Back pain is a major health and economic problem for preventive medicine. It has been found to be significantly associated with nursing. The present paper reviews a number of epidemiological studies on back pain in nurses and examines the main confounding factors. The different approaches to back pain prevention are briefly discussed.

Back Pain↗

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Lymphocyte subpopulations of workers in a plant producing plastic materials (preliminary study).

Lymphocyte subpopulations were studied in 31 men working in a plant producing plastic materials in relation with control groups of similar age and smoking habit. 8 workers (group A) were exposed to solvents (mainly methylethylketone and dimethylformamide), 8 men (group B) to dust containing particles of calcium carbonate, polyvinylchloride, phtalates, unsaturated oils, paraffin wax, iron oxides, titanium bioxides, barium, zinc and lead and 15 men (group C), working in the same department as group B, were studied after a period of 16 months during which lead chromate was employed in the preparation of colors. The lymphocyte subpopulations were normal in group A, while in B there was a significant increase of HLA-DR + cells (monocytes, B and activated T lymphocytes). In group C, T helper/inducer lymphocytes (mainly CD4(+)-CD45RO- "virgin" lymphocytes), CD19+ B lymphocytes, CD3-HLADR+ and CD3-CD25+ (activated B lymphocytes and monocytes) were significantly reduced without changes of serum IgM, IgG and IgA. Highly significant correlation was found between B lymphocytes (reduced in the workers about 40%) and CD4(+)-CD45R0+ "memory" lymphocytes (reduced about 20%). Moreover, blood lead (correlated with urinary chromium) showed a highly significant negative correlation with the B lymphocytes. This study demonstrates that combined exposure to toxic agents produces specific modifications in the lymphocyte subsets without changes in immunoglobulins and confirms the results of previous researches showing that the exposure to lead or chromate induces reduction of lymphocytes in the peripheral blood.

Adult↗

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Vanadate and cardiovascular system.

Rats were given 1, 10, 40, or 100 ppm of vanadium in drinking water for seven months, while rabbits received 1 ppm of vanadium (as sodium metavanadate, NaVO3) in drinking water for twelve months. Rats developed arterial hypertension through complex effects of vanadium on central neurogenic pathways, central and periferal catecholaminergic mechanisms, specific autacoidal systems (kallikrein-kinin, reninangiotensin-aldosterone, enkephalin ones), and effectors (vessels and heart). The above effects of vanadium were in part confirmed in the rabbits which, however, did not show arterial hypertension since the increase of vascular resistance was counteracted by a reduction of both cardiac inotropism and cardiac output. Vanadium was accumulated in tissues as vanadyl; higher levels were found in the bone and in the kidney, but relevant amounts were determined in aorta, heart and brain. There was evidence, in the rabbits, that vanadium reduces synthesis and/or release of nitric oxide, the endothelium-derived vasodilating factor, likely through a reduced formation from bradykinin. The functional, analytical and morphological results obtained in this study show that chronic exposure to vanadium induces arterial hypertension by mechanisms only in part related to the levels and times of exposure, and to the species.

Animals↗

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The "Tor Vergata" epidemiological blood pressure study. Hereditary and environmental factors.

The aim of this study was to evaluate the influence of hereditary and/or environmental factors on blood pressure patterns. The study group consisted of 1002 individuals. Comparison of blood pressure values among groups was performed by the Bravais-Pearson r correlation coefficient. Results among the different groups were: p < 0.001 in the parents-offspring group (n = 413) for both systolic (SBP) and diastolic blood pressure (DBP); p < 0.001 in the father-offspring group (n = 382) for SBP only; p < 0.001 in the mother-offspring group (n = 389) for both SBP and DBP; NS in the father-son group (n = 199) for any blood pressure value; p < 0.01 in the father-daughter group (n = 183) for SBP only; p < 0.001 in the mother-son and daughter groups (n = 201 and n = 188 respectively) for both SBP and DBP. Family aggregation analysis disclosed p < 0.01 and p < 0.05 for SBP and DBP respectively in the mother-her sibling group. No significant values were found in the father-his sibling group or between offspring and either their paternal or maternal uncles/aunts. Conversely, a significant correlation (p < 0.001) was found between spouses (fathers and mothers) for both SBP and DBP. These results support the hypothesis that both hereditary and environmental factors exert their influence on blood pressure patterns. We performed both univariate and bivariate statistical analyses. The latter included a) variable separation, b) independent variables, and c) variable correlation. Bivariate analysis of variable correlation proved to be the most suitable.

Environment↗

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[The evaluation of day hospital activities: an analysis of intervention protocols and a comparison between the indicators of the activities of the day hospital and of the regular admission].

Day hospital (DH) activity may avoid in-staying of patients resulting in an increase of efficiency and in a more satisfying diagnostical-therapeutical process for the patient. All the same, it is quite difficult to identify parametres and indicators to be used in the evaluation and quantification of DH, so that both scientific literature reporting experiences and law are lacking. One of the reasons is probably due to the lack of nosological characterization of patients and protocols of DH activity, so that the definition relies only on organizational and technical parameters. Characterization of protocols of intervention is the basic approach to the present DH investigation. Parameters such as: multiplicity of services, weekly planning of the activity and surveillance needed by the patient are considered the fundamental criteria to identify and quantify DH in the present research carried out at the University Regional Hospital of Pisa. The aim of this article is, on one side, to give a methodology of investigation based, as far as possible, on "explicit" indicators and parameters, so that the experience may be exported into other contexts and on the other, to give an example of resource analysis and efficiency evaluation which were internally used for "audit" review.

Clinical Protocols↗

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[Trace elements in biological samples and immunologic parameters in environmentally exposed populations (preliminary study)].

In non-smoking policemen from a town of Central Italy, blood CD4+ lymphocytes were reduced and CD8+ were increased as compared with a control group. This immunological alteration was not evident in the smoking policemen. Urine lead (marker of exposure to toxic agents produced by traffic) and blood natural killer (NK) CD16+ lymphocytes as well as serum copper and HLA-DR+ cells (B, T, NK activated lymphocytes and monocytes) were significantly correlated in the whole group of 42 examined subjects. Another study was performed on 15 healthy men, occupationally not exposed to toxic agents and living in a suburban area. Their urine lead, was positively correlated with the serum IgA immunoglobulins and negatively correlated with blood CD5(+)-CD19+ (a B subset bearing the T CD5 antigen) lymphocytes. On the contrary, urine chromium was negatively correlated with serum IgA and positively correlated with CD16(+)-56+ NK and CD5(+)-CD19+ B lymphocytes as well as with HLA-DR+cells. Serum zinc was also correlated with total HLA-DR+and CD3-HLA+DR+ (activated B and NK lymphocytes and monocytes) cells. These later data suggest that only zinc and copper but also trivalent chromium (to which normal population is mainly exposed in ordinary environmental conditions) may play a role in the mechanisms regulating the immune response.

Air Pollutants, Occupational↗

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[Allergic contact dermatitis to nickel: modification of receptor expression on peripheral lymphocytes of women after oral provocation tests (preliminary data)].

Blood lymphocyte subset evaluation was performed before after oral challenge with 10 mg of Ni, in 9 healthy women and in 15 allergic to Ni. Following challenge, 7 allergic showed a flare up of eczema and/or urticaria. In the controls, CD4+ lymphocytes were modified 24 hours after Ni challenge: CD4+/CD44RO- "virgin" cells were reduced while CD4+/CD45RO+ "memory" cells increased. The allergic women, not sensitive to oral Ni, showed an increase of B lymphocytes after the test. On the contrary, the oral Ni reacting patients presented a reduction of monocytes 4 hours after Ni ingestion and marked reduction (ranging from 20 to 50%) of T and B lymphocytes after 24 hours. These significant T and B lymphocytes changes suggest a migration of the cells in peripheral tissues, likely skin and GUT mucosa.

Administration, Oral↗