Road Traffic Pollution and Childhood Leukemia: A Nationwide Case-control Study in Italy

BACKGROUND

The association of childhood leukemia with traffic pollution was considered in a number of studies from 1989 onwards, with results not entirely consistent and little information regarding subtypes.

AIM OF THE STUDY

We used the data of the Italian SETIL case-control on childhood leukemia to explore the risk by leukemia subtypes associated to exposure to vehicular traffic.

METHODS

We included in the analyses 648 cases of childhood leukemia (565 Acute lymphoblastic-ALL and 80 Acute non lymphoblastic-AnLL) and 980 controls. Information on traffic exposure was collected from questionnaire interviews and from the geocoding of house addresses, for all periods of life of the children.

RESULTS

We observed an increase in risk for AnLL, and at a lower extent for ALL, with indicators of exposure to traffic pollutants. In particular, the risk was associated to the report of closeness of the house to traffic lights and to the passage of trucks (OR: 1.76; 95% CI 1.03-3.01 for ALL and 6.35; 95% CI 2.59-15.6 for AnLL). The association was shown also in the analyses limited to AML and in the stratified analyses and in respect to the house in different period of life.

CONCLUSIONS

Results from the SETIL study provide some support to the association of traffic related exposure and risk for AnLL, but at a lesser extent for ALL. Our conclusion highlights the need for leukemia type specific analyses in future studies. Results support the need of controlling exposure from traffic pollution, even if knowledge is not complete.

Knee osteoarthritis in a chestnut farmer - Case Report

INTRODUCTION

Several studies have dealt with the issue of professional risk factors and onset of knee osteoarthritis (OA). In particular, occupational epidemiological studies have provided evidence that activities resulting in biomechanical overload may be linked with an increased risk of knee OA - also among farmers. To our knowledge, no cases of knee OA among chestnut farmers have been reported in the literature.

CASE REPORT

We report the case of a 70-year-old Caucasian male who has worked for more than 50 years on a chestnut farm. In 2007, an X-ray and a MRI, performed after a workplace accident to his left knee, showed the presence of knee OA. His job required a range of repetitive tasks, such as squatting, kneeling, climbing, walking on sloping terrain, assuming uncomfortable postures, and lifting and carrying heavy loads for the great majority of the working day. All the aforementioned tasks are known occupational risk factors for knee OA. Regarding individual risk factors, at the time of the first diagnosis of knee OA, the worker was 64-years-old with a body mass index of 26.5 kg/m2. He reported no cases of arthritis among his relatives and no sports playing on his part. In addition, his medical history revealed the presence of two minor lumbar disc herniations and tendinitis of the long head of the biceps.

CONCLUSION

Considering the lack of major individual risk factors for knee OA, it is reasonable to suppose that five decades of exposure to biomechanical overload as a chestnut farmer was a relevant risk factor for the onset of the disease.

Fattening rabbits in mobile arks: effect of housing system on in vivo oxidative status and meat quality

<p>The aim of this trial was to study the effect of an alternative housing system on the oxidative status and meat quality of fattening rabbits. From May to June 2014, 60 rabbits of 35 d of age were reared in Mobile Arks (MA) placed on alfalfa grass and frequently moved for 40 d. To assess the health status of animals, blood samples were collected at slaughter in MA and in conventional cages (C). Meat quality parameters were also evaluated. Concerning the <em>in vivo </em>oxidative status, ark-reared rabbits showed higher thiobarbituric reactive substances values than C ones, probably for the higher motor activity due to the larger living area. The lipid percentage of <em>Longissimus lumborum </em>muscle was lower (1.22 <em>vs. </em>1.48%) in the ark group. There were no significant differences in the muscle pH, colour, water holding capacity and cooking loss. Given the higher intake of grass, rich in vitamins, carotenes, polyphenols and polyunsaturated fatty acids, the antioxidant content of meat was higher in ark-reared rabbits (7.42 <em>vs. </em>6.82 µg/g of retinol, 719.2 <em>vs. </em>683.3 ng/g of α-tocopherol, respectively). Even the fatty acid profile of MA rabbits reflected the higher intake of essential fatty acids from grass and the n-3 long chain polyunsaturated fatty acids (arachidonic acid, eicosapentaenoic acid and docosahexaenoic acid) were almost doubled. Our study suggested that the fattening of rabbits in ark system could be a possible alternative system to improve the meat quality of rabbits.</p><p><strong><br /></strong></p>

PubMed search filters for the study of putative outdoor air pollution determinants of disease

OBJECTIVES

Several PubMed search filters have been developed in contexts other than environmental. We aimed at identifying efficient PubMed search filters for the study of environmental determinants of diseases related to outdoor air pollution.

METHODS

We compiled a list of Medical Subject Headings (MeSH) and non-MeSH terms seeming pertinent to outdoor air pollutants exposure as determinants of diseases in the general population. We estimated proportions of potentially pertinent articles to formulate two filters (one 'more specific', one 'more sensitive'). Their overall performance was evaluated as compared with our gold standard derived from systematic reviews on diseases potentially related to outdoor air pollution. We tested these filters in the study of three diseases potentially associated with outdoor air pollution and calculated the number of needed to read (NNR) abstracts to identify one potentially pertinent article in the context of these diseases. Last searches were run in January 2016.

RESULTS

The 'more specific' filter was based on the combination of terms that yielded a threshold of potentially pertinent articles ≥40%. The 'more sensitive' filter was based on the combination of all search terms under study. When compared with the gold standard, the 'more specific' filter reported the highest specificity (67.4%; with a sensitivity of 82.5%), while the 'more sensitive' one reported the highest sensitivity (98.5%; with a specificity of 47.9%). The NNR to find one potentially pertinent article was 1.9 for the 'more specific' filter and 3.3 for the 'more sensitive' one.

CONCLUSIONS

The proposed search filters could help healthcare professionals investigate environmental determinants of medical conditions that could be potentially related to outdoor air pollution.

Severity of Carpal Tunnel Syndrome and Diagnostic Accuracy of Hand and Body Anthropometric Measures

Objective

To study the diagnostic properties of hand/wrist and body measures according to validated clinical and electrophysiological carpal tunnel syndrome (CTS) severity scales.

Methods

We performed a prospective case-control study. For each case, two controls were enrolled. Two five-stage clinical and electrophysiological scales were used to evaluate CTS severity. Anthropometric measurements were collected and obesity indicators and hand/wrist ratios were calculated. Area under the receiver operating characteristic curves (AUC), sensitivity, specificity, and likelihood ratios were calculated separately by gender.

Results

We consecutively enrolled 370 cases and 747 controls. The wrist-palm ratio, waist-hip-height ratio and waist-stature ratio showed the highest proportion of cases with abnormal values in the severe stages of CTS for clinical and electrophysiological severity scales in both genders. Accuracy tended to increase with CTS severity for females and males. In severe stage, most of the indexes presented moderate accuracy in both genders. Among subjects with severe CTS, the wrist-palm ratio presented the highest AUC for hand measures in the clinical and electrophysiological severity scales both in females (AUC 0.83 and 0.76, respectively) and males (AUC 0.91 and 0.82, respectively). Among subjects with severe CTS, the waist-stature ratio showed the highest AUC for body measures in the clinical and electrophysiological severity scales both in females (AUC 0.78 and 0.77, respectively) and males (AUC 0.84 and 0.76, respectively). The results of waist-hip-height ratio AUC were similar.

Conclusions

Wrist-palm ratio, waist-hip-height ratio and waist-stature ratio could contribute to support the diagnostic hypothesis of severe CTS that however has to be confirmed by nerve conduction study.

Parental Tobacco Smoking and Acute Myeloid Leukemia: The Childhood Leukemia International Consortium

The association between tobacco smoke and acute myeloid leukemia (AML) is well established in adults but not in children. Individual-level data on parental cigarette smoking were obtained from 12 case-control studies from the Childhood Leukemia International Consortium (CLIC, 1974-2012), including 1,330 AML cases diagnosed at age <15 years and 13,169 controls. We conducted pooled analyses of CLIC studies, as well as meta-analyses of CLIC and non-CLIC studies. Overall, maternal smoking before, during, or after pregnancy was not associated with childhood AML; there was a suggestion, however, that smoking during pregnancy was associated with an increased risk in Hispanics (odds ratio = 2.08, 95% confidence interval (CI): 1.20, 3.61) but not in other ethnic groups. By contrast, the odds ratios for paternal lifetime smoking were 1.34 (95% CI: 1.11, 1.62) and 1.18 (95% CI: 0.92, 1.51) in pooled and meta-analyses, respectively. Overall, increased risks from 1.2- to 1.3-fold were observed for pre- and postnatal smoking (P < 0.05), with higher risks reported for heavy smokers. Associations with paternal smoking varied by histological type. Our analyses suggest an association between paternal smoking and childhood AML. The association with maternal smoking appears limited to Hispanic children, raising questions about ethnic differences in tobacco-related exposures and biological mechanisms, as well as study-specific biases.

Carcass traits and meat quality of growing rabbits in pens with and without different multilevel platforms

The aim of this trial was to determine the effect of the presence of wire or plastic mesh elevated platforms on carcass traits and meat quality characteristics, with particular attention to the oxidative status of growing rabbits. A total of 174 five-week old rabbits were randomly divided into 3 groups with 2 replications (6 pens; 29 rabbits/pen): pens without platforms (NoP) with a stocking density of 16 rabbits/m2 and pens with wire-mesh platforms (WP) or plastic-mesh platforms (PP) that were placed on 2 levels, with a stocking density of 16 rabbits/m2 on the floor or 9.14 rabbits/m2 when the platform were included. At 84 d rabbits were slaughtered. The slaughter traits and Longissimus lumborum (LL) physical and chemical compositition were not affected by treatments. Rabbits from the PP group showed the highest retinol and γ-tocotrienol content on LL muscle, whereas the NoP ones showed a higher α-tocotrienol and α-tocopherol level. The absence of platforms led to decreased (P&lt;0.001) thiobarbituric acid-reactive substances values and induced an improvement in n-3 polyunsaturated fatty acids. Levels of linoleic, linolenic and docosahexaenoic acids were equal to those of the WP group (23.45, 3.75, 0.64% in NoP and 22.6, 4.14, 0.53% in WP, respectively) but higher than in PP rabbits (20.86, 3.05, 0.45%, respectively). It can be concluded that the pens with elevated platforms provide greater possibilities for movement, which is beneficial from the viewpoint of animal welfare. However, this greater activity influences the oxidative status of the meat, decreasing the antioxidant content and worsening the lipid oxidation of rabbit meat.

Carpal tunnel syndrome and manual work: the OCTOPUS cohort, results of a ten-year longitudinal study

OBJECTIVE

The American Conference of Governmental Industrial Hygienists (ACGIH) proposed a method to assess the hand, wrist and forearm biomechanical overload based on exertions frequency (hand-activity level) and force use (normalized peak force). We applied the ACGIH threshold limit value (TLV)® method to a large occupational cohort to assess its ability to predict carpal tunnel syndrome (CTS) onset.

METHODS

A cohort of industrial and service workers was followed-up between 2000 and 2011. We investigated the incidence of CTS symptoms and CTS confirmed by nerve conduction studies (NCS). We then classified exposure with respect to action limit (AL) and TLV. Cox regression models including age, gender, body mass index, and presence of predisposing pathologies were conducted to estimate hazard ratios (HR) of CTS and population attributable fractions.

RESULTS

We analyzed data from 3131 workers [females, N=2032 (65%); mean age at baseline 39.3, standard deviation (SD) 9.4 years]. We observed 431 incident cases of CTS symptoms in 8000 person-years and 126 cases of CTS confirmed by NCS in 8883 person-years. The ACGIH TLV® method predicted both CTS symptoms [HR between AL and TLV 2.18, 95% confidence interval (95% CI) 1.86-2.56; above TLV 2.07, 95% CI 1.52-2.81] and CTS confirmed by NCS (HR between AL and TLV 1.93, 95% CI 1.38-2.71; above TLV 1.95, 95% CI 1.27-3.00). About one third of CTS cases were attributable to exposure levels above the AL.

CONCLUSIONS

The ACGIH TLV® method predicted the risk of CTS, but the dose-response was flat above the AL; a fine-tuning of the proposed thresholds should be considered.

Radiation-induced mesothelioma among long-term solid cancer survivors: a longitudinal analysis of SEER database

We investigated the association between external beam radiotherapy (EBRT) and pleural and peritoneal mesothelioma among long‐term (>5 years) solid cancer survivors. We analyzed data from the US Surveillance, Epidemiology, and End Results (SEER) program (1973–2012). We fitted survival models adjusted by age, gender, race, year, surgery, and relative risk of primary mesothelioma in the county of residence (proxy for individual asbestos exposure). We estimated hazard ratios [HR] with reference to nonirradiated patients. We distinguished between scattered and direct irradiation to study the dose–response. We observed 301 mesotheliomas (265 pleural; 32 peritoneal; 4 others) among 935,637 patients. EBRT increased the risk of mesothelioma (any site; HR 1.34, 95% CI 1.04–1.77). We observed an increased risk of pleural mesothelioma (HR for EBRT 1.34, 95% CI 1.01–1.77), but we did not find signs of a dose–response relationship (HR for scattered irradiation 1.38; HR for direct irradiation 1.23). On the opposite, only direct peritoneal irradiation was associated with peritoneal mesothelioma (HR 2.20, 95% CI 0.99–4.88), particularly for latencies ≥10 years (HR 3.28, 95% CI 1.14–9.43). A competing risks analysis revealed that the clinical impact of radiation‐induced mesothelioma was limited by the high frequency of competing events. The cumulative incidence function of mesothelioma after 40 years of observation was very low (nonirradiated patients 0.00032, irradiated patients 0.00055).EBRT might be a determinant of mesothelioma. Longer latency periods are associated with higher risks, while the dose–response seems nonlinear. The clinical impact of mesothelioma after EBRT for primary solid cancers is limited.

Transfer of bioactive compounds from pasture to meat in organic free-range chickens

The aim of this study was to analyze the transfer of bioactive compounds from the pasture to the body and meat of organic free-range chickens and to verify the effect of these compounds on the oxidative processes of the meat. Starting at 21 d of age, 100 male naked-neck birds were divided into two homogeneous groups: an indoor group (0.12 m(2)/bird) and an outdoor group (0.12 m(2)/bird indoor and 10 m(2)/bird of forage paddock). At slaughter (81 d of age), blood samples were collected, and the carcasses were stored for 24 h at 4°C (20 birds/group). The grass samples had higher values of carotenoids, tocopherols, and flavonoids respect to standard feed (based on dry matter comparison). The polyunsaturated fatty acid ( PUFA: ) content was also greater in grass, especially the n-3 series (so named because its first double bond occurs after the third carbon atom counting from the methyl at the end of the molecule). The antioxidant profile of the grass improved the antioxidant status of the crop and gizzard contents in the outdoor chickens. The higher antioxidant intake resulted in a higher plasma concentration of antioxidants in outdoor birds; thiobarbituric acid reactive substances ( TBARS: ) and the antioxidant capacity of the plasma were also better in the outdoor than the indoor group. The meat of the outdoor birds had higher levels of antioxidants, mainly due to the higher amount of tocopherols and tocotrienols. Despite the higher antioxidant protection in the drumstick of the outdoor group, the TBARs value was greater, probably due to the kinetic activity of birds, the higher percentage of PUFAs, and the peroxidability index. In conclusion, grazing improved the nutritional value of the meat (PUFA n-3 and the ratio between n-6 and n-3 PUFA) with a minor negative effect on the oxidative stability. Suitable strategies to reduce such negative effects (e.g., reduction of kinetic activity in the last days of rearing) should be studied.

[Time trend in mesothelioma and lung cancer risk in asbestos workers in Italy]

This study aims at investigating, in asbestos exposed workers, the time trend of their risk of mesothelioma and of other neoplasm after very long latency and after the cessation of asbestos exposure. We pooled a large number of Italian cohorts of asbestos workers and updated mortality follow-up. The pool of data for statistical analyses includes 51,988 workers, of which 6,058 women: 54.2% was alive at follow-up, 42.6% was dead, and 2.8%was lost. Cause of death is known for 94.3%: 2,548 deaths from lung cancer, 748 frompleural cancer, 173 fromperitoneal cancer, and 434 from asbestosis. An exposure index is being developed to compare the different cohorts. Data analysis is in progress. This study will have the size for analysing not only time trends in mesothelioma, but also the occurrence of rarer diseases and cancer specific mortality in women.

Occupational mononeuropathies in industry

Peripheral nerve injuries have the potential to cause significant disability and can be commonly associated with recreational and occupational activities. Acute nerve injuries are mainly related to violent trauma, while repeated mechanical trauma due to external forces or repetitive motions can produce chronic nerve compression injury. This chapter will present a narrative review of the existing evidence of the association between peripheral compressive nerve disorders and work-related risk factors. Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy in the general population and in working populations employed in manual repetitive and forceful activities. The work-relatedness of CTS is essentially based on epidemiologic evidence and the results of experimental studies showing the capability of repetitive wrist extreme postures, associated with hand-wrist forceful exertions, to increase the pressure inside the carpal tunnel and to compress the median nerve. Assembly industry, food processing and packaging, hand-arm vibrating tools, and jobs involving high-repetition, high-force tasks put workers at risk for CTS. Less strong evidence exists of the association between ulnar elbow neuropathy and manual tasks or repetitive stretch on squatting and peroneal nerve neuropathy at the fibular head. Very few reports are available about the association between occupation and other compressive peripheral nerve injuries.

Heavy lifting at work and risk of retinal detachment: a population-based register study in Denmark

Objectives

To investigate the relationship between rhegmatogenous retinal detachment (RRD) and frequent heavy lifting in a Danish working population through national register data.

Methods

A dynamic cohort of all men aged 20–59 years in Denmark was followed through the Danish Occupational Hospitalisation Register from 1995 to 2010 for diagnosed RRD. Occupational categories were classified according to their potential for heavy lifting in 4 main groups: heavy lifters, manual workers unlikely to be heavy lifters, other manual workers and non-manual workers unlikely to be heavy lifters. The age-standardised rate of diagnosed RRD for heavy lifting occupations was compared with that experienced by the other 3 occupational categories. Rate ratios (RRs) and 95% CIs were estimated through a Poisson regression model adjusted for calendar period and age group.

Results

The highest age-standardised rate of diagnosed RRD was recorded among non-manual workers performing occupational activities unlikely to be associated with heavy lifting (18.0 cases per 100 000 person-years). The RR for workers in jobs expected to entail a high frequency of heavy lifting compared with manual workers whose occupation was unlikely to be associated with heavy lifting was 0.91 (95% CI 0.73 to 1.14), while in comparison with other manual workers, it was 0.93 (95% CI 0.78 to 1.11). The RR compared with non-manual workers in occupations unlikely to entail heavy lifting was 0.51 (95% CI 0.43 to 0.60).

Conclusions

These findings do not support an association of occupational heavy lifting with diagnosed RRD. The epidemiological evidence for this association is still inconclusive. Future studies should use a more specific measure of exposure to resolve the outstanding uncertainties.

Anthropometric measurements as a screening test for carpal tunnel syndrome: receiver operating characteristic curves and accuracy

OBJECTIVE

To identify optimal cutoff values for body, hand, and wrist measurements in order to correctly identify individuals with carpal tunnel syndrome (CTS), using receiver operating characteristic (ROC) curves.

METHODS

We enrolled patients with CTS and control subjects at a 1:2 ratio, regardless of age and sex. The diagnosis of CTS was based on clinical findings and delayed distal conduction velocity of the median nerve. The anthropometric measurements included weight, height, waist circumference, hip circumferences, wrist depth/width, third digit length, and palm length/width. Obesity indicators and hand/wrist ratios were calculated. Area under the ROC curve (AUC), sensitivity, specificity, and likelihood ratios were calculated separately according to sex. To assess the role of multiple anthropometric measurements, we fit multivariable logistic regression models including age, wrist ratio, shape index, body mass index, and waist-to-hip ratio.

RESULTS

The study group comprised 1,117 subjects (250 female patients and 474 female controls; 120 male patients and 273 male controls). In women, the accuracy of all anthropometric measures was low (AUC ≤0.64). In men, the accuracy of the hand ratio, shape index, and wrist-to-palm ratio was moderate (AUC = 0.75). The estimates from the multivariable models confirmed the well-known associations between the selected variables and the risk of CTS, but the use of multiple predictors did not dramatically improve the diagnostic performance observed for single anthropometric indexes.

CONCLUSION

In clinical practice, the cutoff values for many anthropometric measurements have limited value as tools for the diagnosis of CTS.