rubrica

Lavoro

  • Dario Consonni1

  1. Clinica del lavoro, Milano

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Ricerca bibliografica periodo dal 1 giugno 2012 al 15 agosto 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 ("2011/10/16"[PDAT] : "2011/12/27"[PDAT])

Breve commento a cura di Dario Consonni
In questa selezione segnaliamo tre articoli che si occupano della salute degli immigrati. Due lavori sono stati condotti dallo stesso gruppo di autori dell’ISTAT su campioni rappresentativi di popolazione di ampie dimensioni. Il primo ha documentato una aumentata frequenza di infortuni sul lavoro tra gli immigrati, particolarmente nel settore edilizio. Il secondo ha indagato atteggiamenti discriminativi sul luogo di lavoro, mostrando un aumento di percezione di tali atteggiamenti tra i lavoratori provenienti dall’estero. Il terzo articolo riguarda un indagine sulla prevalenza di malattie a trasmissione sessuale (positività per HIV, epatite B e sifilide) ed epatite C tra le lavoratrici del sesso a Verona.

1. Salvatore MA, Baglio G, Cacciani L, Spagnolo A, Rosano A. Work-Related Injuries Among Immigrant Workers in Italy. J Immigr Minor Health. 2012 Jul 3. [Epub ahead of print]
National Institute of Statistics, Rome, Italy, antonio.salvatore@uniroma1.it.

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

2. Salvatore MA, Baglio G, Cacciani L, Spagnolo A, Rosano A. [Discrimination at the workplace among immigrants in Italy]. Med Lav. 2012 Jul-Aug;103(4):249-58.
Istituto Nazionale di Statistica, Roma. salvatore@istat.it

Abstract
BACKGROUND: Discrimination at the workplace can be considered a risk factor for immigrants' health. OBJECTIVES: In this study we compared the occurrence of episodes of arrogance or discrimination perceived at the workplace between documented immigrants coming from countries with high migration pressure and Italians, and evaluated the role of selected risk factors among immigrants. METHODS: Using data from the 2007 Labour Force Survey conducted by the Italian National Institute of Statistics, adjusted odds ratios (ORs) for socio-demographic and occupational variables were estimated among a nationally representative sample of 61,214 employed persons aged 15 years or more. RESULTS: The occurrence of perceived arrogance or discrimination was higher among immigrant compared to Italian males for all geographical areas of origin considered. Adjusted ORs were 4.6 (95% CI: 3.6-5.8) for Africans, 3.4 (95% CI: 2.5-4.6) for Asians, 2.1 (95% CI :1.6-2.8) for Eastern Europeans, and 2.0 (95% CI: 1.0-3.7) for Latin Americans. Among male immigrants a higher occurrence of arrogance or discrimination was found for construction and other industrial workers and for those residing in central-southern regions of Italy. Among female workers only Latin Americans and Africans showed a higher occurrence of perceived arrogance or discrimination compared to Italians: adjusted ORs were respectively 3.9 (95% CI: 2.6-5.7) and 2.6 (95% CI:1.5-4.5). Female immigrants with a medium-to-high level of education or a highly skilled job, and those residing in the central-southern regions of ltaly perceived the highest occurrence of arrogance or discrimination. CONCLUSIONS: The study highlighted the need for policies to protect the wellbeing of immigrants that seem to be particularly exposed to patterns of discrimination at the workplace.

3. Zermiani M, Mengoli C, Rimondo C, Galvan U, Cruciani M, Serpelloni G. Prevalence of sexually transmitted diseases and hepatitis C in a survey of female sex workers in the north-East of Italy. Open AIDS J. 2012;6:60-4. Epub 2012 Jul 12.
Center of Preventive Medicine and HIV Screening Center, ULSS 20 Verona, Italy.

Abstract
A key issue in the prevention and control of Sexually Transmitted Diseases (STD) is to provide access to health centres, and in diagnosing and treating STD. The present study is aimed to assess the prevalence of sexually transmitted diseases (STDs) and Hepatitis C virus (HCV) in a population of immigrant female sex workers (FSWs). We conducted a cross sectional survey of FSWs working in Verona, North-eastern Italy. Screening test included serology for STDs [including Human Immunodeficiency Virus (HIV), syphilis and Hepatitis B virus (HBV)] and hepatitis C virus (HCV).Sixteen out of 345 (4.6%) street FSWs screened during 1999-2007 resulted positive for HIV, 12 (3.5%) were positive for HBsAg, 7 (2.0%) were positive for syphilis serological test, and 3 (0.9%) were positive for HCV. Comparison of the prevalence data between women from Africa (286/345, 82.8%) and other countries showed no statistical difference for HIV infection (R.R. 1.44; 95% CI, 0.34-6.19) and for presence of HBsAg (R.R. 2.27; 95% CI, 0.30-17.24). The positivity of syphilis serologic tests had a lower prevalence among African FSWs (mostly coming from Nigeria) than among FSWs from Eastern Europe (57/345, 16.5%). This difference was statistically significant (R.R. 0.03; 95% CI, 0.00-0.28). The prevalence of HIV infection increased with age (p=0.04, by chi2 for trend analysis), but not with the time worked as sex workers in Italy. Moreover, the presence of any of the screened infections was predictable by both age and earlier time of immigration by way of logistic multivariable regression. The prevalence of HIV and HBsAg was higher in the whole analyzed cohort compared to the general population; prevalence of syphilis was significantly higher in FSWs from Eastern Europe than in FSWs from Africa. HCV prevalence remains low among non intravenous drug abuser FSWs. The data offers a starting point to address targeted intervention that would prevent FSWs acquiring and transmitting STDs.

4. Sancini A, Tomei F, Gioffrè PA, Sinibaldi F, Corbosiero P, Rinaldi G, Marrocco M, Scimitto L, Fiaschetti M, Tomei G, Ciarrocca M. Occupational exposure to traffic pollutants and peripheral blood counts. Ann Ig. 2012 Jul-Aug;24(4):325-44.
Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, Sapienza University of Rome, Italy.

Abstract
Aim of the study is to evaluate whether occupational exposure to low doses of pollutants present in the air of the city selected for the study could cause alterations in peripheral blood counts in workers of the Municipal Police with outdoor tasks vs workers with indoor tasks. 279 non smoker males were enrolled and divided on the basis of their different kind of task. The dosage of air pollutants was carried out through the use of personal air samplers on a representative group of workers. Data obtained were subject to statistical evaluation consisting of Homogeneity of variance test, ANOVA univariate test with post hoc Bonferroni correction, Jonckheere-Terpstra test and multiple linear regression analysis. The differences were considered statistically significant when p values were lower than 0.05. Mean levels of RBC, HB, MCHC, WBC and neutrophil cells were significantly higher in traffic policemen and police drivers compared to controls (workers with indoor tasks). Mean levels of MCV, MCH and lymphocytes were significantly lower in traffic policemen and police drivers compared to controls. These results were confirmed by Multiple linear regression test and Jonckheere-Terpstra test. The results suggest that prolonged occupational exposure to low doses of traffic pollutants can alter some lines of the hematopoietic system in exposed workers.

5. Abballe A, Barbieri PG, di Domenico A, Garattini S, Iacovella N, Ingelido AM, Marra V, Miniero R, Valentini S, De Felip E. Occupational exposure to PCDDs, PCDFs, and PCBs of metallurgical workers in some industrial plants of the Brescia area, northern Italy. Chemosphere. 2012 Aug 14. [Epub ahead of print]
Dipartimento Ambiente e connessa Prevenzione Primaria, Istituto Superiore di Sanità, Roma, Italy.

Abstract
BACKGROUND: The study was carried out in order to respond to public concern on the occupational exposure of metallurgical workers to highly toxic PCDDs, PCDFs, and PCBs in the area of the city of Brescia, northern Italy. OBJECTIVES: The study investigated the effects on the haematic burden of occupational exposures to the aforesaid contaminants in different work environments, attempting to establish causal relationships and providing indications for occupational health preventive measures. METHODS: Chemical concentrations were measured in blood serum of "professionally exposed" (PE) and "not professionally exposed" (NPE) subjects. NPE subjects included industrial administrative employees, Brescia inhabitants, and remote rural people. RESULTS: The central tendency indexes of contaminant cumulative concentrations were higher in PE than in NPE samples (for the mean values: PCDDs+PCDFs, 22.9 vs. 19.5 pgWHO-TEQ(1997)/glb; DL-PCBs, 26.0 vs. 23.6 pgWHO-TEQ(1997)/glb; PCDDs+PCDFs+DL-PCBs (TEQ(TOT)), 48.9 vs. 43.1 pgWHO-TEQ(1997)/glb; Σ(6)[NDL-PCBs], 427 vs. 401ngg(-1)lb); however, no statistical differences were detected at P=0.05. A significant difference for PCDDs+PCDFs and TEQ(TOT) was observed as the NPE data were progressively reduced to those of the remote rural people. The existence of a differential occupational exposure due to different environments was detected by applying the factor analysis to congener-specific data (analytical profiles). CONCLUSIONS: Findings indicate that metallurgical workers may be exposed to PCDD, PCDF, and PCB more than the general population, in particular due to non-negligible contributions to exposure from workplace ambient air. Findings also suggest that an improvement of preventive measures may be required to avoid chemical overexposure in certain metallurgical workplaces. To identify exposure groups, the DL- and NDL-PCB analytical profiles seemed to be more sensitive to environmental exposure sources/pathways than those of PCDDs and PCDFs.

6. Vinceti M, Rothman KJ, Crespi CM, Sterni A, Cherubini A, Guerra L, Maffeis G, Ferretti E, Fabbi S, Teggi S, Consonni D, De Girolamo G, Meggiato A, Palazzi G,Paolucci P, Malagoli C. Leukemia risk in children exposed to benzene and PM(10) from vehicular traffic: a case-control study in an Italian population. Eur J Epidemiol. 2012 Aug 15. [Epub ahead of print]
CREAGEN, Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Public Health Sciences, University of Modena and Reggio Emilia, Via Campi 287, 41125, Modena, Italy, marco.vinceti@unimore.it.

Abstract
Benzene, a recognized occupational leukemogen in adults, has been hypothesized to also increase the risk of childhood leukemia. We carried out a population-based case-control study in a northern Italy community involving 83 cases with acute childhood leukemia diagnosed in the years 1998-2009 and 332 matched controls. We assessed residential exposure to benzene and to particulate matter ≤10 μm (PM(10)) from motorized traffic using geocoded residences and detailed emission and dispersion modeling. Exposure to benzene, and to a lesser extent to PM(10), appeared to be independently associated with an excess leukemia risk. When we stratified the study population by age and by leukemia subtype, the relative risk associated with benzene exposure was higher among children aged less than 5 years, and despite small numbers this relation appeared to be considerably stronger for acute myeloid leukemia than for acute lymphoblastic leukemia. Overall, these findings suggest that exposure to low levels of benzene released from motorized traffic may increase the risk of childhood leukemia, and suggest a possible independent effect of PM(10), although unmeasured confounding due to other pollutants cannot be ruled out.

7. Ciarrocca M, Tomei F, Caciari T, Cetica C, Andrè JC, Fiaschetti M, Schifano MP, Scala B, Scimitto L, Tomei G, Sancini A. Exposure to Arsenic in urban and rural areas and effects on thyroid hormones. Inhal Toxicol. 2012 Aug;24(9):589-98.
University of Rome "Sapienza", Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine , Rome , Italy.

Abstract
Context: Arsenic is a ubiquitous element present in urban air as a pollutant, and it may interfere with thyroid hormones. Objective: To evaluate the association between the personal exposure to arsenic and levels of TSH, fT4, fT3, and Tg in urban and rural workers. Materials and methods: Total urinary arsenic and thyroid markers were obtained from 108 non-smoking traffic policemen and 77 subjects working as roadmen in a rural area. Fifty subjects were monitored to evaluate airborne exposure to arsenic. Results: The mean value of exposure to arsenic was 2.9 µg/m(3) in traffic policemen, while the mean value was less than 0.1 µg/m(3) in roadmen. The mean values of urinary arsenic (10.4 μg/g creatinine vs. 5.2 μg/g creatinine; p = 0.000), TSH (1.6 µlU/ml vs. 1.3 µlU/ml; p = 0.006), fT3 (3.5 pg/ml vs. 3.7 pg/ml; p = 0.000), fT4 (1.2 ng/dl vs. 1.3 ng/dl; p = 0.000) and Tg (42.8 ng/ml vs. 36.1 ng/ml; p = 0.04) were significantly different between traffic policemen and roadmen. In traffic policemen, urinary arsenic and arsenic in the air were correlated to the airborne arsenic and TSH values, respectively. Urinary arsenic was correlated to TSH, Tg, fT3, and fT4 values. The multiple linear regression models showed the following associations: i) among urinary arsenic, arsenic in the air and job title; ii) among TSH, fT3, Tg and urinary arsenic; and iii) between fT4 and both urinary arsenic and alcohol intake. Conclusion: These results provide information about the relationship between exposure to arsenic and thyroid markers and may be useful for other categories of outdoor workers who are similarly exposed.

8. Cresci M, Foffa I, Ait-Ali L, Pulignani S, Kemeny A, Gianicolo EA, Andreassi MG. Maternal Environmental Exposure, Infant GSTP1 Polymorphism, and Risk of Isolated Congenital Heart Disease. Pediatr Cardiol. 2012 Jul 20. [Epub ahead of print]
Unità di Ricerca Genetica, G. Pasquinucci Hospital, CNR Istituto di Fisiologia Clinica, Via Aurelia Sud-Montepepe, 54100, Massa, Italy.

Abstract
The GSTP1 gene, highly expressed early in fetal life, is the most abundant phase 2 xenobiotic metabolism enzyme in a human placenta. Fetal inherited GSTP1 Ile105Val polymorphism may modify the metabolism and excretion of xenobiotics from fetal tissue and increase the risk of congenital heart disease (CHD). This study aimed to analyze the joint effects of GSTP1 genetic polymorphism (Ile105Val) and maternal environmental exposure on CHD risk. Within a case-control design, a total of 190 children with CHD (104 boys age 4 ± 5.6 years) and 190 healthy children (114 newborn boys) were genotyped for the GSTP1 Ile105Val polymorphism. Mothers completed a structured questionnaire on the demographics as well as the preconceptional and lifestyle exposures. A higher frequency of mothers of children with CHD (38 %) reported a positive history of exposure to toxicants (occupational and environmental) than mothers of healthy children (23 %) (p = 0.0013). Logistic regression analysis showed that maternal occupational and environmental exposures increased the risk of CHD (odds ratio, 2.6; 95 % confidence interval, 1.6-4.2; p < 0.0001). No significant differences in Ile105Val genotype frequencies were observed between the children with CHD and the healthy children (p = 0.9). Furthermore, case-control analysis showed no evidence of significant interaction between the maternal exposures and GSTP1 polymorphism. Maternal exposure to toxicants increased the risk of children with CHD. However, fetal GSTP1 Ile105Val polymorphism did not increase the risk of CHD.

9. Merlo DF, Filiberti R, Kobernus M, Bartonova A, Gamulin M, Ferencic Z, Dusinska M, Fucic A. Cancer risk and the complexity of the interactions between environmental and host factors: HENVINET interactive diagrams as simple tools for exploring and understanding the scientific evidence. Environ Health. 2012 Jun 28;11 Suppl 1:S9
IRCCS AOU San Martino-IST-National Cancer Research Institute, Genoa, Italy. franco.merlo@stge.it.

Abstract
BACKGROUND: Development of graphical/visual presentations of cancer etiology caused by environmental stressors is a process that requires combining the complex biological interactions between xenobiotics in living and occupational environment with genes (gene-environment interaction) and genomic and non-genomic based disease specific mechanisms in living organisms. Traditionally, presentation of causal relationships includes the statistical association between exposure to one xenobiotic and the disease corrected for the effect of potential confounders. METHODS: Within the FP6 project HENVINET, we aimed at considering together all known agents and mechanisms involved in development of selected cancer types. Selection of cancer types for causal diagrams was based on the corpus of available data and reported relative risk (RR). In constructing causal diagrams the complexity of the interactions between xenobiotics was considered a priority in the interpretation of cancer risk. Additionally, gene-environment interactions were incorporated such as polymorphisms in genes for repair and for phase I and II enzymes involved in metabolism of xenobiotics and their elimination. Information on possible age or gender susceptibility is also included. Diagrams are user friendly thanks to multistep access to information packages and the possibility of referring to related literature and a glossary of terms. Diagrams cover both chemical and physical agents (ionizing and non-ionizing radiation) and provide basic information on the strength of the association between type of exposure and cancer risk reported by human studies and supported by mechanistic studies. Causal diagrams developed within HENVINET project represent a valuable source of information for professionals working in the field of environmental health and epidemiology, and as educational material for students. INTRODUCTION: Cancer risk results from a complex interaction of environmental exposures with inherited gene polymorphisms, genetic burden collected during development and non genomic capacity of response to environmental insults. In order to adopt effective preventive measures and the associated regulatory actions, a comprehensive investigation of cancer etiology is crucial. Variations and fluctuations of cancer incidence in human populations do not necessarily reflect environmental pollution policies or population distribution of polymorphisms of genes known to be associated with increased cancer risk. Tools which may be used in such a comprehensive research, including molecular biology applied to field studies, require a methodological shift from the reductionism that has been used until recently as a basic axiom in interpretation of data. The complexity of the interactions between cells, genes and the environment, i.e. the resonance of the living matter with the environment, can be synthesized by systems biology. Within the HENVINET project such philosophy was followed in order to develop interactive causal diagrams for the investigation of cancers with possible etiology in environmental exposure. RESULTS: Causal diagrams represent integrated knowledge and seed tool for their future development and development of similar diagrams for other environmentally related diseases such as asthma or sterility. In this paper development and application of causal diagrams for cancer are presented and discussed.

10. Bonfiglioli R, Mattioli S, Armstrong T, Graziosi F, Marinelli F, Farioli A, Violante F. Validation of the ACGIH TLV for hand activity level in the OCTOPUS cohort: a two-year longitudinal study of carpal tunnel syndrome. Scand J Work Environ Health. 2012 Jul 2. pii: 3312. doi: 10.5271/sjweh.3312. [Epub ahead of print]
UO Medicina del Lavoro; S Orsola-Malpighi University Hospital, Via Pelagio Palagi 9, I-40138 Bologna, Italy. s.mattioli@unibo.it.

Abstract
OBJECTIVES: This study aimed to evaluate the risk of musculoskeletal disorders to the hand-wrist system. The American Conference of Governmental Industrial Hygienists (ACGIH) proposed threshold limit values (TLV©) based on hand activity level (HAL) and normalized peak force (PF). We validated ACGIH TLV© in OCTOPUS, a large cohort study on carpal tunnel syndrome (CTS). METHODS: Industrial and service workers were followed from 2000-2003. We classified subjects with respect to action limit (AL) and TLV. Case definitions were: (i) self-reported symptoms; and (ii) combination of symptoms and positive nerve conduction studies. Poisson regression models including age, gender, body mass index, and presence of predisposing pathologies were conducted to estimate incidence rate ratios (IRR) of CTS. RESULTS: There were 4097 eligible workers. Of these, 236 (5.8%) were non-responders, 2194 (53.6%) had a complete follow-up, 728 (17.8%) were lost after intermediate assessment, and 939 (22.9%) were lost after baseline. Among the 3860 subjects with complete information at baseline, 2599 (67.3%) were women [mean age 38.1 [standard deviation (SD) 38.1] years; mean body mass index (BMI) 23.8 (SD 3.9) kg/m2]. ACGIH TLV© classification predicted both CTS symptoms [IRR between AL and TLV 2.43 [95% confidence interval (95% CI) 1.77-3.33]; above TLV 3.32 (95% CI 2.34-4.72)] and CTS confirmed by nerve conduction studies [IRR between AL and TLV 1.95 (95% CI 1.21-3.16); above TLV 2.70 (95% CI 1.48-4.91)]. CONCLUSIONS: We found a dose-response relationship between ACGIH TLV© classification and risk of CTS. The increased risk observed for workers exposed between AL and TLV suggests that the current AL and TLV might not be sufficiently protective.

11. Messano GA, Petti S. General dental practitioners and hearing impairment. J Dent. 2012 Oct;40(10):821-8. Epub 2012 Jun 29.
Department of Public Health and Infectious Diseases, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy.

Abstract
OBJECTIVE: Hearing impairment (HI) remains a problem among dentists Hearing loss at speech frequencies was recently reported among dentists and dental hygienists. This study aimed to investigate prevalence and factors associated with perceived HI among dentists. METHODS: In 2009-2010, 100 general dental practitioners (GDPs) and 115 general (medical) practitioners (GPs) (mean ages, 43.7 and 44.4 years) from Rome (Italy), who commenced practice ≥10 years ago, were interviewed on a series of occupation- and recreation-related HI risk factors and on HI-associated symptoms (tinnitus, sensation of fullness, hypoacusis). Prevalence of presumptive HI (≥1 symptom perceived during workdays and weekends) was assessed and factors associated with presumptive HI were investigated. RESULTS: Prevalence was 30.0% (95% confidence interval, 21.0-39.0%) and 14.8% (95% confidence interval, 8.3-21.3%) among GDPs and GPs, respectively. Occupation (GDP vs. GP), family history of hypoacusis, hypertension, ear diseases and smoking were significantly associated with presumptive HI. Within GDPs alone, significant associations were found for frequent use of ultrasonic scalers, use of dental turbines aged≥1 year and prosthodontics as prevalent specialty. CONCLUSIONS: GDPs experienced HI risk than GPs. Such a risk was not generalized to all dentists, but was specific for those who frequently used noisy equipment (aged turbines, ultrasonic scalers) during their daily practice. CLINICAL SIGNIFICANCE: GDPs with 10 or more years of practice who routinely use potentially noisy equipment, could be at risk of HI. In order to prevent such condition, daily maintenance and periodical replacement of dental instruments is recommended.

12. Pavanello S, Fedeli U, Mastrangelo G, Rota F, Overvad K, Raaschou-Nielsen O, Tjønneland A, Vogel U. Role of CYP1A2 polymorphisms on lung cancer risk in a prospective study. Cancer Genet. 2012 Jun;205(6):278-84.
Occupational Health Section, Department of Cardiological, Thoracic and Vascular Sciences, Università di Padova, Padova, Italy.

Abstract
Cytochrome P4501A2 (CYP1A2) is a key enzyme for lung carcinogen activation and lung inflammation. We studied the interactions of the CYP1A2 functional variants -3860G/A(rs2069514),-2467T/delT(rs3569413),-163C/A(rs762551)] with occupational/environmental carcinogenic exposures in the development of lung cancer in a case-control study nested in the Danish prospective cohort "Diet, Cancer and Health." At enrollment (1993-1997), blood samples for genotype analyses and information on lifestyle were collected 5 (mean value) years before the onset of the disease. The study population included 425 lung cancer cases and 786 subcohort members, who were gender- and age-matched. We found that -163A carriers were at increased risk of lung cancer (P=0.035) in a multivariate COX regression model, which was adjusted for personal habits (i.e., cumulative smoking, passive smoke at home, alcohol intake, and fruit intake) and occupational exposure. Additionally, the interaction between -2467delT and smoking increases lung cancer risk in males, especially light smokers (<21.5 pack-years, P=0.004). The increased lung cancer risk found in -163C carriers, independent of smoking status, and in -2467delT male smokers, suggests that these variants could influence lung cancer development through different mechanisms (i.e. lung carcinogen activation and lung inflammation).

13. Tabibi R, Corsini E, Brambilla G, Bonizzi L, Melzi d'Eril G, Rabozzi G, Sokooti M, Romanò L, Somaruga C, Vellere F, Zanetti A, Colosio C. Immune changes in animal breeders: a pilot study conducted in northern Italy. Ann Agric Environ Med. 2012 Jun 27;19(2):221-5.
Department of Occupational and Environmental Health, University of Milan, International Centre for Rural Health, University Hospital San Paolo, Milan, Italy.

Abstract
Objective: Farming is associated with exposure to a wide variety of risk factors including organic dusts, endotoxins, allergens and other chemicals. The ability of some of these agents to interact with the immune system is demonstrated in the presented study which was undertaken to evaluate the relationship between pig and cow breeding, and the immune system early changes. Particular attention is paid to selected serum cytokines. Methods: Sixty four animal breeders (36 cattle and 28 pig breeders) were selected as the exposed group, and 32 rural workers not engaged in animal breeding were utilised as the controls. Personal data were collected through a questionnaire, and selected serum parameters measured, including cytokines IL-6, IL-8, IL-10, IFNγ and TNFα, immunoglobulins and proteins, and total and differential white blood cell counts. Results: The study stresses the significant increase of TNF-α, IL-8, and IL-10 in animal breeders, with the highest values in pig breeders, and a slight but statistically significant increase in albumin and total serum proteins. Conclusions: The findings of the presented study suggest a condition of immune system activation in animal breeders, with the highest levels observed in pig breeders. These changes may be attributable to exposure to organic dusts, endotoxins, or to the different biological agents present in the rural environment. The prognostic significance of these findings, however, remains unclear, but the observed changes might be indicative of a risk of developing respiratory toxic and allergic diseases, which need to be further investigated.

14. Fantuzzi G, Righi E, Predieri G, Giacobazzi P, Petra B, Aggazzotti G. Airborne trichloramine (NCl(3)) levels and self-reported health symptoms in indoor swimming pool workers: dose-response relationships. J Expo Sci Environ Epidemiol. 2012 Jun 27. doi: 10.1038/jes.2012.56. [Epub ahead of print]
Department of Public Health Sciences, University of Modena and Reggio Emilia, Via G. Campi, 287, 41125 Modena, Italy.

Abstract
The hypothesis that attendance at indoor chlorinated swimming pool is a risk factor for irritative ocular and respiratory symptoms and bronchial asthma is well known in literature, although epidemiological evidence is still inconclusive. The aim of this study was to evaluate the association between airborne trichloramine (NCl(3)) levels and irritative symptoms in swimming pool employees in order to obtain detailed data regarding dose-response relationships and to identify the airborne NCl(3) exposure level, if any, without health effects. A total of 20 indoor swimming pools in the Emilia Romagna region of Italy were included in the study. Information about the health status of 128 employees was collected using a self-administered questionnaire. Exposure to airborne NCl(3) was evaluated in indoor swimming pools by a modified DPD/KI method. The results of the study evidenced a mean value of airborne NCl(3) of 0.65±0.20 mg/m(3) (ranging from 0.20 to 1.02 mg/m(3)). Both ocular and upper respiratory symptoms, in particular red eyes, runny nose, voice loss and cold symptoms, were declared more frequently by lifeguards and trainers when compared with employees working in other areas of the facility (office, cafe, and so on). Pool attendants exposed to airborne NCl(3) levels of >0.5 mg/m(3) experienced higher risks for runny nose (OR: 2.91; 95% CI: 1.22-6.93) red eyes (OR: 3.16; 95% CI: 1.46-6.82), voice loss (OR: 3.56; 95% CI: 1.60-7.95) and itchy eyes (OR: 2.23; 95% CI: 1.04-4.78) than other employees. Moreover, red eyes, itchy eyes, runny nose and voice loss are related to airborne NCl(3) levels, with strong dose-response relationships. In conclusion, this study shows that lifeguards and trainers experience ocular and respiratory irritative symptoms more frequently than employees not exposed. Irritative symptoms become significant starting from airborne NCl(3) levels of >0.5 mg/m(3), confirming that the WHO-recommended value can be considered protective in occupational exposure to airborne NCl(3) in indoor swimming pools.

15. Corbin M, Richiardi L, Vermeulen R, Kromhout H, Merletti F, Peters S, Simonato L, Steenland K, Pearce N, Maule M. Hierarchical regression for multiple comparisons in a case-control study of occupational risks for lung cancer. PLoS One. 2012;7(6):e38944. Epub 2012 Jun 11.
Department of Medical Sciences, Cancer Epidemiology Unit, CeRMS and CPO-Piemonte, University of Turin, Turin, Italy. m.corbin@massey.ac.nz

Abstract
BACKGROUND: Occupational studies often involve multiple comparisons and therefore suffer from false positive findings. Semi-Bayes adjustment methods have sometimes been used to address this issue. Hierarchical regression is a more general approach, including Semi-Bayes adjustment as a special case, that aims at improving the validity of standard maximum-likelihood estimates in the presence of multiple comparisons by incorporating similarities between the exposures of interest in a second-stage model. METHODOLOGY/PRINCIPAL FINDINGS: We re-analysed data from an occupational case-control study of lung cancer, applying hierarchical regression. In the second-stage model, we included the exposure to three known lung carcinogens (asbestos, chromium and silica) for each occupation, under the assumption that occupations entailing similar carcinogenic exposures are associated with similar risks of lung cancer. Hierarchical regression estimates had smaller confidence intervals than maximum-likelihood estimates. The shrinkage toward the null was stronger for extreme, less stable estimates (e.g., "specialised farmers": maximum-likelihood OR: 3.44, 95%CI 0.90-13.17; hierarchical regression OR: 1.53, 95%CI 0.63-3.68). Unlike Semi-Bayes adjustment toward the global mean, hierarchical regression did not shrink all the ORs towards the null (e.g., "Metal smelting, converting and refining furnacemen": maximum-likelihood OR: 1.07, Semi-Bayes OR: 1.06, hierarchical regression OR: 1.26). CONCLUSIONS/SIGNIFICANCE: Hierarchical regression could be a valuable tool in occupational studies in which disease risk is estimated for a large amount of occupations when we have information available on the key carcinogenic exposures involved in each occupation. With the constant progress in exposure assessment methods in occupational settings and the availability of Job Exposure Matrices, it should become easier to apply this approach.

16. Sancini A, Fioravanti M, Andreozzi G, Giorgio VD, Tomei G, Tomei F, Ciarrocca M. Meta-analysis of studies examining long-term construction injury rates. Occup Med (Lond). 2012 Jul;62(5):356-61. Epub 2012 Jun 7.
Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336,00161 Rome, Italy.

Abstract
Background The construction industry is one of the employment sectors with the highest risk of injuries. Aims To evaluate the injury trend in the construction industry from data published from 1987 to 2010. Methods All papers with at least two measurements of injuries within a medium- to long-term period were included. The numbers of fatal and non-fatal injuries were examined in two separate groups: 100 000 workers per year and 200 000 worked hours per year. Results All injuries significantly decreased between the first and the second measurement, with fatal injuries decreasing by 35% and non-fatal ones by 33% in workers/year and by 22% in worked hours/year. There was high heterogeneity among the sources of data for workers/year index (I(2) = 49% for fatal injuries, 99% for non-fatal injuries) but no heterogeneity for worked hours/year index (I(2) = 0). Meta-regression analysis showed a significant linear relationship between time and risk reduction for fatal injuries (r = 0.63; P < 0.001; a 6% reduction per year); trend reduction for non-fatal injuries was not related to the time taken between the measurements. Conclusions Fatal injuries have a reduction trend that depends on large interventions, whereas non-fatal injuries are more prone to episodic changes. Furthermore, while the workers/year index allows easier evaluation of the injury rate variation in a single working environment, the worked hours/year index is better at comparing the injury rate variation in different working environments because it reduces the sources of heterogeneity.

17. Maestrelli P, Schlünssen V, Mason P, Sigsgaard T; ERS Task Force on the Management of Work-related Asthma. Contribution of host factors and workplace exposure to the outcome of occupational asthma. Eur Respir Rev. 2012 Jun 1;21(124):88-96.
Dept of Environmental Medicine and Public Health, University of Padova, Padua, Italy. piero.maestrelli@unipd.it

Abstract
The outcome of occupational asthma after diagnosis is often poor. The identification of factors associated with a worse outcome may help in the management of the disease, determining its prognosis and assessing the permanent impairment attributable to occupational exposure. The aim of this systematic review was to provide the available evidence from the medical literature to answer the question: "What is the contribution of host factors and workplace exposure to the risk of a bad outcome of occupational asthma?" A systematic literature search was conducted in March 2010. We retrieved 177 abstracts. Of these, 67 were assessed as potentially relevant. After full text evaluation, 35 articles that were actually relevant for the question were included in the analysis. The information obtained was sufficient to establish that older age, high-molecular-weight agents, impaired lung function and longer duration of exposure to the offending agent at the time of diagnosis had a negative role on the outcome of occupational asthma. Atopy and smoking at diagnosis did not seem to influence the outcome of occupational asthma. A limited number of studies considered sex and the pattern of asthmatic reaction on specific inhalation challenge and their findings were contradictory.

18. Scarselli A, Binazzi A, Marzio DD, Marinaccio A, Iavicoli S. Hexavalent chromium compounds in the workplace: assessing the extent and magnitude of occupational exposure in Italy. Occup Environ Hyg. 2012 Jun;9(6):398-407.
Epidemiology Unit, Occupational Medicine Department, ex ISPESL Research Area, Italian Workers' Compensation Authority-INAIL, Rome, Italy. alberto.scarselli@ispesl.it

Abstract
Hexavalent chromium (Cr(VI)) compounds have been classified as carcinogenic to humans. This study evaluates the extent and magnitude of occupational exposures to Cr(VI) in Italy. Data were collected from exposure registries of companies compulsorily notified by the National Workers' Compensation Authority. Each measurement was characterized by economic activity sector, work force size, worker personal data, job description, year of measurement, and level of exposure. Descriptive statistical analysis was carried out on the retrieved information. The number of workers potentially exposed was estimated for some industrial sectors. A mixed-effects model was adopted to evaluate the association between exposure variables and exposure concentrations. Over 8400 measurements of Cr(VI) exposures were selected from the database of registries for 1996-2009. Most exposures occurred in the manufacture of fabricated metal products (>50%), and the occupational group most frequently measured was metal finishing-, plating- and coating-machine operators (>52%). Measurements were associated with various Cr(VI) compounds, including chromium trioxide, potassium dichromate, sodium dichromate, strontium chromate, and zinc chromate. Cr(VI) exposure has decreased in more recent years, and the fixed-effects (Cr(VI) compound, activity sector, size and location of the facility, job category, and year of measurement of the final statistical model explained more than 70% of the variance in the observed exposure data. This study summarized data recorded in the Italian occupational exposure database and identified specific exposure patterns to Cr(VI). The mean level of exposure to Cr(VI) was 30.41 μg/m³, and 50,118 workers were estimated at exposure risk in the selected industrial sectors. Systematic recording of occupational exposures is a source of data that allows recognition of high risk situations and improvements in exposure assessment for epidemiologic studies.

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