A qualitative study on the oral health of humanitarian migrants in Canada

OBJECTIVES

There is limited evidence to guide oral health policy and services for the 25,000 refugees and asylum seekers who arrive in Canada yearly. The purpose of this study was to explore and understand the pre-migration use of dental services, oral health knowledge, and the effects of oral disease among newly arrived humanitarian migrants in order to inform policy and practice for the population.

METHODS

Using focused ethnography and the public health model of the dental care process, we conducted face-to-face interviews (50-60 minutes) with a purposive sample of humanitarian migrants who had indicated the need for dental care. We observed mobile dental clinics that provided care to underserved communities in Montreal. Data were analyzed using a thematic and contextual approach that combined inductive and deductive frameworks.

RESULTS

Participants included 25 humanitarian migrants from four global geographical regions. Five major thematic categories were explored: problem-based dental consultation, self-assessed oral health status, causes of oral diseases, personal oral hygiene, and good oral health for wellbeing. In their countries of origin, participants consulted a dentist when oral symptoms persisted. They cited excessive sugar consumption and inadequate oral hygiene as causes of oral diseases, and reported significant oral diseases impacts that limited their daily functions and wellbeing once in Canada.

CONCLUSIONS

Humanitarian migrants were knowledgeable about causes of oral disease and the importance of good oral health, yet poor oral health continued to affect their lives in Canada in important ways.

["On professions considered as a cause of disease" (1849) by Enrico de Betta. The first Italian modern discussion on diseases and work]

The doctoral dissertation in Pavia in 1849 by Enrico de Betta is presented as a well-constructed, comprehensive and modern discussion of diseases ascribable to work. 150 years after Ramazzini's treatise, Enrico de Betta, through an updated knowledge of contemporary literature especially French and German, refreshed and renewed the knowledge inherited from Ramazzini in the light of the changes introduced with the beginnings of industrial hygiene and the first steps taken in occupational epidemiology. In the introduction to the text and accompanying notes, the authors offer an interpretation of the significance of overcoming the main Ramazzinian paradigms. This takes into account the current debate, especially in the French cultural sphere, on the meaning of autonomy and complementarity of the various disciplines that are the foundations of the protection and promotion of the health conditions of the working classes. It is suggested therefore that a simplistic view of Ramazzini as the unique 'father" of modern occupational health and safety at work needs to be abandoned. The work of de Betta does not seem to have had much success in Italy. The debate and interventions on the relationship between diseases and work still had to wait half a century to produce effects, but this took place in a very different context, that of Giolitti's era.

Cradles of industry and occupational medicine in the modern world: Milan 1906 -- Annus Mirabilis

BACKGROUND

The example examined is Milan, Italy's main industrial city, where the great International Exhibition was held in 1906. This was the culmination of a period of accelerated industrial growth that modern-day historiography considers to be when Italy's first real industrial revolution began. The twenty-five years between the National Industrial Exhibition of 1881, which was also held in Milan, and the 1906 Exhibition truly reflected a period which was crucial for this transformation to take of. Alongside industry, which was then going through a phase of reorganization and development, Milanese civil society was increasingly turning its interest and attention to what was called the "social question". In an atmosphere of debate and exchange of ideas and experience with Turin, another major industrial city of the north and the birthplace of the Italian engineering and automobile industries, social organizations, political parties and trade unions began to be established thus heralding the Italian approach towards twentieth-century welfare.

RESULTS

This is the context in which the first International Congress on Occupational Diseases was held in Milan from 9 to 14 June 1906 within the framework of the International Exhibition. The success achieved with this initiative. organized by Luigi Devoto and Malachia De Cristoforis, which was to continue with the founding of the International Permanent Commission on Occupational Health, showed that the time was ripe for a new subject to appear on the scene--the occupational health physician--who from then on was to play an important role in the promotion of workers' health.

CONCLUSIONS

The article outlines the main features of the Italian industrial transformation at the turn of the new century with special attention focused on Milan, the capital of industry in Italy. It also describes the impact on public opinion caused by the events surrounding the epic construction of the transalpine railway tunnels which began in 1856 with the Mont Cenis tunnel, then the tragic enterprise of the St. Gotthard tunnel in 1883, ending in 1906 with the inauguration of the Simplon tunnel. The Milan congress is examined as well as the developments which, from then on, began increasingly to give physicians specialised in occupational diseases a higher profile in events of an international nature in the defence of workers' health but also in the interests of economic development.

The contribution of Enrico C. Vigliani (1907-1992) to the international development of occupational medicine and industrial hygiene

BACKGROUND

One of the last century's greatest personalities in Occupational Medicine was Enrico Carlo Vigliani (1907-1992), director of the "Clinica del Lavoro" in Milan (1942-1977), editor-in-chief of "La Medicina del Lavoro" (1942-1991), Secretary-Treasurer and then President of the "Permanent Commission and International Association on Occupational Health" (1957-1981), the original nucleus of the ICOH.

OBJECTIVES

The 20th anniversary of his death provides us with the opportunity to discuss the role of this brilliant scholar in the international development of Occupational Medicine and Industrial Hygiene.

METHODS

A comprehensive analysis of Vigliani's scientific works was conducted. In addition, his close collaborators and pupils were interviewed.

RESULTS

In the 1930s, as a young doctor, Vigliani, first in the world, demonstrated the effect of lead on porphyrin metabolism. Afterwards he conducted pioneering studies on occupational oncology (benzene-induced leukaemia, bladder cancer due to aromatic amines, asbestos-related tumours), pathogenesis of silicosis, encephalopathy in carbon disulfide poisoning, byssinosis and metal fume fever, so influencing international research and the implementation of preventive measures against these conditions. Vigliani's scientific authority was widely recognized internationally, as confirmed by his role in ICOH. During his period of active service, the Commission developed from an academic institution to a more open association, substantially increasing its membership. Furthermore, he contributed to establishing subcommittees devoted to specific topics (now called "scientific committees"), one of the strengths of the present Commission.

CONCLUSIONS

Vigliani's contribution to the development of Occupational Health may be considered as an expression of his genial eclecticism which ranged from clinical medicine to the environment.

[Asbestos in pre-industrial times: from natural wonder to subject of scientific investigation]

The author proposes a reading of "Concerning incombustible flax or asbestos stone" which was published in 1696 by Giovanni Giustino Ciampini, who was a historian, a man of the church and scientist in Rome. The text, which was originally written in Latin, is an excellent and early description of the need felt by the majority of scientists in Europe at that time for a change in method: that is, to use scientific experiments to explain and control the natural phenomena observed and even perhaps mythologized right from antiquity. In the case of asbestos this was necessary to check the veracity and consistency of a series of recommendations handed down by the earliest authors but also to revive and reinvent the techniques that had largely been lost so as to be able to utilize and develop a substance that it was thought could be of great benefit to society. In the presentation of Ciampini's text an attempt is made to recall and contextualize the earliest knowledge on asbestos and follow its evolution over a long historical period, up to the first half of the nineteenth century. It can thus be seen how asbestos, once considered "a wonder of nature", became a raw material widely used in industrial applications. The most significant steps in this phase of transformation were taken thanks to Italian entrepreneurs and technicians and to the presence of asbestos in the Alpine valleys of Italy.

Prevention of silica health effects in Italy: current challenges for the Occupational Health and Safety Unit of the Italian National Health Service

BACKGROUND

Since its foundation in 2002, the Italian Silica Network (NIS), a collaborative network of professionals and public authorities, has been engaged in several aspects of research, control, and prevention of silica exposure and effects, and also in support for compensation claims for silica-related occupational health effects in Italy.

METHODS

We start with a report on the NIS point of view concerning the recent scientific results (from epidemiology and laboratory studies), including those carried out by NIS in cooperation with Italian universities and other public agencies. This is followed by a description of the data on silica exposure in different Italian workplaces and guidelines for the management of occupational exposure to silica, as developed by two model regional programmes for the ceramics industry, metal foundries and tunnel excavation.

RESULTS

The NIS initiatives highlighted the persistence of workplace conditions posing a significant risk for silica-related health effects, particularly in small industries and workshops. Experimental work has also shown that a number of physical and chemical factors affect the bioreactivity of silica particles.

CONCLUSION

Based on NIS experience, it appears clear that currently conditions exist in Italy so as to positively contribute to the WHO Programme for the eradication of silicosis and the other diseases related to silica exposure. In order to achieve this goal, a coordinated and wide-ranging effort is required to reduce the wide gap in specific prevention activities, particularly in small industries and workshops, where high levels of silica exposure sometimes occur.

Mesothelioma and asbestos, fifty years of evidence: Chris Wagner and the contribution of the Italian occupational medicine community

BACKGROUND

One of the first studies that "convincingly" described the relationship between pleural mesothelioma and asbestos was made by Wagner, Sleggs and Marchard in 1960. This article, published fifty years ago, contains much of what we still know to-day about malignant mesothelioma.

OBJECTIVES

The aims of this article were to analyze the historical and scientific developments that led to the publication of Wagner's paper, to critically examine its contents and to consider the contribution to the initernational debate on the carcinogenesis of asbestos fibres made by occupational medicine in Italy in that period.

METHODS

A thorough analysis ofscientific and historical literature on the relationship between asbestos exposure and tumours was conducted, with special regard to the articles by Italian authors in the 1960's.

RESULTS

The decisive role of Wagner's paper in understanding the aetiopathogenetic mechanisms of asbestos-related tumours is inconfutable. In particular, his article clearly demonstrated the existence of a typical cancer of the mesothelium, expressing three fundamental principles of the epidemiology of occupational cancer: association with the carcinogen, latency and individual susceptibility. Enrico Vigliani, then director of the "Clinica del Lavoro" in Milan, made important contributions to this debate, also through the collection of data regarding mortality among Italian asbestos workers.

CONCLUSIONS

Wagner's 1960 paper can be considered as a milestone not only in the history of occupational and environmental health, but also in the evolution of other medical disciplines such as epidemiology, pathology and oncology. A re-appraisal of the Italian contributions to the international debate on this subject should be considered.

[The Italian Society of Occupational Medicine and Industrial Hygiene: one hundred years of history]

This research project, in conjunction with the SIMLII foundation's 80th anniversary, is aimed to reconstruct the historical chronology of the institutional life of the Society: the Directive bodies, the by-laws, the main steps of the scientific activity, especially the Congresses of Occupational Health. The research will also analyze the most important elements of historical context explaining Society's evolution: the relationships between SIMLII and political-institutional and legislative framework, social and economic changes, medical science's evolution and the university teaching and research, and finally the interactions with the international context. The research covers the years since the first national meeting of Occupation Health, in 1907, in which scientific activity was particularly intense, although the foundation was officially only in 1929. The investigation of the documentation after the 2nd World War is aimed at reconstructing the reborn of the international relations and the social, cultural and economic changes occurred between 1968 and 1978 and the deep impact on industrial relations and the enactment of the "Statuto dei lavoratori" in 1970 and the Health Reform in 1978.

[A doctoral thesis on occupational diseases from 1816: workers' diseases in the post-Ramazzinian era]

No medical "classical" work has been in any way as successful as Ramazzini's De Morbis Artificum Diatriba. The book's success is confirmed by the constantly increasing number of new editions, emulations, translations and quotations and corresponding dissemination. As is proven by web access, our contemporaries continue to contemplate Ramazzini with admiration and wonder, confidence, devotion and curiosity and also as a means of seeking confirmation of the concepts that are variously presented. It is possible to describe a temporal phenomenon of "differential impact" of Ramazzini's work. Throughout the twentieth century, and especially on "celebrated" anniversaries (1900, 1913, 1914, 1933, 1964, 2000), many "tributes" to the author were recorded. During the nineteenth century in major European countries, but less so in Italy, Ramazzini's lesson was recorded as superseded "on an objective basis". The context had completely changed, as did both work and workers after a century-old continuity. Between the 1700's and the early 1800's Ramazzini dominated the field like a mountain in the desert; with editions of De Morbis in Latin and in translations following one on the other, with a positive cultural and popularizing impact on a public consisting of the international scientific and professional avant-garde. The means of dissemination consisted first and foremost of including all or part of the corpus of the Diatriba in "dictionaries" or "encyclopaedias" of medicine. Another means that was widely used, efficacious and typically academic, was through the doctoral theses discussed in all major European universities. Among these contributions was the thesis discussed in 1816 in Paris, by Louis-André Gosse of Geneva (1791-1873), which is presented in the previous pages in the translation from the French.

Characterization of channel-forming activity in muscle biopsy from a porin-deficient human patient

A bioptic specimen from the muscles of a patient suffering from severe myopathy was inspected for the presence of human porin 31HL. Western blotting suggested that the specimen was free of the most abundant eukaryotic porin 31HL (HVDAC1). The specimen was treated with detergent and the soluble protein fraction was passed through a dry hydroxyapatite column. The passthrough of this column was inspected for channel formation in artificial lipid-bilayer membranes. The channel observed under these conditions had a single-channel conductance of about 2.5 nS in 1 M KCl, was cation selective, and was found to be virtually voltage independent. Experiments with a control specimen from a healthy human being, without any indication for muscle myopathy, revealed the presence of the voltage-dependent porin 31HL in the sample. It is discussed whether the patient's bioptic specimen contained another human porin, which has not been studied to date in its natural environment.

[Biomechanical overcharge of the upper limbs in hairdressers: from the task analysis to the job/exposition matrix]

The analysis of professional diseases denounced from hairdressers in Italy and in Tuscany shows among these workers a reduction of some "typical" work related diseases, like dermatitis, asthma, etc. and a raise of upper limbs disorders. The upper limbs risk assessment process is very tough for the hairdresser's activity, because the working cycle includes different tasks (shampoo, cut, dyeing, etc.) and their combination in a working day is related to customers requests. The job illustrates the first results of a project started last year from the Tuscany Technical Advisory Department for Risk Assessment and. Prevention (CONTARP) of the Italian Workers' Compensation Authority (INAIL) and PISLL "G. Pieraccini" - ASL 10 of Florence. Through a study conducted with the OCRA Check List method on a sample constituted by 12 employees of five shops of the Florentine territory, we have arrived to a job-exposure matrix that allows to draw an index of exposure to the specific risk for every task, keeping in mind the contributions of the single repetitive assignment performed by the operator during the working day.

The pathogenesis of the white matter abnormalities in phenylketonuria. A multimodal 3.0 tesla MRI and magnetic resonance spectroscopy (1H MRS) study

OBJECTIVE

To gain insights into the nature and pathogenesis of white matter (WM) abnormalities in PKU.

METHODS

Thirty-two patients with phenylalanine hydroxylase deficiency (21 with early and 11 with late diagnosis and treatment) and 30 healthy controls underwent an integrated clinical, neuroimaging (3.0 T MRI, diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI)) and neurochemical (1H MRS) investigation.

RESULTS

All patients had white matter abnormalities on T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) scans; parietal white was consistently affected, followed by occipital, frontal and temporal white matter. T1-weighted hypointense alterations were also found in 8 of 32 patients. DWI hyperintense areas overlapped with those detected on T2W/FLAIR. The apparent diffusion coefficient (ADC) was reduced and correlated inversely with severity of white matter involvement. Fractional anisotropy index, eigenvalues lambda(min), lambda(middle), lambda(max) obtained from DTI data, and the principal brain metabolites assessed by 1H MRS (except brain phenylalanine (Phe)) were normal. Brain Phe peak was detected in all but two subjects. Brain and blood Phe were strictly associated. Blood Phe at the diagnosis, patient's age, and concurrent brain Phe independently influence white matter alteration (as expressed by conventional MRI or ADC values).

CONCLUSIONS

(a) MRI abnormalities in phenylketonuria are the result of a distinctive alteration of white matter suggesting the intracellular accumulation of a hydrophilic metabolite, which leaves unaffected white matter architecture and structure. (b) White matter abnormalities do not seem to reflect the mechanisms involved in the derangement of mental development in PKU. (c) Our data do not support the usefulness of conventional brain MRI examination in the clinical monitoring of phenylketonuria patients.

A long-lasting pandemic: diseases caused by dust containing silica: Italy within the international context

Diseases caused by dust containing silica represent an exemplary case study in the field of work-related diseases and in the history of the discovery of chronic industrial disease and its relationship to industrial society. Both dust and steam are indissolubly linked to the Industrial Revolution which everywhere was expected to replace slaves with masses of proletarians alike lesser gods. The identification of different nosological entities of dust-related diseases, the discovery that the most harmful dust particles in gold mines were invisible, insurance compensation and the development of the silicosis threshold limit value were all subjects of intense political negotiation that accompanied, with the connivance of doctors and scientists, a compromise between the health of workers and the economic health of industry. The preference for damage compensation (insurance system) over risk prevention (industrial hygienic measures) was also asserted and maintained in post-war Italy. Decline and modification of silicosis in Italy proceeded at the same rate as the introduction and subsequent application of more effective preventative legislation, especially with the protest movements of the working class at the end of the 1960s, together with the elimination of entire sectors of industrial activities, first those specialising in extraction and then the metallurgy.

Severe abnormalities of the pons in two infants with goldenhar syndrome

We describe 2 cases of Goldenhar syndrome with severe abnormalities of the pons. The first case is a 10-month-old Caucasian female infant. At birth the girl showed polydactyly, labiopalatoschisis, right ear agenesis, left eye coloboma and vertebral anomalies. She also had marked hypotonia, severely reduced movements and respiratory and feeding abnormalities. She required gastrostomy at 5 months and tracheostomy at 7 months. Brain MRI scans showed moderate cerebellar hypoplasia and severe abnormalities of the pons with a congenital cleft. The child died at age 12 months. Case 2 is a Caucasian boy. Clinical signs and presentation were similar to case 1. The child also had severely reduced lacrimation, sweating, with thermoregulation abnormalities. He also underwent gastrostomy at 18 months. The child is now 3 years old and is able to sit only with support. Brain MRI was similar to case 1. The association of Goldenhar syndrome and pons abnormalities in 2 subjects suggests that this is more than a mere coincidence. Further studies and characterization of the genes involved in Goldenhar syndrome are needed to establish an adequate genotype-phenotype correlation.

Isolated sulphite oxidase deficiency: clinical and biochemical features in an Italian patient

A patient with isolated sulphite oxidase deficiency presented with seizures at 12 h of life and followed a severe course, dying at 10 months of age. There was mild facial dysmorphism and the brain showed multiple cystic fibrosis.

Trisomy 6q syndrome: a case with a << de novo >> 6q23 tandem duplication

In this study, we report the combined use of whole and partial chromosome 6 painting probe and YACS probes to define the unbalanced region of a de novo 6q+ marker chromosome. A male patient with peculiar features of << distal 6q trisomy syndrome >> showed a direct duplication of 6q23 region. Comparing the phenotype of this child with the phenotype of other << de novo >> partial 6q trisomy, we conclude that band 6q23 has an important role in defining 6q trisomy.

[Male breast tumors in railway engine drivers: investigation of 5 cases]

The paper describes the results of the investigation carried out on five cases of male breast tumours in railway engine drivers notified to the public Occupational Health Service of Florence in 1999. The aim was to evaluate the possibility of professional extremely low frequency electromagnetic fields (ELF) exposure etiology. The extent of this exposure is described with particular care to engine drivers, comparing the one measured in Italy with those reported in other countries.

Survival trends of childhood cancer diagnosed during 1970-1994 in Piedmont, Italy: a report from the Childhood Cancer Registry

BACKGROUND

The Childhood Cancer Registry of Piedmont (CCRP) started its activity in 1967. It is population based and covers the Piedmont Region (population 4,500,000; NW Italy). This article reports on time trends in survival after a childhood cancer diagnosed during 1970-1994.

PROCEDURE

During 1970-1994, 2,329 incident cases were registered at CCRP on the basis of histological and/or clinical information, excluding 30 cases reported only by death certificate. Histological or hematological diagnosis was available for 2,067 cases. Vital status was assessed through the offices of the town of residence. At the end of follow-up, 1,202 cases were alive, 1,084 dead and 43 were not traceable. Survival was measured for the major diagnostic groups using both univariate and multivariate statistics.

RESULTS

The 5-yr survival rate for acute lymphoblastic leukemia (ALL) improved regularly from 24.7% in 1970-1974 to 81.1% in 1990-1994, for acute nonlymphoblastic leukemia (ANLL) from 0% to 38.1%, for non-Hodgkin lymphoma (NHL) from 25.2% to 67.7%, for tumors of the central nervous system (CNS) (all types) from 33.4% to 75.9% and for Ewing tumor from 0% to 90%. Focusing on survival by period of diagnosis, the highest 5-year survival rate was observed for children diagnosed during 1985-1989 for medulloblastoma, neuroblastoma (NB), retinoblastoma, Wilms tumor, osteosarcoma, and rhabdomyosarcoma and for children diagnosed in 1990-1994 for the remaining sites. The trend over time was statistically significant for ALL, ANLL, NHL, CNS tumors, NB, and osteosarcoma as well as for all malignancies together.

CONCLUSIONS

Population-based survival studies are useful complements to clinical studies. Survival results in the present study are similar to those presented for other European countries and the United States. For most types of neoplasm (except CNS) survival probability appears to stabilize 5-10 years after diagnosis.

[Amendments to Directive 90/394/CEE and effects on chapter VII of Law 626/94]

The European Union (EU) has recently twice amended the framework Council Directive 90/394/CEE on the protection of workers from risks related to exposure to carcinogens at work: protective measures were extended to category 1 and 2 mutagens; a new carcinogenic agent was identified in "work involving exposure to hardwood dusts" and three exposure limit values were fixed for carcinogens. The EU Member States are required to incorporate amending Directives into national legislation not later than 29 April 2003. Italy acknowledged these directives by the Decree 66/00 of the 25/2/2000. In this paper the development and the evolution of European legislation in the twenty years from 1980 to 2000 are overviewed: first, occupational exposure limits were defined and introduced for harmful chemicals, then for occupational carcinogens and later three binding limit values for benzene, VCM and hardwood dusts were fixed. The paper attempts to identify the expected problems and advantages that incorporation of the amending Directives will have on the protection of workers from carcinogenic risk.

[Occupational experience, epidemiologic observations, and scientific evidence in an illustrative case: adverse effects of the production and use of aromatic amines in Italy]

Economical, social and technical interrelations between synthetic dyes' production and bladder cancer in workmen engaged in the manufacture are reviewed. International situation is the background of Italian situation, mainly of the Lombardy region and Turin area. For decades social actors, individuals and institutions, acted as separate bodies, contributed to delay and omit the protection of workers' health. The situation changed when scientific knowledge, technical developments and workers' commitment prioritized workers' health as a main goal. The epidemic of bladder cancers among dyestuff workers was a cornerstone in the development of a different scenario in the production responsibility, workers' participation and eventually scientific community. The authors hypothesise that in our country these events stimulated the growth of epidemiology and epidemiologists; furthermore since then institutions promulgated a new and up-to-date wave of protective legislation in the workers' H&S field.

Cervical spine cord compression by eosinophilic granuloma. Case report

Eosinophilic granuloma is a term reserved for the most often and benign form of disorder known as Langerhans cells histiocytosis. It is a disease of children and adolescents that very rarely affects adults, representing the localized form of a pathological proliferation of histiocytes in bones, like skull and long bones. Vertebral involvement is uncommon, approximately 8% of the cases, being the cervical localization the least affected. Moreover, the involvement of the spinal cord and roots remains a rare occurrence. Only five cases characterized by signs of cervical spinal cord compression have been reported. We report the sixth case in a 42-year-old-man who evolved with resolution of symptoms, and has remained asymptomatic after treatment. The clinical, radiological and histological features and, also, the value, in selected cases, of surgical treatment followed by low-dose radiation therapy is discussed. A review of the pertinent literature is also presented.

Immediate posttraumatic seizures: is routine hospitalization necessary?

OBJECTIVE

A recent Internet survey of pediatric neurosurgeons showed that 86% routinely admitted children with immediate posttraumatic seizures (PTS) for a brief period of observation. We wished to determine whether certain children meeting predefined criteria could instead be safely discharged from the emergency room.

METHODS

We reviewed the records of children admitted during the past 5 years with a diagnosis of seizure and head injury. Children with a minor head injury, a PTS occurring within 24 h of injury and no intracranial abnormalities on admission CT scan were included. Children with previous neurological conditions, a history of prior seizures (other than PTS or febrile seizures), a prior history of anticonvulsant use, or intracranial abnormalities on the admission CT scan were excluded. Records were abstracted for child's age, gender, length of admission, previous history of PTS or febrile seizures, mechanism of injury, location of impact, time between impact and PTS, the number, length and type of PTS, Glasgow Coma Score (GCS) on admission, subsequent complications and hospital costs.

RESULTS

Seventy-one children met the inclusion criteria. Eleven children presented to the emergency room with prolonged seizures, transient apnea or persistently low GCS and required admission to the intensive care unit (ICU). Among the 60 remaining children with simple PTS, none had further seizures during the follow-up period, and none had significant complications. The average cost of hospitalization was known for 58 children; after excluding the costs for 5 patients who were admitted to the ICU, the average hospital cost amounted to USD 1,615 per patient.

CONCLUSIONS

Our data suggest that children with isolated minor head injuries and simple PTS who recover fully in the emergency room, whose CT scans show no intracranial abnormalities and who have no prior history of neurological disease, epilepsy or anticonvulsant use are at low risk for recurrent seizures or neurological complications, and could potentially be sent home to a reliable caretaker and a stable home situation. However, because of the limited sample size in this study, the statistical risk of a bad outcome may be as high as 9%; we therefore suggest that much larger studies are potentially needed before this becomes a standard policy.

[20 years of biological monitoring (1976-1995) of occupational lead exposure in various Tuscan provinces]

We report the results of 24,475 blood lead determinations (PbB) performed by the Occupational Toxicology Laboratory of Florence between 1976 and 1995. Biological monitoring was carried out in 383 factories localized in the districts of Florence, Prato, Pistoia, Lucca and Pisa. The most represented production fields were colouring ceramic factories, artistic ceramics, transfer-pictures for ceramics, glass factories, typographies, glass decoration factories, chemical factories. In twenty years, the median values of PbB decreased from 48 to 17 micrograms/100 ml in males and from 40 to 8 micrograms/100 ml in females. The 95 degrees centile ranged from 84 to 46 micrograms/100 ml for males and from 63 to 42 micrograms/100 ml for females. In the 1988-95 period, we observed an increase of both the 95 degrees centile and the maximal values because of the inclusion of data from workers employed in factories where the "decorazione a scavo" technique, which is characterized by elevated environmental lead concentrations, was used. In the period 1991-93, the ranges of PbB observed in glass decoration factories were 13-160 micrograms/100 ml for males and 4-80 micrograms/100 ml for females, respectively.

[Frequency of lumbago in a cohort of nursing students]

The etiology and frequency of low back pain among health care personnel have been widely studied by means of cross sectional studies. The aim of our study was to calculate low back pain incidence in a prospective cohort of nursing students. A population of 344 subjects (72 males and 272 females) was involved in this investigation. Every student was submitted to a clinical and functional examination of the spine before beginning training and was checked in two following steps by a specific questionnaire for epidemiological studies of spinal disorders in working communities. 197 subjects (57.3%)(41 males and 156 females) completed follow-up. The low back pain incidence was similar at the end of two exposure periods (12.1% and 13.1%). The cumulative incidence was 22.5% throughout the study period. The longitudinal study allowed good control of selection bias and confounding factors; more over it showed that compared to other measurements of occurrence the cumulative incidence was between other occurrence measures, more informative, in our case, than prevalence and incidence rates. A cumulative incidence of low back pain over 20% after only two years of exposure in a young and healthy population of nursing students, requires implementation of ergonomic measures for patient handling tasks.

[Exposure to carcinogens in work environment today. State of the art, problems and prospects raised by the Law 626/94]

The implementation in our country of recent legislation on carcinogenic risk assessment and management (VIIth title of Law 626/94) is considered. The authors describe potentialities and limits of the new legislation and of the derived Guidelines issued by the Regions. The health policy in this field and possible evolution in the near future are outlined, bearing in mind the experience of other countries. A short list of questions is suggested as a contribution to the discussion on the future scenario: whether exposure to carcinogens should be lower in the working environment than in the general environment; what is the relative importance of multifactoriality, individual biological variability, individual life-style in the genesis of cancers; whether medical health surveillance is worthwhile in terms of primary prevention; is it always true that there is no threshold limit value for carcinogens; what is the role of individual attitudes to prevention in exposure to carcinogens compared to "objective" protection; which balance between costs and benefits should be aimed at.

[Activities of the industrial physician in a state preventive health service. The case of Italy]

We analyzed the occupational health activities of physicians in a public occupational health service using the Method of Organizational Congruences (MOC). Occupational health activities are changing in Italy with the application of the European Community Directives (Decreto Legislativo 626/94). We identified four major organizational constraints: a lack and difficult in interdisciplinary work, absence of worker control on the activities, limitations in planning specific industrial area studies, increased conflict between prevention and control activities. We predict for the future an increase of these constraints with a reduction in the professional level of the physicians employed in the state system of local occupational health units.

Biliary malformation with renal tubular insufficiency in two male infants: third family report

We report two male sibs, born to non-consanguineous healthy parents, who showed arthrogryposis, cholestatic jaundice and tubular renal insufficiency. The liver biopsy of the first case showed scanty hypoplastic biliary ducts. This association, first reported by Lutz and Richner in 1973, is a distinct syndrome, characterized by intra-extrahepatic biliary hypoplasia, and described in McKusick's catalogue under the number 210550. All reported cases were males and consanguinity was found in two families. For these reasons, the possibility of an autosomal recessive or of an X-linked transmission should be considered. A similar association, in reports by Nezelof, Di Rocco, and Saraiva, without intra-extrahepatic atresia but with a cholestatic pigmentary liver disease was considered as another condition (no. 301820) by McKusick in 1992.

[Hepatic chemoembolization for the treatment of carcinoid syndrome]

Clinical manifestation of carcinoide syndrome are often difficult to control with medical treatment and so present a large problem for doctors. In the majority of cases, such manifestations are seen in patients with hepatic metastases. In such cases the control of the problem can be achieved by local hepatic treatment. A 57 year old patient with carcinoide syndrome for a year, with extensive hepatic tumor from a carcinoide tumor, whose origins were not lokted, had a urinary excretion 5-hidroxi-indolacetic = 73 mg in 24 hours, he used cyproheptadin, loperamida and metisergida without showing improvement. In light of the failure of medical treatment and the impossibility of surgery he was given into hepatic chemoembolization (QEH) with lipiodol, doxorrubicin (1.0 mg/Kg) and mitomicin (10.0 mg) twice. Clinical control with absolute recovery of "flushing" and diarrhea were achieved, a dose of 5-HIAA U (5.5 mg) after the first application. Transitory alterations of the aminotransferasis alkaline phosphates and leucocytosis. Besides the post embolization syndrome that regressed in 20 days, there were no complications recurring after treatment. The period of recovery was more than 9 months. We can then conclude that hepatic chemoembolization is an efficient treatment to control carcinoid syndrome.

[The diffusion of information on the carcinogenicity of asbestos in the Italian scientific community before 1965]

The spreading of information on asbestos carcinogenicity within the Italian scientific community before 1965. The paper deals with the development of recognition of asbestos carcinogenicity within the Italian scientific community. This development was difficult in Italy as in other countries. Articles and other papers in handbooks and congress proceedings, by Italian authors, published in the period 1934-1965, were considered. The first cases of lung cancer in Italian workers exposed to asbestos were observed in 1955-56, the first cases of malignant mesothelioma in 1965. The cases observed were very few, but knowledge on asbestos carcinogenicity became widespread within the Italian scientific community during the fifties (from 1953 on wards) with the publication of several handbooks of occupational medicine.

[The risk of the carpal tunnel syndrome in some work activities]

The aim of the study was to generate hypotheses on what could be the ISTAT (National Institute of Statistics) job classes with a major risk of carpal tunnel syndrome in order to plan more specific analytic epidemiology studies and apply more correct ergonomic solutions. A case-control cross-sectional survey without matching was carried out. The source of data were the computerized medical records of a large regional hospital: 833 carpal tunnel syndrome cases (mean age 48, SD 9.33) and 3222 controls (mean age 43.5, SD 13.22) hospitalized for other diseases, were selected. The odds ratio (OR) and 95% confidence limits, controlled for age and gender by a logistic linear regression model, were calculated as measures of association for the comparison between non-exposed managerial/administrative staff and industrial workers. The analysis showed a statistically significant risk for some ISTAT job classes, in particular class 53 (spinners, weavers, dyers and similar jobs) (OR = 2.65; C.L. 1.52-4.62) class 54 (knitters, tailors, hatmakers, upholsterers and similar jobs) (OR = 1.69; C.L. 1.06-2.71), 55 (tanners, shoemakers, leather manufacture workers and similar jobs) (OR = 2.74; C.L. 1.66-4.53) and group 742 (Hotel and restaurant cooks) (OR = 2.99; C.L. 1.45-6.13). Job classes 45 (carpenters, welders and similar jobs). 62 (electricians, electrotechnicians, radio engineers and similar jobs), 63 (gasfitters, plumbers, heating engineers and similar jobs) and 85 (porters and other jobs involving manual handling of loads) showed ORs higher than 2 but without statistical significance. The results are valid for planning further studies, especially in the textile and shoe and leather manufacturing sectors.

FISH analysis in Prader-Willi and Angelman syndrome patients

We report on a combined high resolution cytogenetic and fluorescent in situ hybridization study (FISH) on 15 Prader-Willi syndrome (PWS) and 14 Angelman syndrome (AS) patients. High resolution banding showed a microdeletion in the 15q11-q13 region in 7 out of 15 PWS patients, and FISH analysis of the D15S11 and SNRPN cosmids demonstrated absence of the critical region in three additional cases. Likewise 8 out of 14 AS patients were found to be deleted with FISH, using the GABRB3 specific cosmid, whereas only 4 of them had a cytogenetically detectable deletion.

Characterization of phenylketonuria alleles in the Italian population

In order to identify the molecular basis of phenylketonuria (PKU) in Italy, we screened the entire coding sequence of the phenylalanine hydroxylase gene in 20 Italian PKU patients, whose origins are scattered throughout Italy. The frequency of each identified mutation and of 5 other European mutations was determined within a panel of 92 Italian PKU patients. This approach allowed us to identify 20 different PKU mutations and characterize 64% of the Italian PKU chromosomes. Eleven mutations (IVS10nt546, L48S, R158Q, R261Q, P281L, R261X, R252W, delta T55, IVS7nt1, IVS12nt1, Y414C) represent 55.4% of the Italian PKU alleles, the most common mutations being IVS10nt546 (12.4%) and L48S (9%). All the other mutations are very rare. These data confirm the great heterogeneity expected from previous RFLP haplotype studies. Genotype/phenotype correlation allowed for assessment of the clinical impact of the 20 identified mutations.

[Relations between mental health and work. Review of the literature]

Interest in occupational mental illness has increased as a result also of the technological changes at the workplace. A total of 22 epidemiological studies on this topic were reviewed on the following basis: subject of the study, epidemiological design, type of psychometric scale, results. The authors discuss the methods and constraints of these studies, especially the lack of knowledge on occupational exposure and its relationship to mental health. The need for further studies in order to improve prevention of mental illness at the workplace is stressed.

[The epidemiological aspects of eye screening in occupational medicine]

The wide-spread use of video display units in many work places has led to an increase in ophthalmologic examinations of the operators. For this reason, instruments for visual test screening (for example Visotest) have become widely used. Nevertheless, the literature does not seem to offer any clarification about the utility of these instruments as epidemiological tools. The costs and benefits of visual screening programmes were estimated in relation to specific visual deficit prevalence in a differently age-structured population. Via epidemiological calculation, it was demonstrated that positive and negative predictive values, which are directly related to deficit prevalence, are more important than sensitivity and specificity calculations. In view of the disorders screened, a visual test with a low positive predictive value is more expensive than one with a low negative predictive value. A visual test for visual deficits screening does not appear to be advisable in young populations, where the true positives/false positives ratio is 1:4, whereas in older populations the ratio is 2:1.