• Dario Consonni1

  1. Clinica del lavoro, Milano

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Ricerca bibliografica periodo dal 16 agosto 2012 al 31 ottobre 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 ("2012/08/16"[PDAT] : "2012/10/31"[PDAT])
1. Campo L, Vimercati L, Carrus A, Bisceglia L, Pesatori AC, Bertazzi PA, Assennato G, Fustinoni S. Environmental and biological monitoring of PAHs exposure in coke-oven workers at the Taranto plant compared to two groups from the general population of Apulia, Italy. Med Lav. 2012 Sep-Oct;103(5):347-60.
Department of Clinical Sciences and Community Health, University of Milan and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.

BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs) exposure in the coke industry poses a risk for workers' health as well as for subjects living in the plant vicinity. OBJECTIVES: To assess PAHs exposure in coke-oven workers (CW) at the Taranto plant, Apulia, and in subjects from the general population living near (NC) and far away (FC) from the plant. METHODS: Exposure was assessed by personal air sampling and urinary 1-hydroxypyrene (1-OHP) measured in 100 CW 18 NC and 15 FC. RESULTS: Median airborne benzo[a]pyrene (BaP) levels were 152, 1.5, and 3.6 ng/m3 in CW NC, and FC, respectively. In CW, median 1-OHP increased from 1.45 to 1.96 microg/g creatinine (crt) during the work shift (p > 0.05); in NC and FC, 1-OHP levels were 0.56 and 0.53 microg/g crt. No significant differences between NC and FC for both air and urinary indices were found. BaP exposure in CW exceeded the recently proposed German acceptable (70 ng/m3) and tolerable (700 ng/m3) risk-based limit values in 82 and 11% of subjects, respectively. In NC and FC, BaP exposure exceeded the European target value for ambient air (1 ng/m3) in 67 and 60% of subjects, respectively. Biomonitoring showed that 21% of CW had 1-OHP levels higher than the proposed biological limit value for the coke-oven industry (4.4 microg/g crt), while 93% of FC, and 88% of NC, had 1-OHP levels exceeding the Italian reference value (0.3 microg/g crt). Among non-smokers, a linear regression between 1-OHP and BaP (Pearson value r = 0.65, p < 0.05) allowed us to estimate levels of 1.2 and 1.9 microg/g crt for 1-OHP end-of-shift corresponding to acceptable and tolerable limit values. CONCLUSIONS: Although lower than in the past, PAHs exposure in the coke plant still poses a health risk for workers and the general population and requires further efforts to improve workplace conditions.

Breve commento a cura di Dario Consonni
I risultati di questo studio sono di grande attualità e rappresentano un’utile integrazione delle informazioni provenienti da altri studi sui lavoratori dell’ILVA di Taranto e la popolazione residente nelle sue vicinanze.

2. Lovreglio P, D'Errico MN, De Pasquale P, Gilberti ME, Drago I, Panuzzo L, Lepera A, Serra R, Ferrara F, Basso A, Apostoli P, Soleo L. Environmental factors affecting the urinary excretion of inorganic arsenic in the general population. Med Lav. 2012 Sep-Oct;103(5):372-81.
Dipartimento Interdisciplinare di Medicina, Sezione di Medicina del Lavoro "E.C. Vigliani", Università di Bari, Bari, Italy.

OBJECTIVE: To assess the critical issues concerning the use of urinary inorganic arsenic (iAs), including As3, As5, monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA), as biomarker of internal dose in order to monitor environmental and occupational exposure to inorganic As, considering the influence of diet and drinking water on excretion of iAs. METHODS: The design protocol stipulated collection of weekly urine samples from 6 male subjects for 5 consecutive months. In all the urine samples, iAs was determined by Hydride Generation-Atomic Absorption Spectrophotometry (HG-AAS). In the subjects with iAs higher than 35 microg/L, Biological Exposure Index (BEI) proposed by the American Conference of Governmental Industrial Hygienists (ACGIH), urinary arsenic speciation was performed by HPLC-ICP-MS. Exposure to airborne As was evaluated monthly using personal environmental samplers worn for 8 hours. Throughout the study, the participants filled out a daily food diary, also detailing types of water drunk. RESULT: Exposure to airborne As was invariably below the limit of detection, equal to 1 ng/m3. A total of 77 urine samples were collected. iAs was always detectable and was higher in 7 urine samples, obtained from 5 of the 6 subjects examined, than the BEI. Among foods with a high As content, the intake of seafood and fish within 72 hours before providing the sample seems to be the principal source of the iAs concentrations, while the intake of rice or drinking water showed no influence on this biological marker. Instead, drinking wine within 24 hours before urine sample collection can cause a significant increase in the excretion of iAs. CONCLUSIONS: In populations that eat large amounts of fish and seafood, the use of iAs to monitor occupational and environmental exposure to inorganic As seems to present some problems, and urinary As speciation may be essential at least in cases with As measurements above the biological limit values. In any case, a diet sheet reporting all foods eaten within 3 days of urine collection seems to be an indispensable tool to ensure a correct interpretation of the results.

Breve commento a cura di Dario Consonni
I risultati di questo studio non sono nuovi, ma sono rilevanti perchè ribadiscono l’importanza di tenere conto dei fattori alimentari quando si voglia valutare correttamente l’esposizione occupazionale e ambientale (ad esempio tramite acqua potabile) ad arsenico.

3. Campagna M, Satta G, Campo L, Flore V, Ibba A, Meloni M, Tocco MG, Avataneo G, Flore C, Fustinoni S, Cocco P. Biological monitoring of low-level exposure to benzene. Med Lav. 2012 Sep-Oct;103(5):338-46.
Department of Public Health, Clinical and Molecular Medicine, Occupational Health Section, University of Cagliari, Asse Didattico della Facoltà di Medicina, Monserrato, Cagliari, Italy.

INTRODUCTION: Conflicting opinions exist about the reliability of biomarkers of low-level exposure to benzene. We compared the ability of the urinary excretion of trans,trans-muconic acid (t,t-MA), s-phenilmercapturic acid (s-PAMA) and urinary benzene (U-Benz) to detect low level occupational and environmental exposure to benzene. METHODS: We monitored airborne benzene by personal air sampling, and U-Benz, s-PMAI, t,t-MA and cotinine (U-Cotinine) in spot urine samples, collected at 8 am and 8 pm, in 32 oil refinery workers and 65 subjects, randomly selected among the general population of urban and suburban Cagliari, Italy. Information on personal characteristics, diet and events during the sampling day was acquired through in person interviews. RESULTS: The median concentration of airborne benzene was 25.2 microg/m3 in oil refinery workers, and 8.5 microg/m3 in the general population subgroup. U-Benz in morning and evening samples was significantly more elevated among oil refinery workers than the general population subgroup (p = 0.012, and p = 7.4 x 10(-7), respectively) and among current smokers compared to non-smokers (p = 5.2 x 10(-8), and p = 5.2 x 10(-5) respectively). Benzene biomarkers and their readings in the two sampling phases were well correlated to each other. The Spearman's correlation coefficient with airborne benzene was significant for U-Benz in the evening sample, while no correlation was seen with t,t-MA and s-PMA readings in either samplings. The two benzene metabolites were frequently below limit of detection (LOD), particularly among the general population study subjects (17-9% and 39%, for t,t-MA and s-PMA respectively). Morning U-Cotinine excretion showed a good correlation with U-Benz in the morning and in the evening sampling (p < 0.001), and with s-PMA in the evening sample (p < 0.001), but not with t,t-MA in either samplings. t,t-MA in the evening sample was the only biomarker showing a moderate inverse correlation with BMI (p < 0.05). The multiple regression analysis adjusting by BMI and number of cigarettes smoked during the day confirmed the results of the univariate analysis. DISCUSSION: Our results suggest that unmetabolized U-Benz would allow a more reliable biomonitoring of low-level exposure to benzene than s-PMA and t,t-MA.

Breve commento a cura di Dario Consonni
Uno degli (ormai molti) studi che mostra la maggiore utilità del benzene urinario rispetto ad altri indicatori di esposizione (S-PMA, t,t-MA) nel monitoraggio dell’esposizione a benzene ai bassi livelli oggi riscontrabili nella maggioranza degli ambienti di lavoro e di vita.

4. Mirabelli D, Cacciatore AM, Ferrante D, Amendola P, Vermeulen R, Merletti F. Cohort study of workers employed in an Italian tire manufacturing plant, 1962-2004. Cancer Causes Control. 2012 Oct 20. [Epub ahead of print]
Unit of Cancer Epidemiology, University of Turin and CPO-Piemonte, via Santena 7, 10125, Turin, Italy,

PURPOSE: To investigate mortality and bladder cancer incidence among workers of a tire manufacturing plant where antioxidants severely contaminated by beta-naphthylamine were never used. METHODS: Mortality follow-up was performed of 9,501 workers first hired between 1962 when the plant started operations and 2000. Person-years of observation from 1962 to 2004, expected deaths, and standardized mortality ratios (SMR) were calculated. Follow-up for bladder cancer incidence from 1988 to 2003 was carried out, and standardized incidence ratios (SIR) were calculated. Multivariable (Poisson) analyses of bladder cancer incidence and mortality by duration of employment (DOE) and time since first employment (TSFE) were performed. RESULTS: Among men, SMRs were significantly reduced for all causes, all cancers, lung cancer, cardiovascular, and ischemic heart diseases. Bladder cancer mortality and leukemia mortality were close to expectation but increased with TSFE. Seventy-two incident cases of bladder cancer were observed (SIR = 1.15; 95 % confidence interval 0.90-1.44), and multivariable analysis suggested a possible increase in rate ratios with DOE. Among women, mortality was close to expectation, but the limited number of observed deaths prevented detailed analyses. CONCLUSIONS: No significant cancer excess was observed. A suggestion of increased risks of bladder cancer and leukemias after extended TSFE was present in men, deserving consideration as exposure to carcinogens possibly occurred early in plant operation. Furthermore, this cohort of workers is still relatively young and less than 10 % have died. There was, thus, limited power to detect small increases in risk at rare cancer sites. Further epidemiological surveillance of this cohort is planned.

5. Sabatini L, Barbieri A, Lodi V, Violante FS. Biological monitoring of occupational exposure to antineoplastic drugs in hospital settings. Med Lav. 2012 Sep-Oct;103(5):394-401.
Unità Operativa di Medicina del Lavoro, Policlinico Sant'Orsola-Malpighi, Bologna.

BACKGROUND: In view of the evidence of cytotoxicity of chemotherapic antineoplastic drugs (AD), current guidelines recommend the evaluation of the health risks of hospital personnel exposed to these compounds. Biological monitoring is the main tool to evaluate all possible drug intake and measure workers' real risk. OBJECTIVES: The aim of this study was to assess occupational exposure toAD in a large hospital in Northern Italy in order to verify the effectiveness of the structural and procedural improvements carried out over the last decade. METHODS: Three biological monitoring campaigns were performed using LC-MS/MS analysis of cyclophosphamide (CP) and metotrexate (MTX) as biomarkers of internal dose in the urine of hospital workers. In the first two campaigns, 50 and 81 workers respectively were monitored during AD preparation operations. The last campaign, concerning AD administration activity, was performed after a centralized preparation unit had been set up. Two environmental monitoring campaigns were carried out as well, to complete AD exposure assessment. RESULTS: During the first monitoring campaign we found positive urinary samples in all the wards studied (total positivity 36%), whereas in the second campaign 11% of the samples were positive and four departments showed negative results in all urine samples. The last campaign showed all urinary CP and MTX levels below the detection limit of the analytical method CONCLUSION: Exposure of oncology ward nurses considerably decreased due to the centralization of AD preparation operations together with training and education of workers. The last biological monitoring results were reassuring; nevertheless, surface contamination still occurred and safety measures should be further improved in order to achieve the lowest reasonably possible contamination levels.

6. De Palma G, Cortesi I, Ghitti R, Festa D, Bergonzi R, Apostoli P. Biological monitoring as a valid tool to assess occupational exposure to mixtures of 2,4-:2,6-toluene diisocyanate. Med Lav. 2012 Sep-Oct;103(5):361-71.
Department of Experimental and Applied Medicine, Section of Occupational Health and Industrial Hygiene, University of Brescia, Brescia, Italy.

BACKGROUND AND OBJECTIVES: Despite its advantages over environmental monitoring, biological monitoring of exposure to 2,4-:2,6-toluene diisocyanate (TDI) mixtures is still underused. The present study was designed in order to evaluate the feasibility and reliability of biological monitoring in a factory producing polyurethane foam blocks. METHODS: Airborne TDI isomers were sampled by both static and personal pumps and determined by HPLC with fluorimetric detection. Specific metabolites 2,4- and 2,6-toluenediamine (TDA) were determined by gas chromatography-mass spectrometry on hydrolysed urine samples collected from 16 workers at the beginning of the workweek and both before (BS) and at the end (ES) of the 4th workday. Additional samples were collected at the end of the 1st half-shift and at the beginning of the 2nd half-shift in 5 workers. RESULTS: In the foam production shop, TDI values were on average about 20 microg/m3, with higher levels in the 2nd half-shift and peak levels in workers operating along the polymerization tunnel. Average TDI levels were significantly correlated with ES TDA concentrations (p < 0.0001). TDA showed a fast urinary elimination phase leading to progressively higher TDA levels either during the shift (5 workers) and at the end-of-shift. A slower elimination phase with a weekly accumulation was demonstrated by values at the beginning of the workweek (higher than in unexposed subjects) and by their elevation in subsequent BS samples. CONCLUSIONS: The study demonstrates the feasibility and reliability of biological monitoring in workers exposed to 2,4-:2, 6-TDI mixtures. This approach can provide information about both the daily and weekly exposure levels.

7. Cocco P, Satta G, D'Andrea I, Nonne T, Udas G, Zucca M, Mannetje AT, Becker N, de Sanjosé S, Foretova L, Staines A, Maynadié M, Nieters A, Brennan P, Ennas MG, Boffetta P. Lymphoma risk in livestock farmers: Results of the Epilymph study. Int J Cancer. 2012 Oct 15. doi: 10.1002/ijc.27908. [Epub ahead of print]
Department of Public Health, Clinical and Molecular Medicine, Occupational Health Section, University of Cagliari, Italy.

We explored risk of lymphoma and its most prevalent subtypes associated with occupational contact with livestock, and whether risk was modified by age at first contact, in 2,348 incident lymphoma cases and 2,462 controls who participated in the EPILYMPH case-control study. A detailed occupational history was collected in cases and controls, including working in a livestock farm, species of livestock, its approximate number, and circumstances of contact. For each disease outcome, and each type of livestock, Odds ratios (OR) and their 95% confidence intervals (95% CI) were calculated using unconditional logistic regression, adjusting for age, gender, education and centre. Lymphoma risk (all subtypes combined) was not increased amongst those exposed to contact with any livestock (OR = 1.0, 95% CI 0.8 -1.2). Overall, we did not observe an association between occupational contact with livestock and risk of lymphoma (all types) and B-cell lymphoma. The risk of DLBCL, was significantly lower amongst subjects who started occupational contact with any species of livestock before or at age 12 (OR = 0.5, 95% CI 0.2 -0.9), but not al older ages. A significant heterogeneity in risk of B cell lymphoma by age at first contact was detected for contact with cattle, poultry and swine. Early occupational contact with livestock might be associated with a decrease in risk of B cell lymphoma.

8. Peluso M, Bollati V, Munnia A, Srivatanakul P, Jedpiyawongse A, Sangrajrang S, Piro S, Ceppi M, Bertazzi PA, Boffetta P, Baccarelli AA. DNA methylation differences in exposed workers and nearby residents of the Ma Ta Phut industrial estate, Rayong, Thailand. Int J Epidemiol. 2012 Oct 13. [Epub ahead of print]
Cancer Risk Factor Branch, Cancer Prevention and Research Institute, Florence, Italy, Department of Occupational and Environmental Health, University of Milan and Istituto Di Ricovero e Cura a Carattere Scientifico Ca' Granda Maggiore Policlinico Hospital, Milan, Italy, Molecular Epidemiology Unit, Research Division, National Cancer Institute, Bangkok, Thailand, Molecular Epidemiology Unit, National Cancer Institute, Genoa, Italy, The Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, NY, USA, International Prevention Research Institute, Lyon, France and Laboratory of Environmental Epigenetics, Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA.

BACKGROUND: Adverse biological effects from airborne pollutants are a primary environmental concern in highly industrialized areas. Recent studies linked air pollution exposures with altered blood Deoxyribo-nucleic acid (DNA) methylation, but effects from industrial sources and underlying biological mechanisms are still largely unexplored. METHODS: The Ma Ta Phut industrial estate (MIE) in Rayong, Thailand hosts one of the largest steel, oil refinery and petrochemical complexes in south-eastern Asia. We measured a panel of blood DNA methylation markers previously associated with air pollution exposures, including repeated elements [long interspersed nuclear element-1 (LINE-1) and Alu] and genes [p53, hypermethylated-in-cancer-1 (HIC1), p16 and interleukin-6 (IL-6)], in 67 MIE workers, 65 Ma Ta Phut residents and 45 rural controls. To evaluate the role of DNA damage and oxidation, we correlated DNA methylation measures with bulky DNA and 3-(2-deoxy-β-D-erythro-pentafuranosyl)pyrimido[1,2-α]purin-10(3H)-one deoxyguanosine (M(1)dG) adducts. RESULTS: In covariate-adjusted models, MIE workers, compared with rural residents, showed lower LINE-1 (74.8% vs 78.0%; P < 0.001), p53 (8.0% vs 15.7%; P < 0.001) and IL-6 methylation (39.2% vs 45.0%; P = 0.027) and higher HIC1 methylation (22.2% vs 15.3%, P < 0.001). For all four markers, Ma Ta Phut residents exhibited methylation levels intermediate between MIE workers and rural controls (LINE-1, 75.7%, P < 0.001; p53, 9.0%, P < 0.001; IL-6, 39.8%, P = 0.041; HIC1, 17.8%, P = 0.05; all P-values vs rural controls). Bulky DNA adducts showed negative correlation with p53 methylation (P = 0.01). M(1)dG showed negative correlations with LINE-1 (P = 0.003) and IL-6 methylation (P = 0.05). CONCLUSIONS: Our findings indicate that industrial exposures may induce alterations of DNA methylation patterns detectable in blood leucocyte DNA. Correlation of DNA adducts with DNA hypomethylation suggests potential mediation by DNA damage.

9. Carugno M, Pesatori AC, Ferrario MM, Ferrari AL, Silva FJ, Martins AC, Felli VE, Coggon D, Bonzini M. Physical and psychosocial risk factors for musculoskeletal disorders in Brazilian and Italian nurses. Cad Saude Publica. 2012 Sep;28(9):1632-42.
Department of Occupational and Environmental Health, University of Milan, Milan, Italy.

As part of the international CUPID investigation, we compared physical and psychosocial risk factors for musculoskeletal disorders among nurses in Brazil and Italy. Using questionnaires, we collected information on musculoskeletal disorders and potential risk factors from 751 nurses employed in public hospitals. By fitting countryspecific multiple logistic regression models, we investigated the association of stressful physical activities and psychosocial characteristics with site-specific and multisite pain, and associated sickness absence. We found no clear relationship between low back pain and occupational lifting, but neck and shoulder pain were more common among nurses who reported prolonged work with the arms in an elevated position. After adjustment for potential confounding variables, pain in the low back, neck and shoulder, multisite pain, and sickness absence were all associated with somatizing tendency in both countries. Our findings support a role of somatizing tendency in predisposition to musculoskeletal disorders, acting as an important mediator of the individual response to triggering exposures, such as workload.

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