothelioma patients. Methods We analysed by a scanning electron microscope equipped with X-ray microanalysis wet (formalin-fixed) lung tissue samples from eight mesothelioma patients who lived in Casale Monferrato or Bari and underwent surgery. Their occupational and residential history was obtained during face-to-face interviews. Semi-quantitative and quantitative indices of cumulative environmental exposure to asbestos were computed, based on residential distance from the AC plants and duration of stay. ResultsThe lung fibre burden ranged from 110 000 to 4 300 000 fibres per gram of dry lung (f/g) and was >1 000 000 f/g in three subjects. In four cases, only amphibole fibres were detected. Environmental exposures had ceased at least 10 years before samples were taken. No patient had other definite or probable asbestos exposures. A linear relationship was observed between the lung fibre burden and all three indices of environmental cumulative exposure to asbestos. Conclusions Environmental exposure to a mixture of asbestos fibres may lead to a high lung fibre burden of amphiboles years after exposure cessation. The epidemiological evidence of an increased mesothelioma risk for the general population of Casale Monferrato and Bari, associated with asbestos contamination of the living environment, is corroborated.

16.Angelini S, Maffei F, Bermejo JL, Ravegnini G, L'insalata D, Cantelli-Forti G, Violante FS, Hrelia P. Environmental exposure to benzene, micronucleus formation and polymorphisms in DNA-repair genes: A pilot study. Mutat Res. 2012 Mar 18;743(1-2):99-104. Epub 2012 Jan 11.
Department of Pharmacology, University of Bologna, Via Irnerio 48, Bologna 40126, Italy.

This report is part of a biomarker study conducted in an Italian population with exposure to environmental benzene ranging from 1.43 to 31.41μg/m(3) (values from personal sampling). DNA damage induced by benzene is the crucial mechanism of its genotoxicity, which leads to chronic benzene poisoning, haematotoxicity and leukaemia. Therefore, genetic variation in DNA-repair genes may modulate susceptibility to benzene-induced DNA damage. In light of this, the effects of polymorphisms in DNA-repair genes (APEX1, hOGG1, NBS1, XPD, XRCC1, and XRCC3) on micronucleus (MN) formation as a biomarker of early biological effects were evaluated. A significantly higher median MN frequency was recorded in traffic wardens than in controls. However, none of the analysed polymorphisms was significantly associated with the median MN frequency. A gene-gender interaction was observed for the APEX1 genotype. The APEX1 variant genotype was associated with significantly lower median MN frequency in men, not in women. Statistical analysis did not reveal any association between the score of the protective alleles - hypothetically pushing the pathway towards optimal DNA-damage repair - and MN. Even though there are some limitations in the study, our results indicate that the general population may be exposed to benzene concentrations higher than the threshold level for air-quality standards in the European Union of 10μg/m(3). Furthermore, urban traffic wardens are exposed to significantly higher levels of benzene than individuals spending most of the time indoors. This higher exposure may contribute to DNA damage, suggesting that benzene might be implicated both as an environmental and occupational risk factor in leukaemia and other haematological diseases. In conclusion, this study suggest the need for (i) regular monitoring of traffic wardens for possible exposure to benzene, as a precautionary step to reduce the associated health risks, and (ii) more comprehensive studies in order to better elucidate the involvement of APEX1 genotypes in benzene genotoxicity.

17.Cattaneo A, Somigliana A, Gemmi M, Bernabeo F, Savoca D, Cavallo DM, Bertazzi PA. Airborne Concentrations of Chrysotile Asbestos in Serpentine Quarries and Stone Processing Facilities in Valmalenco, Italy. Ann Occup Hyg. 2012 Jan 2. [Epub ahead of print]
Department of Occupational and Environmental Health, Università degli Studi di Milano, Milan, Italy.

Asbestos may be naturally present in rocks and soils. In some cases, there is the possibility of releasing asbestos fibres into the atmosphere from the rock or soil, subsequently exposing workers and the general population, which can lead to an increased risk of developing asbestos-related diseases. In the present study, air contaminated with asbestos fibres released from serpentinites was investigated in occupational settings (quarries and processing factories) and in the environment close to working facilities and at urban sites. The only naturally occurrence of asbestos found in Valmalenco area was chrysotile; amphibole fibres were never detected. An experimental cut-off diameter of 0.25 μm was established for distinguishing between Valmalenco chrysotile and antigorite single fibres using selected area electron diffraction analyses. Air contamination from chrysotile fibres in the examined occupational settings was site-dependent as the degree of asbestos contamination of Valmalenco serpentinites is highly variable from place to place. Block cutting of massive serpentinites with multiple blades or discs and drilling at the quarry sites that had the highest levels of asbestos contamination generated the highest exposures to (i.e. over the occupational exposure limits) asbestos. Conversely, working activities on foliated serpentinites produced airborne chrysotile concentrations comparable with ambient levels. Environmental chrysotile concentrations were always below the Italian limit for life environments (0.002 f ml(-1)), except for one sample collected at a quarry property boundary. The present exposure assessment study should encourage the development of an effective and concordant policy for proper use of asbestos-bearing rocks and soils as well as for the protection of public health.

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