Do we trust scientific evidence? A multicentre retrospective analysis of first IVF/ICSI cycles before and after the OPTIMIST trial

STUDY QUESTION

Has the practice of individualizing the recombinant-FSH starting dose been superseded after the largest randomized controlled trial (RCT) in assisted reproduction technology (ART), the OPTIMIST trial?

SUMMARY ANSWER

The OPTIMIST trial has influenced our ART daily practice to a limited degree, but adherence is still generally poor.

WHAT IS KNOWN ALREADY

Although the 'one size fits all' approach has been discouraged for decades by most authors, the OPTIMIST study group demonstrated in a large prospective RCT that, in general, dosage individualization does not improve the prospects for live birth, although it may decrease ovarian hyperstimulation syndrome (OHSS) risk in expected high responders.

STUDY DESIGN, SIZE, DURATION

Retrospective analysis of all first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles from 1st January 2017 to 31st December 2018, before and after the OPTIMIST publication on November 2017.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Two thousand six hundred and seventy-seven patients, between 18 and 42 years old, undergoing their first IVF-ICSI cycle in seven Italian fertility centres, were included. Patients were allocated to three groups according to their ovarian reserve markers: predicted poor ovarian responders (POR), predicted normo-responders (NR) and expected hyper-responders (HRs).

MAIN RESULTS AND THE ROLE OF CHANCE

Between 2017 and 2018, there was an overall increase in prescription of the standard 150 IU dose proposed by the OPTIMIST trial and a reduction in the use of a starting dose >300 IU. After subgroup analysis, the decrease in doses >300 IU remained significant in the POR and NR sub-groups.

LIMITATIONS, REASONS FOR CAUTION

The retrospective nature of the study. Physicians need time to adapt to new scientific evidence and a comparison between 2017 and 2019 may have found a greater impact of the Optimist trial, although other changes over the longer time span might have increased confounding. We cannot be sure that the observed changes can be attributed to knowledge of the OPTIMIST trial.

WIDER IMPLICATIONS OF THE FINDINGS

Clinicians may be slow to adopt recommendations based on RCTs; more attention should be given to how these are disseminated and promoted.

STUDY FUNDING/COMPETING INTEREST(S)

No external funding was used for this study. E.P. reports grants and personal fees from MSD, grants from Ferring, from IBSA, grants and personal fees from Merck, grants from TEVA, grants from Gedeon Richter, outside the submitted work. E.S. reports grants from Ferring, grants and personal fees from Merck-Serono, grants and personal fees from Theramex, outside the submitted work. All other authors do not have conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

Not applicable.

Patient-centered communication, patient satisfaction, and retention in care in assisted reproductive technology visits

PURPOSE

To explore the association between patient-centered communication, patients' satisfaction, and retention in care in assisted reproductive technology (ART) visits.

METHODS

ART visits at eight Italian clinics were videotaped and coded using the Roter Interaction Analysis System, which includes a Patient-Centered Index (PCI), a summary "patient-centered communication" ratio. After the visit, patients completed a satisfaction questionnaire (SATQ). After 3 months, patients were asked about their retention in care. Spearman correlations and Mann-Whitney tests were used to test associations between the study variables; the open-ended item of SATQ was analyzed through content analysis.

RESULTS

Eighty-five visits were videotaped (involving 28 gynecologists and 160 patients). PCI score (μ = 0.51 ± 0.28) revealed a more disease-oriented communication during the visit. Patients reported high levels of satisfaction with the visit and identified in the information provision or in the doctor's humanity or kindness the main reasons of satisfaction. At the follow-up, the majority of the couples declared to have followed the clinicians' recommendations and to have remained related to the ART center. No associations were found among the study variables, except for a lower male satisfaction among couples who declared to have changed ART clinic.

CONCLUSIONS

Contrary to what was expected, the style of physician-patient communication was not found to be associated with patient satisfaction and retention in care. However, patients were highly satisfied and engaged. The actual meaning of a communication that is "patient-centered" in the ART context might be wider, including the couples' need for information, as suggested by qualitative findings.

Doctor-couple communication during assisted reproductive technology visits

STUDY QUESTION

What are the characteristics of doctor-couple communication content during actual ART visits?

SUMMARY ANSWER

Physicians were mainly focused on providing biomedical information, while communication content from couples had a 2-fold focus on providing biomedical information and on positive talk.

WHAT IS KNOWN ALREADY

Communication aspects in ART seem crucial for clinical decision-making, retention in care and critical conversations with couples due to low treatment success rates. However, no studies have been carried out on the actual interaction between the doctor and the couple in this context.

STUDY DESIGN, SIZE, DURATION

This observational study involved 28 clinicians and 160 patients referred to eight Italian ART clinics during a one-year recruitment period.

PARTICIPANTS/MATERIALS, SETTING, METHODS

ART visits at eight Italian clinics were videotaped. The visits were coded using the Roter Interaction Analysis System (RIAS), particularly focusing on RIAS composite categories, verbal dominance and patient-centeredness score.

MAIN RESULTS AND THE ROLE OF CHANCE

A total of 85 visits were eligible for analysis (62% acceptance rate), involving 28 clinicians and 160 patients (including 75 couples). The average visit duration was 37 ± 17.7 min. The mean verbal dominance was 1.9 ± 0.86 (range: 0.72-5.74). Physicians mainly focused on providing biomedical information. Communication content from couples had a 2-fold focus on providing biomedical information and on positive talk. The mean of patient centeredness index (PCI) was 0.51 (SD = 0.28; range 0.08-1.77); visits in which the doctor was a woman or the treatment indication was for heterologous fertilization showed higher PCI scores. Overall, females accounted for 67% of all patient talk. Taking this imbalance into account as expected frequencies for each composite category, males reported significantly more utterances in almost all of the socioemotional categories.

LIMITATIONS, REASONS FOR CAUTION

These results are preliminary and observational and only regard Italy. Communication during visits may have been biased since the professionals who agreed to participate showed an interest in communication issues. Another limitation is a possible Hawthorne effect due to the fact that participants were aware of being videotaped.

WIDER IMPLICATIONS OF THE FINDINGS

Our study showed that ART physicians mainly adopted an informative model of communication and a more disease-oriented approach. Findings revealed the complexity of communication content during ART consultations, given its triadic characteristic in which the third party is also a patient; clinicians should be aware of this complex aspect and of the specific male and female perspectives to be taken into account. The results could be useful for training ART professionals.

STUDY FUNDING/COMPETING INTEREST(S)

This study was possible thanks to an unconditional grant from Ferring Spa to the Department of Health Sciences, University of Milan. There are no competing interests to declare.

TRIAL REGISTRATION NUMBER

N/A.

Effects on Plasmatic Androstenedione in Female Workers Exposed to Urban Stressors

The purpose of this study is to investigate whether occupational exposure to urban stressors can cause alterations on androstenedione plasma levels and related diseases in female traffic police compared to a control group. The research was carried out on an initial sample of 468 female workers (209 traffic police and 259 controls). After excluding the subjects with confounding factors, 192 female subjects: 96 traffic police and 96 controls were included in the study. Traffic police and controls were matched by age, length of service, body mass index, alcohol consumption and cigarette smoking habits, habitual consumption of Italian coffee, and habitual intake of soy and liquorice in diet. The results show that the percentage of subjects with fertility and mental health disorders were no different between traffic police and controls. Mean androstenedione values were significantly higher in female traffic police compared to controls. The distribution into classes of androstenedione values in traffic police was statistically significant. The percentage of traffic police with fertility and mental health disorders were not significant compared to controls. Our results suggest that the occupational exposure to urban stressors could alter plasma androstenedione levels in female traffic police. According to our previous research all the hormonal parameters studied, including androstenedione, could be used as early biological markers of chronic exposure to urban stressors, usable in occupational sets.

Work related stress and blood glucose levels

AIM

The aim of the study is to evaluate work-related subjective stress in a group of workers on a major Italian company in the field of healthcare through the administration of a valid "questionnaire-tool indicator" (HSE Indicator Tool), and to analyze any correlation between stress levels taken from questionnaire scores and blood glucose values.

MATERIAL AND METHODS

We studied a final sample consisting of 241 subjects with different tasks. The HSE questionnaire - made up of 35 items (divided into 7 organizational dimensions) with 5 possible answers - has been distributed to all the subjects in occasion of the health surveillance examinations provided by law. The questionnaire was then analyzed using its specific software to process the results related to the 7 dimensions. These results were compared using the Pearson correlation and multiple linear regression with the blood glucose values obtained from each subject.

RESULTS

From the analysis of the data the following areas resulted critical, in other words linked to an intermediate (yellow area) or high (red area) condition of stress: sustain from managers, sustain from colleagues, quality of relationships and professional changes. A significant positive correlation (p <0.05) between the mean values of all critical areas and the concentrations of glucose values have been highlighted with the correlation index of Pearson. Multiple linear regression confirmed these findings, showing that the critical dimensions resulting from the questionnaire were the significant variables that can increase the levels of blood glucose.

CONCLUSION

The preliminary results indicate that perceived work stress can be statistically associated with increased levels of blood glucose.

Correlation between benzene and testosterone in workers exposed to urban pollution

AIM

Many studies have examined the effects of benzene on testosterone. The purpose of this study was to evaluate the possible correlation between the blood levels of benzene and the levels of testosterone.

MATERIALS AND METHODS

The study involved a group of 148 subjects. For every worker have been made out a blood sample for the evaluation of benzene and testosterone levels and an urine analysis for the evaluation of the levels of trans, trans-muconic acid and S-phenylmercapturic acid. We estimated the Pearson correlation coefficient between the variables in the sample and the urinary metabolites, age, length of service, gender, BMI. For the analysis of the major confounding factors it was performed a multiple linear regression.

RESULTS

The Pearson correlation coefficiet showed: 1. a significant inverse correlation between the S-phenyl mercapturic acid and free testosterone; 2. a significant direct correlation between trans-trans muconic acid and BMI. After dividing the sample according to the median of blood benzene (161.0 ng / L), Pearson correlation coefficient showed a significant inverse correlation between the S-phenyl mercapturic acid and free testosterone in the group with values below this median.

CONCLUSIONS

Our results, to be considered preliminary, suggest that occupational exposure to low levels of benzene, present in urban pollution, affect the blood levels of testosterone. These results need to be confirmed in future studies, with the eventual possibility of including more specific fertility tests.

Blood pressure changes and polycyclic aromatic hydrocarbons in outdoor workers

OBJECTIVES

Everyday outdoor workers are exposed to chemicals including the polycyclic aromatic hydrocarbons (PAHs). The aim of the study is to evaluate the relationship between hydroxypyrene and blood pressure in outdoor workers.

MATERIALS AND METHODS

374 subjects of both sexes entered the study. We evaluated the assay of urinary hydroxypyrene (1-HOP); their blood pressure (BP) was measured in upright position and in the supine position and the correlation between the levels of 1-HOP and BP was assessed using Pearson test and linear multiple regression.

RESULTS

The results obtained show that in the total sample the levels of urinary 1-OHP are negatively associated with systolic and diastolic BP in supine position and in upright position. The significance is maintained despite the stratification of the sample according to age; in non-smokers we found a negative relationship between 1-OHP and differential blood pressure, both systolic and diastolic.

CONCLUSIONS

The results of the study suggest that occupational exposure to PAHs may be able to significantly influence the blood pressure probably acting on the autonomic nervous system.

[Prolonged exposure to urban pollutants and arterial blood pressure: a whole evaluation of our researches]

AIM

A significant relationship between exposure to cadmium and PAHs from urban air pollution and blood pressure has already been found. The aim of the study is to evaluate if other urban pollutants maintain a similar relationship in outdoor workers.

MATERIALS AND METHODS

349 subjects of both sexes were enrolled in the study; we evaluated values of environmental and biological monitoring of respirable dust, arsenic, lead, benzene, toluene, xylene and we measured blood pressure (BP) in upright and in supine position; to analyze data we used multiple linear regression. Also we valued our results in the light of those we have obtained in previous research.

RESULTS

Multiple linear regression showed no significant results that demonstrate a relationship between BP and these pollutants.

CONCLUSIONS

The results of our study lead to assume that exposure to urban pollutants studied has not connection with blood pressure, and to retain valid the relationship previously observed for cadmium and PAHs, which seem to be the only pollutants that can affect blood pressure.

Urban stressors and plasmatic 17-β-estradiol (E2) in male exposed workers

The aim of the study is to evaluate if the occupational exposure to urban stressors could cause alterations in 17-β-estradiol (E2) plasma levels and related disorders in male traffic police compared with a control group. After excluding from the study, the subjects with the principal confounding factors, traffic police and controls were matched by age, working life, Body Mass Index (BMI), smoking and drinking habit. A total of 171 male traffic police and 171 controls were included in the study. In traffic police, mean E2 values were significantly lower versus controls ( P < 0.001). The distribution of E2 values in traffic police and controls was significant ( P < 0.001). No significant differences were found in percentage of traffic police versus controls concerning the following questionnaire items: fertility and mental health diseases. Our results suggest that the occupational exposure to chemical urban stressor, interacting with and adding to the psychosocial ones, could alter plasma E2 concentrations in male traffic police compared with a control group. According to our previous researches on other neuro-immune-endocrine parameters, E2 could be used as an early biological marker, valuable for the group, to be used in occupational set even before the onset of the pathologies.

[Evaluation of liver function between indoor and outdoor workers: preliminary results]

INTRODUCTION

The aim of our study is to compare liver damage in "outdoor" environment technicians, a category occupationally exposed, and in "indoor" workers.

MATERIALS AND METHODS

We studied 142 male technicians of the environment exposed to urban pollution and 142 male "indoor" workers not exposed. We compared mean and standard deviation of the following liver parameters: glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), gamma-glutamyl-traspeptidasi (γGT) and alkaline phosphatase (PHA), total bilirubin (TB) and direct (DB). We made the two groups comparable for age, length of service, BMI, alcohol consumption and smoking habits, and excluded the workers who presented confounding factors.

RESULTS

We found statistically significant differences about the levels of γGT, PHA, GPT and albumin between the "outdoor" workers exposed and the "indoor" control group. In the outdoor group we observed statistically significant values, GPT (51.8 ± 30.6 I.U./l vs. 30 ± 22.3 I.U./l; p = 0.000), γ-GT (42.2 ± 29.4 I.U./l vs. 22.4 ± 20.7 I.U./l; p = 0.000) and PHA (75.7 ± 20.6 I.U./l vs. 59.1 ± 19.6 I.U./l; p= 0.000) compared to the unexposed group. No statistically significant difference emerged between the averages for the values of GOT (25.3 ± 20.7 I.U./l vs. 26 ± 17.7 I.U./l; p = 0.736) in two groups.

CONCLUSIONS

It clearly emerges that the contaminants may alter the values of liver tests after prolonged exposure.

Work-related stress in healthcare workers

BACKGROUND

In the assessment of work-related stress it is crucial to find the factors that generate and increase it in order to identify categories of individuals at risk, to plan interventions for prevention, elimination or reduction of risk. The aim of the study is to assess the subjective stress in 68 workers of a large Italian company dealing with human health, through the use of a questionnaire-indicating tool, elaborated by the Italian National Institute for insurance against accidents at work (INAIL) and developed by the Health and Safety Executive (HSE).

METHODS

We studied a final sample of 68 individuals (34 drivers/rescuers and 34 video display unit (VDU) operators). The questionnaire consists of 35 items (divided into six areas) with five possible answers each, that cover working conditions considered potential causes of stress.

RESULTS

The drivers/rescuers had a better performance than the VDU operators, especially in the areas "demand", "relationships" and "role". We compared men and women in the two groups, finding that, in VDU operators, women had a better performance than men in all areas, except "role" and "changes", in which the overall scores were the same in men and women. In the drivers/rescuers women showed more critical scores in the items "relationships" and "change".

CONCLUSION

The results show that: the questionnaire-indicating tool is useful, with a demonstrated effectiveness for the occupational physician during the visits and proven validity; additional future efforts should focus on understanding the psycho-social, organizational and individual problems related to stress and the consequent implementation of preventive measures.

Occupational exposure to urban stressors and effects on atrial natriuretic peptide: preliminary results

PURPOSE

The aim of this pilot 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 the concentration of atrial natriuretic peptide (ANP) in workers from the Municipal Police with outdoor tasks, compared to those with indoor tasks.

METHODS

A total of 208 non-smoking male and female subjects were enrolled and divided on the basis of whether their tasks were mainly outdoors or indoors. The dosage of plasma ANP was carried out on all workers included in the study. Differences between means and frequencies were compared using student's t-test for unpaired data and chi-square test with Yates' correction, and they were considered significant when the p value was <0.05.

RESULTS

Even after the subdivision of the total sample on the basis of sex, mean plasma levels of ANP were higher but not statistically significant in traffic police compared with controls.

CONCLUSIONS

The preliminary results suggest that further studies should be conducted before the influence of urban pollution on ANP could be confirmed or rejected.

Early diagnosis of hearing loss: otoacoustic emissions evoked by distortion products and pure-tone audiometry: Preliminary findings

OBJECTIVE

Literary studies underline the effectiveness of distortion product otoacoustic emissions (DPOAEs), which are not affected by the collaboration of the subject examined, in the early diagnosis of hearing loss. Aim of the study is to compare the objective technique of DPOAEs with respect to the pure-tone audiometry in early diagnosis of hearing loss.

MATERIALS AND METHODS

The clinical research was carried out on 852 workers. All subjects underwent pure-tone audiometry, tympanometry and distortion products.

RESULTS

The results show: a) a prevalence of subjects with impaired DPOAEs higher than the prevalence of subjects with impaired audiometries in the studied samples; and, after division by gender: b) a prevalence of subjects with impaired DPOAEs higher than the prevalence of subjects with impaired audiometries only in men; c) a prevalence of impaired DPOAEs and of impaired audiometries in men higher than in women.

CONCLUSIONS

The results suggest the higher effectiveness of DPOAEs compared to pure-tone audiometry in making an early diagnosis of hearing loss.

[Stress and work-related injuries]

OBJECTIVE

The aim of this study was to evaluate in scientific literature the more frequent work injuries among the occupational categories examined (construction workers, healthcare workers, night workers and shift work, drivers) and to identify occupational stressors that increase the risk of injury.

MATERIALS AND METHODS

The research was conducted through review of the scientific literature between 1990 and 2014. Two hundred articles were found of which 42 selected in the following categories: construction workers, healthcare workers, shift workers, lorry drivers.

RESULTS

The movement of machinery and working at height are due to injury for building sector and they were positively correlated with physical (r = 0,206) and mental (r = 0,254) stress. In health workers the injuries are more frequently bruises and sprains (50%). Studies showed a higher rate of injury in a group of shift workers compared to a control group on a rota basis (p <0.0001). Road accidents for drivers represent the most frequent cause of injury of which 13% comes from falling asleep, while 31% from distractions (OR = 3.16; CI = 1:22 to 8:24).

CONCLUSIONS

Nurses have frequent injuries due to bruises, lumbago, punctures with needles and surgical wounds. Construction workers often suffer serious injury derived from falls at height, handling machinery. For workers on a rota basis, injuries are often related to lack of sleep. Road accidents in drivers are the most common injuries. A synergistic action finalized to promote health and safety organization, to ensure a work environment more secure, is advisable.

Work related etiology of amyotrophic lateral sclerosis (ALS): a meta-analysis

BACKGROUND

The aim of this meta-analysis was to evaluate the association between ALS and occupational exposure to physical (ELF-EMF) and chemicals (solvents, heavy metals and pesticides) agents.

METHODS

We considered articles published from 1980 up to April 2013; in total, 750 publications were evaluated. The studies had to satisfy the following criteria: 1) cohort or case-control studies; 2) the presence of individual exposures; 3) clinical diagnosis of sporadic ALS or sporadic ALS on the death certificate. We followed the evaluation of quality in two steps. The first step classified studies according to a rating system based on a mix of criteria developed by scientific organizations, especially developed for studies of risk factors for ALS. The ratings obtained range from I (highest) to V (lowest). The data on risk factors derived from studies with Armon ratings of I, II, and III can reach levels of evidence A (established risk factor), B (likely risk factor), or C (possible risk factor). The second step evaluated the exposure and a score from 1 to 4 was assigned to each item; an exposure with a score of 3 or 4 was considered sufficient. Different analyses were performed on ALS and exposure to metals, solvents, pesticides and electromagnetic fields. In our study the heterogeneity was assessed both by χ2-based Q-tests and through the index of inconsistency I² while the measure RR/OR and CI of 95% to estimate the relationship between ALS and the various considered risk factors was employed.

RESULTS

The association between exposure to pesticides and ALS as a whole is weak and not significant. With regard to the results of individual studies the following critical synthesis can be reported: 1) the selected studies showed a low level of association between ALS and electromagnetic fields; 2) as regards the solvents, the association with ALS in some studies is combined with a slightly increased risk, particularly in women, and in others a slight but significant linear association is observed; 3) for the metals, in some cases there was a stronger association in women than in men; for individual metals, there was an association especially with chromium and lead; 4) lastly, with regard to the products of agricultural pesticides in general, there was an association with ALS in men but not in women, with a dose-response relationship.

CONCLUSIONS

The lack of statistically significant association between occupational exposure and ALS is mainly due to the methodological diversity of the studies and the lack of prospective studies at the workplace.

Ballet and stress. A pilot study

BACKGROUND

Work-related stress is a complex problem requiring a work environment-based assessment. Artists like dancers represent a category of atypical workers potentially at high risk for work-related stress. Aim of our pilot study is to evaluate organizational stress in a population of professional dancers, using the HSE Indicator Tool for Work Related Stress.

METHODS

We administered the Italian version of the HSE Indicator Tool to 38 ballet dancers, males and females. The questionnaire evaluates 7 key organizational dimensions: demand, control, managers' support, peer support, relationships, role and change.

RESULTS

The standards required-ideal conditions are achieved in none of the above-mentioned dimensions. Change is the only dimension for which results fall between the 20th and the 50th percentile, while for other dimensions results fall below the 20th percentile suggesting the need for immediate corrective action. In male dancers an acceptable situation is highlighted for the dimension "change" compared to female dancers. In both sexes there is a high frequency of subjects complaining of verbal abuse, bullying and harassment.

CONCLUSIONS

Despite the small sample size, our pilot study highlights the presence of heightened levels of organizational stress. Preventive measures targeted towards improving communication between managers and dancers and aimed at team building should be implemented.

Correlation between cadmium and blood counts in workers exposed to urban stressor

The objective of this study was to assess the exposures to cadmium (Cd) in urban workers and the association between Cd exposure and values of blood counts. Urinary Cd, blood Cd, and blood counts were obtained from 355 outdoor workers; a subgroup of 99 subjects were monitored to evaluate personal exposure to airborne Cd. The mean value of personal exposure to Cd was 1.5 ng/m3 for traffic assistants and 1.2 ng/m3 for drivers. Urinary and blood Cd were correlated to the airborne Cd (respectively r=3 and r=4). The multiple linear regression models showed the associations among white blood cell, the percentage of neutrophils (NEU%), the percentage of lymphocytes (LYM%), and the concentrations of blood Cd (respectively R2=27, R2=37, R2=581). The subjects with blood Cd values higher than 1.2 μg/L showed an increase of LYM% mean values and a decrease of NEU% mean values with respect to the group with blood Cd values lower than 1.1 μg/L.

Professional exposure to anaesthetic gases in health workers: estimate of some hepatic and renal tests

OBJECTIVES

The aim of this study is to estimate whether the occupational exposure to low dose of anaesthetic gases could cause alterations of haematochemical hepatic and renal parameters in the health workers of a city hospital.

MATERIALS AND METHODS

After excluding the main confounding factors, 154 exposed subjects and 98 not exposed controls were included in the study. The exposed subjects were divided in more exposed (group 1: n.54) and less exposed (group 2: n.100). Each worker included in this study underwent the CBC test (Complete Blood Count test). The differences between means were compared using the Student T test for unpaired data and considered significant when the p value was < 0.05.

RESULTS

The mean values of serum albumin, alpha 1, alpha 2, beta and gamma globulins were significantly decreased in health workers of both groups compared to controls. The mean values of serum creatinine and gamma-GT were significantly higher in health workers of group 2 compared to controls.

CONCLUSIONS

The obtained results suggest that occupational exposure to low dose of anaesthetic gases could influence haematochemical hepatic and renal parameters in exposed health workers.

Urinary hydroxypyrene and estradiol in an occupationally exposed "outdoor" population

BACKGROUND

Polycyclic aromatic hydrocarbons (PAHs) are widely present in the air pollution. The urinary hydroxypyrene (1-HOPu) is considered the main biological biomarker currently available to measure the exposure to PAH. It is supposed responsible of an increase of estradiol levels in males. Aim of this study is to verify whether there is a relation between 1-HOPu and plasmatic estradiol in non-smoker male workers.

METHODS

The study was conducted on a sample of 122 non-smoker policemen in a large Italian city; we monitored their levels of 1-HOPu and the values of estradiol. The sample was divided into three groups according to the levels of urinary hydroxypyrene. The indices of correlation (r) and multiple linear regression (β), between levels of 1-HOPu and estradiol were calculated. It was also calculated the student's t-test among the groups to check the differences.

RESULTS

We found statistically significant correlations and multivariate linear regressions between 1-HOPu and estradiol in the total sample and in group III (levels of 1-HOPu above the 75th percentile). The average levels of estradiol in group III was statistically and significantly higher than in the group I (levels of 1-HOPu below the 25th percentile) and group II (levels 1-HOPu between 25th and the 75th percentile).

CONCLUSIONS

1-HOPu in non-smoker male workers is related with an increase of plasmatic estradiol. We believe that PAHs, of which 1-HOPu is the main biomarker, can interact with the hypothalamic-pituitary axis. The preliminary results suggest that the topic needs further research on male and female as well.

Workers of the printing industry and hepatic damage

BACKGROUND

Typesetting industry is still the primary instrument of communication, despite the development of new technological systems. This study focuses on the analysis of the hepatic effects induced by the use of some organic solvents employed in the printing industry.

METHODS

We studied a group of 194 workers: 93 exposed and 101 not exposed. The level of the exposure to chemical pollutants were assessed through the environmental monitoring of blood concentrations and the analysis of airborne substances. The health survey was performed through the collection of the medical history and the use of hepatic tests, which were evaluated by calculating Mean, Standard Deviation, Student's t-test and X² test with Yates Correction, to investigate statistically significant differences in some hepatic parameters: AST, ALT, ALP, GGT, fractional and total bilirubin. The environmental data sometimes exceeded the TLV-TWA.

RESULTS

The clinical evaluation of the hepatic parameters showed statistically significant differences as to the hematic concentrations of AST, ALT, GGT.

CONCLUSIONS

The results we obtained support the hypothesis of a risk among the printing industrial workers attributable to the hepatotoxic solvents. This risk seems to be related to the use of a mixture of solvents, although at low doses, and the analysis of the results obtained confirms the validity of the investigation for the health screening protocol adopted in order to identify subjects and/or population at risk of hepatotoxicity.

Correlation between urinary nickel and testosterone plasma values in workers occupationally exposed to urban stressors

BACKGROUND

The purpose of this study is to assess whether occupational exposure to low doses of nickel (Ni) present in urban air can cause alterations in the concentration of plasma testosterone in workers of the Municipal Police of a large Italian city assigned to different types of outdoor tasks.

METHODS

359 male subjects were included in the study and divided on the basis of job, age, length of service and smoking habits. The dosage of the atmospheric Ni was performed by personal dosimetries on a sample of the workers included in the study. For each worker included in the study the dosage of whole blood Ni and of the plasma testosterone was carried out. The total sample was subjected to the independent-samples T-test and the Mann-Whitney U test for variables with 2 modes (smoking cigarette) and the ANOVA test and the Kruskal Wallis test for variables with more than 2 modes (age, length of service and job function). The correlation of Pearson with p at 2 wings between the variables was evaluated in the total sample and after subdivision on the basis of smoking and on the basis of the job. After taking into account the major confounding factors the multiple linear regression was performed on the total sample and after breakdown by tasks.

RESULTS

The correlation between the values of urinary Ni and the values of plasma testosterone on the total sample and for all classes of subdivision was found constantly negative. These results were confirmed by multiple linear regression, which indicated the Ni as the only significant variable that can contribute to the alterations of the testosterone.

CONCLUSIONS

Based on the results, the Authors suggest that occupational exposure to low doses of Ni present in the urban environment is able to influence some lines of the hypothalamic-pituitary-gonadal axis in exposed workers.

Thyroid hormones in male workers exposed to urban stressors

BACKGROUND

The occupational exposure to urban pollution may induce adverse effects on the human health.

METHODS

Plasma levels of thyrotropin stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) of 50 outdoor workers and 50 indoor workers were compared.

RESULTS

In the outdoor workers the TSH levels were significantly higher than in the control subjects (p =0.02) while the average of FT3 and FT4 values, was not significantly different compared to the controls (p > 0.05).

CONCLUSIONS

The differences found for TSH levels between outdoor and indoor workers, though not high, suggest that, due to greater exposure to environmental pollutants, the outdoor workers are more susceptible to the development of function abnormalities of the thyroid gland compared to indoor workers.

Liver damage in automotive and industrial workers of the glass

OBJECTIVE

High doses of organic solvents can cause hepatic disease. We investigated whether exposure to low doses of solvents in automotive and industrial workers may lead to changes in liver tests.

METHODS

We studied the liver parameters (glutamic oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), gamma-glutamyl-traspeptidasi (γ-GT), alkaline phosphatase (PHA), total (TB) and direct bilirubin (DB) of 24 workers exposed to organic solvents and of 30 unexposed controls.

RESULTS

A significant increase of GOT, GPT and γ-GT was found in exposed workers compared to unexposed controls workers. The ratio GPT/GOT was significantly higher among the exposed compared to controls.

CONCLUSIONS

The results confirmed the hypothesis that exposure to low doses of solvents may determine a liver damage.

[Urban individual exposure to cadmium and baroreceptor response to posture]

OBJECTIVE

Outdoor workers are daily exposed to urban pollutants. The aim of the study is to evaluate the relationship between the values of environmental monitoring collected by personal dosimetries and changes in blood pressure due to posture in outdoor workers.

MATERIALS AND METHODS

32 subjects of both sexes were enrolled in the study, we evaluated the values of environmental monitoring of breathable dust, nickel, arsenic, cadmium, lead, benzene, toluene, xylene and 16 PAHs. Blood pressure in supine and standing positions was measured in all subjects.

RESULTS

The multiple linear regression analysis showed a significant reduction of orthostatic response of diastolic blood pressure in non-smoking outdoor workers occupationally exposed to cadmium.

CONCLUSIONS

The results of our study let us to believe that exposure to low doses of urban polluted cadmium may affect the response of diastolic blood pressure to orthostatism, as per a paraphysiological condition of sympathetic down-regulation.

Can noise cause high blood pressure? Occupational risk in paper industry

OBJECTIVES

The authors hypothesize cardiovascular effects in paper industry workers exposed to noise.

MATERIALS AND METHODS

The study included 72 paper industry workers exposed to noise and two control groups not exposed to noise. The workers completed a questionnaire and underwent a medical examination, measurement of blood pressure, electrocardiogram, blood tests, audiometry and measurement of noise exposure.

RESULTS

The workers exposed to noise, all hearing impaired, were compared with not exposed and showed: significant increase of mean systolic and diastolic blood pressure values (p<0.001), higher frequency of hypertension, systolic and diastolic blood pressure (p<0.01 and p<0.001) and electrocardiografic abnormalities (p<0.05), significant reduction of blood pressure response in orthostatism (p<0.005).

CONCLUSIONS

Our results suggest that for the workers of the paper industry the noise is an occupational risk factor for cardiovascular effects.

Workers exposed to urban stressors and the effects on antidiuretic hormone secretion

BACKGROUND

The aim of this study was to evaluate whether urban pollutants can affect plasma levels of antidiuretic hormone (ADH) in outdoor workers.

MATERIALS AND METHODS

We selected 208 subjects, 104 exposed to urban stressors and 104 non exposed to urban stressors. We divided these workers in 3 groups: Group 1 (non-smokers and non-drinkers), Group 2 (smokers and not drinkers) and Group 3 (drinkers and not smokers). The means and standard deviations of ADH were calculated, and a Student's t-test was used to compare means. The data were considered significant at p ≤ 0.05.

RESULTS

The outdoor workers in Group 1 had significantly reduced plasma levels of ADH. In contrast, the outdoor workers in Groups 2 and 3 had increased plasma levels of ADH. These results were consistent in both men and women.

CONCLUSIONS

The results suggest that urban pollutants may influence the secretion of ADH.

Liver function in workers exposed of the cosmetics industry

BACKGROUND

The purpose of this study is to assess whether occupational exposure to substances used in the cosmetic factories may cause effects on the liver and blood counts in exposed workers.

METHODS

The study included 48 exposed workers and 86 unexposed controls. All workers included in the study underwent blood count, white blood count, total, direct and indirect bilirubin, transaminases, alkaline phosphatase and cholinesterase. The differences between the means and frequencies were compared using the Student's t-test and chi-square test with Yates correction and were considered significant when the p value was <0.05.

RESULTS

The analysis of the results shows that 35.4% of workers in the cosmetics industry had liver test values above the range. We noted a statistically significant higher prevalence of GPT (p <0.05) and total bilirubin (p <0.05) in the workers of the cosmetics industry compared with the control group.

CONCLUSIONS

The results obtained suggest that occupational exposure to low doses of substances used in the cosmetic industry is able to influence some liver parameters in occupationally exposed workers.

Dynamic blood pressure in workers exposed to urban stressors

BACKGROUND

The occupational exposure to urban pollution may induce adverse effects on the cardiovascular system.

METHODS

Basal blood pressure, electrocardiogram (ECG) and the dynamic blood pressure monitoring during the work shift of 16 policemen (outdoors workers) and 16 administrative employees (indoor workers) were compared.

RESULTS

The mean value of all the diastolic blood pressure surveys in policemen (84,53 ± 10,78) is significantly higher (p = 0,014) than the mean value of all the diastolic blood pressure surveys in indoor workers (82,74 ± 11.52).

CONCLUSIONS

The results of our study suggest that the occupational exposure to urban stressors may induce an increase of the diastolic blood pressure in workers during the working hours.

[Carpal tunnel syndrome and steel industry]

OBJECTIVES

The carpal tunnel syndrome (CTS) is a common working pathology. The CTS diagnosis is not so easy because neurophysiological investigations are necessary. The purpose of this study is to evaluate the working risks and the presence of CTS signs using a focused anamnestic and clinical procedure.

MATERIALS AND METHODS

We evaluated the working risks of CTS in a population of 65 male workers of a steel industry (average age 25.1 and seniority 2.82), performing 5 different tasks. The Borg Scale was used to evaluate the subjective muscle effort. Diurnal paresthesia (V1FG), nocturnal paresthesia (V1FN), hypersensitivity (V1IS), hypostenia (V1IT) were considered.

RESULTS

We identified three main working risks repetitiveness of single actions, static and prolonged posture of the truck, muscle effort. 21.5% of the workers showed at least one of the three symptoms;13.8% showed one or more symptoms; the clinical objectivity was observed in 18.5%. A relation between V1FG, V1FN, clinical objective linked to the workers age of the task 1 (p =0.035) is showed.

CONCLUSIONS

To prevent CTS, the use of the Borg Scale associated with identification of the risks and with the anamenstic-clinical investigation is useful to discriminate people at risk of CTS.

Relationship between occupational exposure to cadmium, transaminases and γ-GT in workers exposed to urban stressors

BACKGROUND

The exposure to Cd has been linked to many disease and liver is the major target organ of Cd toxicity following acute or chronic exposure.No study has ever evaluated the association between liver function tests and exposure to Cd present in urban air in outdoor workers.

MATERIALS AND METHODS

In order to assess the relationship between the exposure to urban Cd and the associated changes in liver functionality markers, we conducted a study on 110 municipal policemen divided into 2 groups according to their tasks: 60 traffic policemen and 50 drivers, underwent tests for the determination of the urinary values of Cd correlated with the blood levels of transaminases and ?-GT. Moreover we investigated the exposure to Cd in the air through a personal dosimetry on a subgroup of 40 subjects (20 traffic policemen 20 police drivers).

RESULTS

The results showed that the average personal exposure to air Cd was significantly higher in traffic policemen than drivers. Furthermore, in the subset of 40 subjects and in the total sample of 110 subjects, the mean values of urinary Cd were significantly higher in traffic policemen rather than in the police drivers. No significant difference was observed in the mean values of liver functionality in both groups.

CONCLUSIONS

Due to the few studies on the effects of the exposure to Cd in big cities, the results of the present study offers useful information about occupational exposure to Cd on the road and in the car and the lack of effects on liver function.

Exposure to solvents in health care workers: assessment of the hepatic effects

OBJECTIVES

The use of organic solvents has been linked to pathologies of different apparatuses. The purpose of this study is to analyze the liver damage induced by organic solvents.

MATERIALS AND METHODS

We analyzed 556 workers, 278 exposed to organic solvents (group 1) and 278 not exposed to organic solvents (group 2). The exposed group was further divided into 2 subgroups: group 1A (139 workers exposed to considerable doses) and group 1B (139 workers exposed to negligible doses). Mean and standard deviation of some liver parameters was calculated. Statistically significant differences between the liver parameters in the different groups and subgroups were detected using the t-test. Multiple linear regression models were used to examine the associations between laboratory parameters and the independent variable.

RESULTS

The data so far obtained showed the existence of statistically significant differences with regard to the total protein, total bilirubin, transaminase GOT and GPT, Gamma Glutamyl Transferase (gamma-GT).

CONCLUSIONS

Our results confirm that exposure to solvents can alter some liver parameters. The blood tests we used can be useful tool for the assessment of the actual occupational hazards and to verify the effectiveness of the measures taken for the prevention and protection.

Coal plant: risk, disease and prevention with on environmental impact

Urban pollution is a current problem, constituting a serious health risk. Many pollutants are present in the urban atmosphere, they are mainly anthropogenic, resulting from the combustion of coal. Several studies have shown the harmful effects of these pollutants, particularly on the respiratory system. Through a library review, we want to explore the effects on the health of general population and of outdoor workers exposed to the products resulting from the combustion of coal, in order to compare them with the estimated effects of the pollutants from the new generation coal plants, certainly less harmful to the environment. In recent years investments in "clean technologies" have resulted in a rapid and significant reduction of all polluting emissions: sulfur dioxide, dust, oxides of nitrogen, ash and gypsum resulting from the desulfurization process. To conclude in the light of the scientific literature we can say that the activation of coal plants based on technologies for the maximum containment and optimal treatment of the production cycle is essential to defend both the environment and the health of the population. Nevertheless it remains necessary to ensure a systematic monitoring of the environment of sanitation and food processing of the population living in the area, with a long-term follow-up.

[Exposure to cadmium and plasma cortisol in workers exposed to urban stressor]

OBJECTIVES

The aim of this study is to estimate the exposure to Cd in a group of roadmen compared to a group of drivers by environmental monitoring and biological monitoring of blood and urinary Cd. It aims to evaluate whether exposure to Cd can affect plasma cortisol.

MATERIALS AND METHODS

The initial sample was composed by 130 employees of Municipal Police Force (roadmen and drivers). After administration of a clinical-anamnestic questionnaire were excluded 50 subjects who presented confounding factors and 30 subjects who weren't comparable. On a final sample of 25 drivers and 25 roadmen were conducted environmental monitoring of Cd, biological monitoring of urinary and blood Cd and assessment of cortisol.

RESULTS

Personal exposure to Cd in air was significantly higher in roadmen compared to drivers (p = 0.015). Urinary and blood Cd were significantly increased in roadmen compared to drivers (p = 0.18 and p = 0.025). There weren't significant differences in plasma cortisol between drivers and roadmen (p> 0.05). The multiple linear regression analysis shows that urinary and blood Cd are dependent on the environment Cd levels and on the job (driver or roadmen) (p = 0.014 and p = 0.012) and plasma cortisol isn't dependent on blood and urinary Cd.

CONCLUSIONS

The results show a higher concentration of Cd in roadmen both in air and urine and they don't indicate an influence of exposure to low doses of Cd on plasma cortisol.

Evaluation of some cardiovascular risk parameters in health professionals exposed to night work

BACKGROUND

Shift work and night work in particular represent a risk factor for the health of exposed workers; aim of our study is to evaluate whether night work may cause alteration of some cardiovascular risk parameters in health workers.

MATERIALS AND METHODS

The research was carried out on 415 health workers, 163 exposed to night work and 252 not exposed. A blood sample was taken from each worker, between 8.00 a.m. and 10.00 a.m. before lunch time, to test total cholesterol, HDL cholesterol, and triglycerides. Blood pressure and heart rate were also measured. Workers with cardiovascular diseases, thyroid diseases, diabetes mellitus, dyslipidemia, those who made use of antihypertensive drugs, hypoglycemic and/or lipid-lowering drugs, subjects with body mass index (BMI) (kg/m2) higher than 30 were excluded.

RESULTS

In the group of exposed compared to controls, increasing values of arterial pressure and heart rate, were not significant. The mean values of total cholesterol and triglycerides were significantly higher in exposed compared to controls while values of HDL cholesterol were significantly lower.

CONCLUSIONS

Night workers have clinically significant changes in blood levels of total cholesterol, HDL cholesterol and triglycerides, such alterations are presumably related to poor food hygiene and to psychosocial stressors.

[Assessment of otoacustic emissions efficiency in diagnosis of hearing loss in workers exposed to airport stressors]

OBJECTIVES

Otoacoustic emissions are signals that originate from the cochlea, measuring them can be considered an objective method in the assessment of auditory function. In our study we wanted to examine their efficiency among normal audiological exams.

MATERIALS AND METHODS

We examined 14 workers exposed to continuous aircraft noise. They underwent ENT examination, metric eardrum test, hearing test tone audiometry system powered by 1 dB, spontaneous otoacoustic emissions and evoked otoacoustic emissions. For inclusion in the study the patients had to show bilateral normoacusia at the audiometry.

RESULTS

The variation of the audiometric tracks was statistically significant (p <0.05) at a frequency of 4 kHz. As to SNR parameter (relationship between sound/noise) we noticed a tendency of the transient-evoked otoacustic emission (TEOAE) to shift their spectral content, in particular a decrease in the high frequency response and on the other hand an increase at low frequencies. A similar trend for shifting in latency of otoacoustic waves emissions after exposure to chronic noise.

CONCLUSIONS

The measurement of evoked transient otoacoustic emissions is well tolerated by the workers and provides objective results, so it is a more effective and objective method then the tone audiometry.

Perceived stress and stress-related parameters

BACKGROUND

The purpose of this study is to evaluate, using a questionnaire developed by our research group, whether occupational exposure to physical, chemical and psychosocial urban stressors can lead to alterations in perceived stress in a group of both male and female outdoor workers. The study also examines possible correlations between the levels of stress as inferred from the scores of the questionnaire and the levels of certain stress-related parameters (prolactin levels, consumption of coffee, chocolate, alcohol and cigarette smoking).

METHODS

We evaluated a final sample of 480 subjects (342 male and 138 female). All workers included in the study were divided into three groups on the basis of scores of the questionnaire.

RESULTS

About 60% of workers showed a moderate or severe stress condition, with a statistically significant prevalence of female workers and younger subjects. There was a statistically significant correlation between the questionnaire score and the mean levels of stress-related parameters. The increase of perceived stress increases significantly the mean levels of prolactin and the consumption of coffee, chocolate and cigarettes. There was no statistically significant differences for alcohol consumption.

CONCLUSIONS

The results show that exposure to chemical physical and psycho-social urban stressors can influence perceived stress in outdoor workers. The questionnaire used in our research could be an useful instruments for physicians during the health surveillance visits

Exposure to antineoplastic drugs in health care and blood chemistry parameters

OBJECTIVES

The purpose of the research is to evaluate whether the exposure to antineoplastic drugs of health workers may cause alteration of blood chemistry parameters.

MATERIALS AND METHODS

Research was conducted on 5800 health workers employed in a hospital in a big Italian city. The final sample is composed of 57 people in charge of cytotoxic drugs compared with 57 subjects not exposed; each worker underwent a general clinical examination and determination of the following values: complete blood count (CBC), white blood cell count (WBC), total protein, BUN, total bilirubin, creatinine, GOT, GPT, alkaline phosphatase, gamma GT. Statistical analysis of data was based on calculation of the mean, standard deviation and the distribution into classes according to the nature of each variable. Differences were considered significant when p was <= 0.05.

RESULTS

The mean and the distribution of values of total bilirubin were significantly higher in the workers exposed to antineoplastic drugs than in workers non-exposed; the mean and the distribution of values of monocytes were significantly lower in subjects exposed compared to controls.

CONCLUSIONS

According to the results antiblastic drugs, at the doses used in the departments we studied, can induce an increase in the values of total bilirubin for liver toxicity and a reduction in the monocyte line due to myelosuppression.

Professional exposure to ionizing radiations in health workers and white blood cells

BACKGROUND

The aim of this study is to estimate if low dose of occupational exposure to ionizing radiations can cause alterations of plasma concentrations of total white blood cells, lymphocytes, monocytes and granulocytes (eosinophils, basophils, neutrophils), in the health workers of a big hospital.

METHODS

266 non smokers subjects of both sexes (133 health workers and 133 controls) were included in this study, compared on the basis of sex, age and working seniority. The complete blood count (CBC) was performed in all included workers.

RESULTS

The differences between the mean values were compared using Student T-test for unpaired data. The frequencies of the single variables were compared using Chi (2) test with Yates correction. The differences were considered significant when the P values were < 0.05. The mean values and the distribution of the mean values of total white blood cell were significantly decreased in health workers of both sexes compared to controls. The average values of granulocytes neutrophils were significantly low in female health workers compared to female controls.

CONCLUSIONS

The obtained results suggest that low dose of occupational exposure to ionizing radiations is able to influence some lines of the hematopoietic system in exposed workers.

[Meta analysis indices of genotoxic damage in urban pollution exposed workers]

OBJECTIVES

The aim of this study is to examine if urban pollution can modify indices of genotoxic damage.

METHODS

Research of articles inherent in the evaluation of these alterations. Differents categories of exposed workers are included in the study (cases, in number of 7287) and compaired with no exposed workers (controls, in number of 8054). To calculate the result of meta-analysis the Effect Size (ES) was used and the confidence interval was calculated.

RESULTS

In this category we evaluated 54 studies and we observed significantly differences in the complex.

CONCLUSIONS

Starting from the individual variables analysis investigated, between exposed and not exposed group, we underline the utility to deepen the studies concerning of these parameters, to appreciate their benefits and to safeguard health of exposed workers.

Occupational exposure to traffic pollutants and peripheral blood counts

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.

[Stress and information-communication technologies: from videoterminal to web]

The relationship between stress and new technologies has always been a vexed question. Sociologists and philosophers say technology is a double edged sword, on one hand it increases the potential of human senses, while on the other hand it forces man to adopt rhythms and conditions not natural but artificial, with consequences for his physical and mental health. Modern Cognitive Ergonomic tries to analyze to technology, interacting with mental functions, causes stress and it tries to offer the most appropriate technological solutions for human work. From our analysis it emerges that the old media have an influence on mood causing episodes of insomnia, irritability, anxiety, etc., even if in a way that cannot be completely evaluated. Contrariwise, a controlled use of the web can improve the communication and the interacting abilities in patients with psychosocial distress and low social skills. Nielsen's Heuristics are a great tool to value methods of informatical and media interfaces.

Meta-analysis of studies examining long-term construction injury rates

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.

[Phlebopathies and occupation]

Chronic venous disorder is a public health problem that affects the western industrialized countries. The aim of this study is to evaluate the etiology and prevalence of venous disease of the lower limb in workers, and to identify some risk factors using a detailed and systematic analysis of the literature from 1964 to 2011. There is an important relationship between standing position at work and venous disease. The prolonged orthostatic position of the body implies: venostasis, high pressure and risks of blood clots and thrombosis; in standing workers there is an overproduction of reactive oxygen species (ROS) with oxidation of the components of cell membranes, endothelial damage and increase in vascular permeability. Other risk factors were investigated: sitting during work time, weight lifting-moving and exposure to heat sources, the data suggest that this risk factors are less important than orthostatic body position. Age, sex and familiarity are relevant as the extra-occupational risk factors. For a more accurate study of the role of the prolonged orthostatic position on the development of venous disease in the lover limb all authors should define exactly the population, the role and the length of standing time at work. They should also set a universal language to define the correct standing position (ie. within 1 m2 or steps) and time (ie. one hour or 50%-70% of work time). Attention should be given to prevention, to use early therapeutic measures in view of mortality as a consequence of venous disease, of the high social costs related to the loss of working days, of medical care and of residual disability.

Arsenic and peripheral blood count in workers exposed to urban stressors

OBJECTIVES

Previous studies have shown that arsenic at high doses can alter the hematopoietic system. The purpose of the present study is to see whether the same problems may be caused by chronic exposure to low doses.

MATERIALS AND METHODS

A sample of 349 policemen of a big urban city was divided into 3 groups according to levels of urinary arsenic. The subjects were further divided according to gender, smoking habits, and work task. We calculated indices of correlation (r) and multiple linear regression (β), between urinary arsenic, RBC, WBC, HB, HT, MCV, MCH, MCHC, platelets, reticulocytes and leukocyte formula (percentage of lymphocytes, monocytes, neutrophils, eosinophils and basophils). It was also calculated Student's t and chi-square test between the various groups to check for any differences.

RESULTS

We found several statistically significant indices of correlation and regression (p(two-tailed) <0.05) between urinary arsenic, red blood cells, white blood cells, hemoglobin, hematocrit, reticulocytes, and all the cell lines of the white series.

CONCLUSIONS

Chronic exposure to low doses of arsenic seems to cause decrease in red blood cells, hematocrit and hemoglobin. However, this response is dependent on the amount of absorbed dose, according to an ormetic mechanism. With regard to the white series, arsenic seems to provoke an inflammatory response; the scarcity of literature" available, and the great variety of results, however, not allow us to definitely characterize the damage caused by this metal on white series.

[Asbestos risk: risk assessment and prevention]

Asbestos is a very relevant medical and social issue, because of its potential dangerous effects on human health. It's present indeed in different environments, because it was widely used in the past. Asbestos is classified as first-class carcinogen, and so labelled with R 45 risk phrase. Exposure to asbestos fibers (both occupational and not) can cause diseases involving mainly the respiratory system. We point out the methods for a correct assessment of the risk from asbestos, with particular reference to current legislation and to the main preventive measures that have to be taken in case of presence of asbestos in a building. A correct prevention has to be carried out through education and information of workers and the use of specific check-lists.

[Urban stressors and thyroid hormones]

OBJECTIVES

The aim of the study is to evaluate whether occupational exposure to urban stressors could cause alterations in thyroid hormones plasma levels (TSH, FT3 and FT4) in female outdoor workers vs. administrative.

MATERIALS AND METHODS

The study has been performed on an initial sample of 198 female subjects divided in two groups (occupationally exposed and not exposed to urban stressors). After excluding the subjects with the main confounding factors, female outdoor workers and administrative staff were matched by age, working life and drinking habit.

RESULTS

In 40 female outdoor workers mean plasma TSH levels were significantly higher compared to 40 administrative staff. The distribution of TSH values in outdoor workers and in administrative staff was significant. Plasma FT3 and FT4 levels were not significantly different in the two groups. Our results suggest that exposure to urban stressors (chemical, physical and psycho-social), can alter the plasma concentration of TSH.

CONCLUSIONS

According to our previous research, plasma TSH levels may be used as an early biological marker of chronic exposure to urban stressors, in occupational set even before the onset of the related disorders.

[Media Studies: a diachronic and cross-curricular approach]

Studies on Media have generated analysis and remarks involving many different disciplines. We have just entered the age of Mass Communication. Each media (papers, radio, movie, TV and web too) wants to interpret reality and offer it to its audience. Each message coming from media is sifted and proposed according to the structural and technical characteristics of the media itself (as M.McLuhan said "the medium is the message"). In time there have been interpretations in favour or against as well, as experts detractors or defenders of media; U Eco called them "apocalyptic" and "integrated". In Medicine there are many different pathologies referable to excessive or incorrect utilization of mass-media: obesity due to high-calorie intake caused by sedentary use of TV, anorexia caused by forced imitation of models created by media, anxiety and sleeping disorders in teen-agers caused by watching TV news. Research are being carried out on mental effort due to incorrect use of screen, similar to the research on VDU operators. Categories gathered from Cognitive Ergonomics are suggested to hypothesize models of correct use of media and maybe the capacity of getting free from the influence of media so that aware audience can have a conscious perspective and not the perception of reality based entirely on the use of any media.

[Protection of working woman's health]

INTRODUCTION

In the past the role of women was mainly that of wife and mother, over the centuries, this role has changed: women assert themselves in every social field and workplace.

OBJECTIVES

Analyze the history of women's work, from prehistory to the present day highlighting the evolution of women's role over the centuries. Identify which may be the different occupational stressors, in particular the organizational and psycho-social ones, to which is submitted a working woman.

MATERIALS AND METHODS

The authors have analyzed the most relevant data from literature, in particular on the issue of mental health.

RESULTS

Provide the main forms of prevention that have to be implemented.

DISCUSSION

The main challenge for women today, is to balance work outside the home and housework. This added to job stressors, may interfere with the psychological and physical wellbeing of the worker.

[Radon risk and prevention]

The chemical element Radon is the strongest source of natural ionizing radiations for men and it is responsible of some patologies, such as lungs cancer. The concentration of this gas in houses is in Italy on average 70-75 Bq/m3. Apart from a regulative first step, represented by the 2002 Radon National Plan, at the moment there are no specified rules regarding the risks of exposition to radon in general population. On the contrary, safeguarding workers exposed to natural sources of radiation, working places are regulated by legislative decrees. In order to carry out corrective actions in case of high rates, it is necessary to correctly measure the expositional levels both with active and passive instruments. The topical knowledge about radon and its effects urge us to take preventive and reductive measures, protecting the well-being if population.

[Meta-analysis: effectiveness of the preventive interventions in agriculture accidents]

The aim of our study is to determine the effectiveness in reducing workplace accidents in agriculture using preventive interventions including awareness and effective knowledge of hazards with workers who followed training-informative programs. On the basis of the data reported in the 11 studies three categories we identified: Reduction in the number of workplace accidents: comparison between groups; Reduction in the number of workplace accidents: before-after comparison; Self-rating of injuries risk reduction. The second category showed significant statistical differences in the subgroup who followed preventive intervention compared to subgroup who did not follow this intervention. The third category showed a significant statistical increase of the Consciousness Index of the agricultural workers who followed the training-informative programs. The results suggested the need to use assessment models more suitable to the nature of the examined variables. A promising area is the evaluation of knowledge of risks achieved by workers exposed to formative-informative programs.