Municipality-Level Characteristics Associated with Very Low to Good Quality of Water Fluoridation in São Paulo State, Brazil, in 2015

INTRODUCTION

Community water fluoridation (CWF) is a measure of recognized importance due to its effectiveness in preventing tooth decay at the population level. However, for the maximum benefit to be achieved, the high-quality standard of CWF must be maintained over time.

OBJECTIVE

To analyze the municipality-level characteristics associated with quality of water fluoridation in São Paulo state, Brazil.

METHODS

An ecological study was performed using official data sources on fluoride concentration surveillance in 2015. The outcome was municipalities that have not met the quality standard, identified as those with less than 80% of water samples within the optimal level for caries prevention. The independent variables were municipality-level indicators related to demographics, economics, and sanitation characteristics. Crude and adjusted prevalence ratios were estimated using Poisson regression with robust variance.

RESULTS

In total, 43.4% municipalities exhibited the outcome. Adjusted by Gini index, the prevalence ratio was 32% higher in municipalities with lower annual gross domestic product per capita. Adjusted by social responsibility index and earlier variables, the prevalence was higher in the municipalities with higher per capita expenditure on sanitation and health surveillance, where the urban population rate was lower, and with a human development index ≤0.761. Adjusted by earlier variables, the prevalence ratio was twice and 3.5 times higher for municipalities, respectively, with per capita income less than or equal to US$574 and where the type of sanitation utility was municipal and private; 50% higher in those with less than 100,000 habitants; and 20% higher in those with a chlorine concentration nonconformity rate above 0.82%.

CONCLUSIONS

To ensure high quality of CWF, additional management measures should be implemented in municipalities with less than 100,000 habitants, a higher chlorine concentration nonconformity rate, a lower per capita income, and where the type of sanitation utility was municipal or private.

KNOWLEDGE TRANSFER STATEMENT

The study showed that the quality of fluoridation was associated with municipality-level characteristics. The findings can be used by policy makers to identify and support municipalities that will need to improve fluoridation quality if they are to reach oral health goals.

Measuring multimorbidity inequality across Italy through the multisource comorbidity score: a nationwide study

Background

Multimorbidity is a growing concern for healthcare systems, with many countries experiencing demographic transition to older population profiles. A simple multisource comorbidity score (MCS) has been recently developed and validated. A very large real-world investigation was conducted with the aim of measuring inequalities in the MCS distribution across Italy.

Methods

Beneficiaries of the Italian National Health Service aged 50–85 years who in 2018 were resident in one of the 10 participant regions formed the study population (15.7 million of the 24.9 million overall resident in Italy). MCS was assigned to each beneficiary by categorizing the individual sum of the comorbid values (i.e. the weights corresponding to the comorbid conditions of which the individual suffered) into one of the six categories denoting a progressive worsening comorbidity status. MCS distributions in women and men across geographic partitions were compared.

Results

Compared with beneficiaries from northern Italy, those from centre and south showed worse comorbidity profile for both women and men. MCS median age (i.e. the age above which half of the beneficiaries suffered at least one comorbidity) ranged from 60 (centre and south) to 68 years (north) in women and from 63 (centre and south) to 68 years (north) in men. The percentage of comorbid population was lower than 50% for northern population, whereas it was around 60% for central and southern ones.

Conclusion

MCS allowed of capturing geographic variability of multimorbidity prevalence, thus showing up its value for addressing health policy in order to guide national health planning.

Effectiveness of adherence to recommended clinical examinations of diabetic patients in preventing diabetes-related hospitalizations

Objective

To validate a set of indicators for quality of diabetes care through their relationship with measurable clinical outcomes.

Design

A retrospective cohort study was carried out from 2010 to 2015.

Setting

Population-based study. Data were retrieved from healthcare utilization databases of three Italian regions (Lombardy, Emilia Romagna and Lazio) on the whole covering 20 million citizens.

Participants

The 77 285 individuals who were newly taken in care for diabetes during 2010 entered into the cohort.

Interventions

Exposure to selected clinical recommendations (i.e. periodic controls for glycated hemoglobin, lipid profile, urine albumin excretion, serum creatinine and dilated eye exams) was recorded.

Main outcomes measures

A composite outcome was employed taking into account hospitalizations for brief-term diabetes complications, uncontrolled diabetes, long-term vascular outcomes and no traumatic lower limb amputation. A multivariable proportional hazards model was fitted to estimate hazard ratio, and 95% confidence intervals (CI), for the exposure-outcome association.

Results

Among the newly taken in care patients with diabetes, those who adhered to almost none (0 or 1), just some (2 or 3) or almost all (4 or 5) recommendations during the first year after diagnosis were 44%, 36% and 20%, respectively. Compared patients who adhered to almost none recommendation, significant risk reductions of 16% (95% CI, 6–24%) and 20% (7–28%) were observed for those who adhered to just some and almost all recommendations, respectively.

Conclusions

Tight control of patients with diabetes through regular clinical examinations must to be considered the cornerstone of national guidance, national audits and quality improvement incentives schemes.

[Measles, mumps, rubella and varicella: antibody titration and vaccinations in a large hospital]

The occurrence contagious diseases such as measles, varicella, mumps and rubella in the hospital open creates situations of alarm, due to the potential involvement of workers, but most importantly for the oftentimes harmful consequences for critical patients, such as pregnant women or immunocompromised individuals. In 2007 antibody titration was initiated in our hospital for four infectious diseases, also pursuant to the Lombardy Region Resolution N. VIII/1587 of 22-12-2005 "Decisions regarding vaccinations in children and adults in the Lombardy Region" which indicate the departments in which a priority exists: maternity-neonatal and infectious illnesses. In 2011 a vaccination campaign was launched for unprotected operators in the Health and Medical Management departments: after an interview with the competent physician of reference, the subjects voluntary submitted themselves to vaccination. The protective antibody data encountered over the years are similar to that reported in the literature, with coverage percentages greater than 93% for varicella and rubella, over 89% for measles and over 85% for mumps. Approximately 80% of the operators are protected against all four diseases. However, the dramatic consequences of potential contagion lead us to strongly recommend vaccinations for non-protected subjects. At present 37 operators have been vaccinated with the trivalent MMR vaccine (Measles, Mumps and Rubella) and 14 for Varicella. The antibody response was verified in all cases.

[The role of the factory doctor in the health promotion of workers: the experience of the "WHP Bergamo" network]

In Bergamo there is a huge network of 46 "health promoting companies" following an accreditation system which requires the implementation of best practices on health promotion in the workplace. For some of these practices, Company Doctor are involved: management of smokers and workers with alcohol consumption; courses for employees about WHP, use of SMS and web-based systems. Local Public Health Authority has created an annual training which also provided tools to Doctors for their activities in the project. Nowadays 55 doctors have been trained. For Accreditation 2012 eight companies will declare as good practice the training of its CD about smoking and three companies their activities on alcohol abuse prevention and control.

[Restrictions on night work: analysis of case studies in a large Lombardy Hospital]

A high percentage of the division's doctors and employees work at night to guarantee urgent assistance and diagnostic services to patients. Night work is not recommended for persons with rather serious case histories due to the disruption of circadian rhythms or the increased workload required of certain operators during nighttime hours. All of the evaluations of health operators with a limited capacity to work on the night shift in our hospital were analysed, except for female workers restricted from night work during pregnancy or puerperium, as provisioned by the regulation that protects working mothers. Forty-two cases were considered (six physicians and 36 operators in the division) out of a total of 2676 employees assigned to night work and the conditions that led to the formulation of the decision are divided as follows: 16 Mental disturbances currently subject to treatment (depression, post-traumatic anxiety disorder, primary insomnia...), 8 Tumours (breast, colon, Ewing Sarcoma), 7 Neurological disorders (multiple sclerosis, myasthenia), 6 Cardiovascular disease (previous IMA; arrhythmias, arterial hypertension not controlled by theraphy) and 5 others patologies (total 45). The cases will be analysed in detail with an analysis of the characteristics of the exempt group of workers and with reference to the temporary or indefinite nature of the exemption.

[The role of the occupational physician in disabled return to work]

Workers, former workers or unemployed workers with disabilities of various kinds often come to the Occupational Health Hospital Department (UOOML), requiring a report on their fitness for work that often is generic or not suitable for specific situations: a detailed knowledge of both working and health conditions, mainly disabilities and job items are needed. The UOOML was never directly involved in the proceedings of targeted fitting-up of the disabled people, while some Doctors of the Department of Prevention of ASL have an advisory role participating in the Technical Committee under Law 68 and the 'Disabled Commission'. INAIL (the National Insurance Institute for Occupational Accidents and Diseases), in case of allocation of percentages of disability higher than 33% (necessary requirement for the targeted employment) provides an assessment of the 'residual capacity'. The Company Occupational Physician cooperates and intervenes in the management of the employment of the disabled worker in very different ways and at several stages of the path of integration or reintegration. Considering the prolonged and effective cooperation among the Doctors of the UOOML and the Psysiatrists of our Hospital, we are developing a specific out-patients' department where a report on the fitness for job, as close as possible to the patient/work-task compliance, is provided to the disabled.

[Diet of neutropenic patients in pediatric oncology service; the experience of the university hospital of Strasbourg (HUS)]

OBJECTIVE

This article clarifies the choices made by the HUS concerning the ways of preparing food reserved to neutropenic children hospitalized in pediatric oncology service. We will describe the results of microbiological analysis of food realized from 2002 to 2007.

METHODS

A specific team prepares this food which is canned and treated by "appertisation" (autoclaving). Each dish portion produced is provided to the service only if the microbiological results are conform, that is to say free of organisms.

RESULTS

Three thousand and seventy-eight dishes were analysed: 82.9% of the analysed packs were conform. The contamination ratio decreased significantly (P<0.001) from 2002 to 2007. The organisms which cause the majority of dishes contamination are Bacillus (44.7%) and environmental mould exhibiting sterile mycelium (8.7%). The food which is the most frequently "nonconform" is the dry food with a contamination rate of 37.9%. The identified concentrations remain mainly lower than 50 colony-forming units per millilitre (CFU/mL): 66.2% for the bacteria and 97.2% for the fungi.

CONCLUSION

Considering the lack of consensus on the acceptable microbiological thresholds and on the food protection level, the HUS make it a rule to have a maximal precautionary principle. Currently, this principle appears to us to be a safety option required for the patients hospitalized in pediatric oncology service.

[Tuberculosis. Focus on risk assessment and health surveillance in health workers: results and perspectives of a multicenter working group]

INTRODUCTION

Tuberculosis (TB) is still a threat for healthcare workers (HCW), due to the non decreasing incidence, the spread of drug-resistance, the introduction of new tests for the screening, the relevant costs of surveillance of exposed subjects. These issues implicate a revision of activities to prevent TB in health-care settings.

METHODS

A multidisciplinary working group, led by occupational physicians, examined the activities to prevent TB performed in 9 Italian hospitals and reviewed the literature, with the aim to formulate evidence-based procedures.

RESULTS

In the considered hospitals, 23.000 HCW are classified as exposed to TB, out of 32.000 HCW exposed to biological risks; yearly, about 6000 subjects are screened for preventive, periodical or post-exposure surveillance and 110-130 chemoprophylaxis are prescribed. A high proportion of HCW (54-75%) refused or interrupt to assume the drugs. In the period 2004-2008, 14 occupational TB were diagnosed (9/100.000 HCW exposed to biological risks).

DISCUSSION

Critical issues are the availability of a specific, written TB control plan, including risk assessment, protocols for identifying, evaluating, managing infectious TB patients, health surveillance, education programs, specifically addressed to increase Standard Precaution adoption and compliance to the screening and to adequate risk perception. Risk assessment identify HCW to be included in TB testing (characterized by low positive predictive value), unrecognized TB and environmental control needed; TB risk classification should include no more than 3 or 4 classes and performed by assessing the issues suggested in the Italian guideline. Tubercolin skin test should be used for HCW screening, adding in vitro test in specific circumstances (for example, skin test positivity in BCG vaccinated HCW); the frequency of the screening should not exceed 2 years. Periodical revision of preventive activities should follow up to date scientific literature and need appropriate data computing.

[Focus on risk assessment in health environments: results and perspectives of a multicenter working group]

The hospital risk assessment (VdR) is certainly a relevant issue concerning the activities of prevention for the health of healthcare workers in relation to biological risk. The aim of this paper is to provide an up-date of the issue, based on the suggestions of recent literature about the rules ratified by the new legislative decree and data supplied by the Group of 10 Hospitals participated in this multicenter study. From the analysis of data on healthcare settings (HCS) participating in the project the following considerations can be formulated: i) All HCS considered VdR from biological agents. The method recommended in the Guidelines SIMLII 2005 is the most followed ii) To grading the risk, the use of invasive procedures for carrying out the analysis results is a necessary element iii) the operators classified as exposed to biological risk, and therefore subject to health surveillance, represent almost all of workforce in 7 out of 10 HCS. The subgroup believes that VdR must be conducted in close collaboration with the occupational physician and should represent a worthwhile investment with spin-off character on prevention, decision making, empowering. The presence of environmental requirements and organizational procedures should be considered, so that HCS is enabled for an effective risk management, without which risk assessments cannot be performed. The method of VdR mentioned in the guidelines MLIS 2005, besides being the most widely used by the company participating in the study, still has practical reasons and opportunities to justify its use. The HCS group felt the need to propose an implementation of the definition of invasive procedures and EPP, together with individual assessment. Flexibility was suggested in identifying different levels of risk with the involvement of occupational physicians, especially in the presence of EPP, also in order to plan content and frequency of health surveillance.

[Exanthemic diseases (measles, chickenpox, rubella and parotitis). Focus on screening and health surveillance of health workers: results and perspectives of a multicenter working group]

BACKGROUND

Nosocomial transmission of varicella-zoster virus, certain paramixovirus and rubivirus might pose a risk of morbidity for varicella (V), rubella (R), mumps (Mu) and measles (Me) in health care workers (HCW), patients and coworkers. International literature and European legislation recommend preventive interventions to minimize the risk.

METHODS

A literature review and a seroprevalence study were carried out in 9 hospitals located in north and central Italy, in order to evaluate risk assessment, health surveillance and fitness for work of HCW exposed to V, R, Mu and Me. Antibodies (Ab) against V, R, Mu and Me were determined. For a subgroup of 4 hospitals; sociodemographic, occupational data and sera were collected and analyzed.

RESULTS

About 36000 tests on about 9000 HCW were analyzed. Differences in seroprevalence ratios (V 85.7-95.1%, R 47-96.8%, Me 71.4-97.8%, Mu 52.5-87.6%) were detected. In a subgroup, a relevant number of non immune HCW was also found among women infertile age and areas at higher risk. Statistically significant differences were detected only for selected variables and viruses.

DISCUSSION AND CONCLUSIONS

Data of multicenter study confirm literature evidences and allow to define good medical practices for manage and minimize the risk of nosocomial transmission of V, R, Me and Mu. Recommendation are issued about serologic screening on HCW exposed to all 4 viruses thorough the modern analytical techniques, in order to assess risk on individual a group basis and to select priorities for intervention. Vaccination should be prescribed for those HCW non immune, selecting areas and HCW according to priorities.

[Focus on coverage and promotion of anti influenza vaccine in health workers: results and perspectives of a multicenter working group]

INTRODUCTION

The influenza illness is a concern for health care workers (HCW) due to the potential nosocomial transmission and sickness absenteeism. Immunization and Isolation Precautions might be effective preventive measures.

AIMS

To formulate recommendations on vaccination in healthcare settings.

METHODS

A multidisciplinary working group, led by occupational physicians (OP), examined the information on seasonal influenza immunisation campaign in 9 Italian hospitals in the period 2005-2009 and reviewed scientific evidence.

RESULTS

Many health organizations recommend vaccination of HCW. The literature shows that seasonal influenza vaccination of healthy adult have a modest effect in reducing work day lost; there is no evidence that it affects transmission or it prevents the disease in elderly residents. These observations might be conditioned by methodological limitations. Further studies are required to avoid the risk of bias and in pediatric settings. The rate of flu vaccination among HCW is widely variable and it depends on individual risk perception and information about efficacy and side effects. In the considered hospitals, in the five-years period the vaccination rate ranged between 0 and 29%: the median value was 16-17% in 2005, 2008 and 2009 (only against H1N1 influence), 11% and 13% in 2007 and 2006 respectively. OP participation in the vaccination campaign seems to increase the immunization rate.

DISCUSSION

Seasonal influenza immunization of HCW might be effective. We recommend to formalize written procedures in health care settings, to perform data computing and to periodically revise immunization activities and promotion and scientific literature, with the aim to appropriately address resources.

[Focus on health surveillance of health workers exposed to blood-transmissible biological agents: results and perspectives of a multicenter working group]

The biological risk from exposure to bloodborne pathogens in health care environments represents a frequent and widespread risk, involving a large number of exposed workers. On the basis of the available scientific innovations, the recent legislation regarding health and safety of workers and the experiences of SIMLII guidelines on health surveillance (HS) workers exposed to biological risk, a multicenter study was carried out, involving nine relevant hospitals and about 32 000 healthcare workers (HCW). A review of the literature was performed, with particular reference to the last 10 years. For each hospital, protocols of HS have been examined according to tasks and biological risk from bloodborne viruses (HBV, HDV, HCV, HIV) as well as management of HCW infected with this pathogens. Differences of risk management in the hospitals, in relationship also with recommendations of the literature have been evaluated. The literature supplies important indications for HS management of HCW exposed to bloodborne pathogens, with relevant information also for patient safety. Preventive examinations are in line with the recommendations of literature and similar across the hospitals for HCV and HIV, while they are different for HBV. Periodic surveillance was different for the frequency, among the hospitals and also as compared to national SIMLII guidelines. As for management, no differentiation among the hospitals was detected as referred to different risk of exposure, while differences were observed around definitions of restrictions. Finally, good medical practices to support occupational physicians in the prevention and management of HCWs' exposed to biological risks are suggested.

[Job fitness management regarding university school of nursings students: our experience over three years (2005-2007)]

Based on definition of worker according to D.Lgs.626/94, art.2, c.1 also the University Students before to start their pratical training in Hospital must be submitted to sanitary surveillance by Occupational Health Physician. Aim of this paper is to report about the Job Fitness Management regarding no. 231 University School of Nursing's Students that in some cases has involved the formulation of limitations and/or prescription.

[Chronic fatigue syndrome: from misunderstood illness to cause of job fitness management problem and of work total disability in a physiotherapist. Case report]

The aim of this paper is to report the case of a Physiotherapist working in a big hospital, affected by Chronic Fatigue Syndrome (CFS). After the diagnosis, made in an High Specialized Center, the Occupational Health Physician, with the cooperation of the Nursing Managing Direction, the Chief of the Department of Rehabilitation and the Physiotherapists Coordinator, had to cope with the job fitness management. Afterwards the patient, in accordance with the Physician of a Trade Union Medical Office and the Occupational Health Physician, tried to obtain the disability pension, that at the end was given by the Medical Commission of the ASL.

[Vaccination and immunization in healthcare workers, towards specific infections: measles, varicella, rubella and mumps. The experience in a hospital in Lombardy]

Lombardy Region, with the Deliberation NoVIII (22-12-2005), about vaccinations in childrens and adults, suggest to offer to the healthcare workers (HCW) of 'Infectious diseases' and of 'Obstetrics and 'Pediatrics' Department, the vaccines for varicella and measles, mumps and rubella (MMR). We performed in 120 HCW of our hospital the dosage of antibodies versus these infectious diseases, in order to protect both workers and critical patients. The study results show that more than 80% of the HCW was immune to all the four infectious diseases. The percentage of immunisation to measles, varicella and rubella exceeded the 90%, while 87.5% of HCW was immune to mumps. We are going to offer the vaccine to the operators that are not immune, but we are also thinking about offer it to the HCW working with critical patient.

[Health surveillance in noise exposure]

The Occupational Health Department of Bergamo Ospedali Riuniti and Occupational Health Public Services set up a project in order to check the health surveillance quality in noise exposed workers. 887 hearing threshold tests, performed between 1998 and 2002, were examined; the audiograms concerned 304 workers exposed to industrial noise higher than 85dB(A), employed in 22 textile, mechanical, wood, stone, building and paper industries. After examining the 887 audiograms we noticed that the health surveillance of noise exposed workers up to now, 14 years after the issuing of the Legislative Decree 277/91, reveals many critical situations, showing an inadequate accuracy and possibility of interpretation of the audiometric tests.

[Occupational disease in construction work]

BACKGROUND

There are very few studies in the Italian and international literature concerning occupational diseases and their prevention in the building industry.

OBJECTIVES

The aim of this study was risk assessment in the building industry.

METHODS

We analyzed the international literature and the results of our cross-sectional study, which involved more than 1000 workers.

RESULTS

The analysis of several studies and of our experience suggests a high occupational risk in this field and shows as main risk factors: noise, dusts, fibers, manual lifting, prolonged static positions, repetitive motions, hand-shoulder and whole-body vibrations, chemicals and weather conditions. In addition, non-occupational risk factors can influence health: e.g., habits and lifestyle, like hypercaloric diet, cigarette smoking and alcohol consumption.

CONCLUSIONS

Preventive measures and training initiatives are urgently needed to improve the safety and the health among building workers.

[Health surveillance in construction]

In the Italian and international literature there are very few studies about work diseases and their prevention in the construction's compartment. The analysis of the most recent articles about this theme, however, suggests the presence of an high professional risk in the compartment and indicates as the most relevant risk factors noise, dusts, fibres, manual lifting, prolonged fixed postures, cumulative trauma disorders, vibrations, chemical substances and climatic conditions. The role that extra-lavorative risk factors can play on health is also relevant; those risks are due to the workers' peculiar life-style: hyper caloric diet, smoke and use of alcohol. Interventions of medical hygienic prevention, formation and information are therefore necessary. Lombardy Region, which from many years is careful to the problems about the prevention in building yards, has created a Working party who has elaborated the "Guide Lines for the sanitary surveillance in the building industry". The indications reported in the Guide Lines could represent, even for the occupational-doctors of the building contractors of the New Hospital, a good base for the working out of the workers' health care activity, in the respect of the dues of the law in force.

Neurobehavioral functions in operating theatre personnel: a multicenter study

The study was conducted to evaluate neuropsychological symptoms, subjective stress and response speed functions in subjects occupationally exposed to low levels of anesthetic gases. A group of 112 operating theatre personnel exposed to anesthetic gases (nitrous oxide and isoflurane), and 135 non exposed hospital workers from 10 hospitals in Northern Italy were examined before and after the shift on the first and the last day of the working week. Three different tasks were administered: a complex reaction time test (the Stroop Color Word); a questionnaire for neuropsychological symptoms (EURO-QUEST); the block design subtest (WAIS). Biological and atmospheric indicators of exposure were measured. In the exposed group, the geometric mean of urinary nitrous oxide at the end of the shift was 7.1 micrograms/l (95th percentile 12.4, range 1.5-43) on the first and 7.8 micrograms/l (95th percentile 21.5, range 1.0-73.3) on the last day of the working week. On the same days, end of shift urinary isoflurane was 0.7 microgram/l (95th percentile 2.6, range 0-4.7) on the first day and 0.8 microgram/l (95th percentile 2.0, range 0-5.6) on the last. The exposed and control subjects were comparable for both basic intellectual abilities and subjective stress levels. No statistical differences were observed between exposed and control subjects for neuropsychological tests and symptoms. No dose-effect relationships were observed between the exposure indicators and the test results. In conclusion, no early behavioral effect on the central nervous system was detectable at the exposure levels measured. The biological exposure limits of 13 micrograms/l for nitrous oxide and 1.8 micrograms/l for isoflurane corresponding respectively to the atmospheric concentrations of 25 ppm and 0.5 ppm seem to be adequately protective for the integrity of workers' neurobehavioral functions, as measured with the tests used.

Colour vision loss in workers exposed to elemental mercury vapour

We evaluated colour vision in 33 workers exposed to elemental mercury (Hg) vapour and in 33 referents matched for sex, age, alcohol consumption and cigarette smoking. The results were expressed as colour confusion index (CCI). In the workers urinary excretion of Hg (HgU) ranged from 28 to 287 micrograms/g creatinine. Subclinical colour vision loss, mainly in the blue-yellow range, was observed in the workers. This effect was related to exposure, as indicated by the correlation between HgU and CCI (r = 0.488, P < 0.01). In the workers whose HgU exceeded 50 micrograms/g creatinine, mean CCI was significantly increased compared to the matched referents. The results suggest that exposure to elemental Hg inducing HgU values exceeding 50 micrograms/g creatinine can induce a dose-related colour vision loss.

Hard metal disease: eight workers with interstitial lung fibrosis due to cobalt exposure

Eight hard metal workers exposed to cobalt containing dust (four producers of stone-cutting cobalt-diamond wheels and four grinders of hard metal tools) and affected by interstitial lung fibrosis have been examined. A close relationship between cobalt exposure and clinical findings was observed in six patients who were still working. The clinical picture ranged from minor symptoms to manifestations resembling those of hypersensitivity pneumonitis, with fever, weight-loss, non-productive cough and dyspnea. A restrictive impairment of the ventilatory function was prevalent. The chest roentgenogram of one patient showed a diffuse reticular nodular pattern, while the others presented a mild reticular accentuation of the interstitium. In five patients, bioptic specimens of the lung parenchyma showed interstitial collagenic fibrosis with inflammatory cells infiltrating the alveolar septa. An increased number of lymphocytes and polymorphs was reported in the bronchoalveolar lavage (BAL) fluid from seven patients. Giant multinucleated cells were present in the BAL of four subjects while an inversion of the helper-suppressor ratio was evident in those patients who were still exposed to cobalt when BAL was performed. In this study, the causal role of metallic cobalt inhalation in the etiology of the lung disease is examined and discussed.

Health survey of workers occupationally exposed to cobalt

The results are presented for a health control program using 236 male workers exposed to a cobalt inhalation risk. The study group consisted of grinders, producers of diamond tools, workers in metallurgical and mechanical industries (where Widia tools are processed and sharpened), and finally formerly exposed workers. All subjects received a clinical examination, the European Community for Coal and Steel questionnaire on respiratory complaints, a chest X-ray, pulmonary function test, electrocardiogram and determination of urinary cobalt; in 91 subjects, the metacholine bronchial provocation test was performed. Three cases of interstitial lung disease were identified. There were no cases with a significant alteration of ventilatory function while 20 cases (16 exposed and four formerly exposed workers) showed a reduced carbon monoxide transfer coefficient (TL,CO,sb/Va).

[Neurobehavioral effects of inhalation anesthetics used occupationally: a critical analysis]

Unlike other apparatuses, the potential effects on the nervous system of occupational exposure to anaesthetic gases have not been exhaustively reviewed. Because of the relevance of these effects, their significance of the quality of life of the exposed subjects and of the increased risk inherent in their delicate work tasks, these themes deserve the greatest attention. This paper briefly examines the data from the international literature as well as the neurobehavioral methods employed, underlines the existing gaps of knowledge and eventually proposes strategies aimed at filling these gaps of knowledge.

[Sanitary surveillance of workers occupationally exposed to volatile anesthetics: proposal for a computerized program for data collection and processing]

The aim of this work is to present a computerized program for an epidemiological evaluation of the data relevant to workers occupationally exposed to anesthetic gases and of the related occupational risks. The great handiness, the speed of execution, the possibility of carrying out researches by mean of multiple variables correlation and the prompt availability of the data, are the distinguishing features of this program.

[Clinico-anamnestic survey in health professionals exposed to volatile anesthetics]

The authors describe the results of a preliminary clinical survey of a group of 220 health workers, physicians and 151 nursing and auxiliary staff members of a large regional hospital in Lombardia, who are exposed to volatile anaesthetics. Contact dermatitis, varices of the legs and arthrosis, particularly that of the cervical and lumbar tract, are the most frequently reported disease in our population. In 75% of cases these disturbances arose after the beginning of the job working in the operating-theatres. When compared with a control group there was a statistically significant difference for contact dermatitis (p less than 0.01) and cervical tract arthrosis (p less than 0.02). The statistical comparison among the subjects exposed to the anaesthetics gases, who were stratified on the basis of the level of exposure and of seniority, confirms a higher prevalence of symptoms due to a reduction of alertness and of psychological and psychomotorial performances in the more exposed personnel. The comparison between female staff exposed and not-exposed to the gases did not show an increase of abortivity, while a statistically significant difference was evident between the female staff (either exposed or not-exposed) and the wives of male workers not exposed to the anaesthetics gases.

[Acute hepatonephritis in a subject occupationally exposed to chloroform]

We describe a case of acute hepatonephritis in a worker of a pharmaceutical factory, due to sporadic and short exposures to chloroform at levels even 70 times higher than its TLV.

[Monitoring of laborers previously exposed to aromatic amines, in accordance with Circulars No. 46 of 12/6/1979 and No. 61 of 4/6/1981 of the Ministry of Labor]

The present report deal, a year after its beginning, with the results of a programme for health control regarding 592 ex-employees of Società Bergamasca Industrie Chimiche. Azo dyes were obtained from benzidine and beta-naphthylamine in this factory from 1947 to 1968. The report analyses the organizing difficulties and the troubles which caused a scarce performance of the programme at different levels: the subjects interested in the control, the Commission responsible for the district, the doctors in charge, the laboratories, the hospital division. In the end some proposals are advanced referring to the provision of the ministerial circular letter no 46, dated june 12, 1979, about the medical control of workers who leave the hazardous working job.