From a comparison between the present Italian regulations and the main international guidelines regarding the assessment and prevention of effects of industrial noise, three main aspects emerge: firstly, the aims of the regulations (i.e. the characteristics and levels of hearing handicap to be prevented); secondly, the models for evaluating the probability of hearing loss; lastly, the limit values and the preventive measures adopted. The Italian regulations with respect to the ISO, ACGIH, NIOSH guidelines and regulations of other European countries, do not supply any precise indications regarding the aforementioned aspects. As a consequence, measures must be adopted to prevent any type of hearing impairment and the level of the noise has to be reduced to the minimum by acting on the environment, machinery and using individual protective devices.

Europe↗

PubMedDate not supplied

[Reference values for xenobiotics in biological matrixes: the state of the art].

The basic concepts of reference values of xenobiotics in biological matrixes have been extensively discussed over the last 3-4 years by transferring the principles from clinical chemistry. In this paper three topics of current interest, i.e. the control of variability factors, metanalysis procedure for production of reference values, the reference values as a part of the system of guide values, are dealt with. The control of variability factors is identified as the most important procedure to guarantee the quality and consequently the usefulness of the reference values. Metanalysis is not considered as a correct method to produce reference values, but rather a method to compare the investigation published and to compel the investigators to standardize their working methods. Lastly reference values should be considered as the first step of an integrated system of values (action levels, limit values) which enable us to correctly interpret the significance of biological monitoring.

Alcohol Drinking↗

PubMedDate not supplied

[Multiple occupational exposure to solvents].

This article review papers published over the last 20 years on multiple occupational exposure to solvents. At low-levels of exposure the toxicokinetic interferences between solvents have generally not been observed in man and presumably a threshold limit exists. Conversely, at exposure levels close to the "limit values" metabolic interference has sometimes been observed and the behaviour of the biological indicators differs from what would be expected. Toxicodynamic interference between solvents can give rise to additive, potentiation, synergistic, antagonistic effects. For the identification of "limit values", it has generally been suggested in the literature that the possible effects deriving from multiple exposure be considered as additive. However, numerous potentiation effects have frequently been reported for combined exposure to substances of widespread use. In this paper lists of multiple exposure in which the doses of the substances, the types of interferences and the behaviour of the biological levels have been drawn up and proposed as a tool for easy consultation.

Alcohol Drinking↗

PubMedDate not supplied

Prevention of risks from occupational exposure to antineoplastic drugs. Consensus document.

Explore the source record for details and available documents.

Antineoplastic Agents↗

PubMedDate not supplied

[Criteria and methods for the study of occupational exposure to antineoplastic agents].

Risk assessment for occupational exposure to antiblastic chemotherapeutic drugs (ACD) is carried out by means of environmental and biological monitoring. These practices are not widespread and furthermore their results are frequently difficult to interpret. This paper discusses some of the most important aspects of risk assessment for ACD and in particular for their exposure evaluation. The following guidelines are proposed: a) working rooms, working procedures, type and quantity of drugs, and preventive measures must be checked using a standardized scheme for collecting data: an example of a check list experimented in some Italian hospitals is presented; b) cyclophosphamide, 5-fluorouracil, and Pt coordination compounds have been identified as tracers of drug mixtures usually administered, and their determination is recommended both in environmental and biological samples; c) for a correct evaluation of exposure, ACD should be determined firstly on the contaminated surfaces or on work clothes and secondly in urine of workers; the measurement of ACD in air must be limited to well documented conditions of high exposure and the urinary mutagenicity tests should be avoided; d) the biological monitoring practices should be enhanced, in particular the determination of ACD adducts to proteins and nucleic acids as promising indicators of effective dose.

Antineoplastic Agents↗

PubMedDate not supplied

Multiple exposure to metals in eight types of welding.

This article evaluates multiple exposures to metals in different types of metal welding such as manual metal arc for mild and stainless steel, continuous wire, submerged arc, laser and brazing. Environmental monitoring was carried out in eight different occupational situations and the inductively coupled plasma mass spectrometry technique was adopted in order to characterize exposure to several elements simultaneously and with high accuracy. The results showed that up to 23 elements could be measured. The highest concentrations were found for Al, Mn, Fr, Ni, Cr, Cu and Zn. For some elements such as In, Nd, I, Rb the concentrations were very low. A qualitative and quantitative variation in fume composition was observed at a certain distance from the welding point, which should be to taken into account when evaluating indirect exposures. It would also be possible, with this technique, to identify specific elements in the mixture which could also be measured in biological fluids.

Air Pollutants, Occupational↗

PubMedDate not supplied

[The occupational medicine physician and risk evaluation: between technical arguments and regulative obligations].

Risk assessment (the characterization of potential adverse health effects of human exposure to environmental hazards) has been used by FDA and EPA for at least 30 yr, and many regulations currently rely on this procedure in USA and other european countries. RA method has been adopted for determinating of the exposure standards for relevant chemical and physical hazards. RA application shall become an important practice in Occupational Health and Industrial Hygiene, also in view of specific international and national regulations and recommendations. In this paper are discussed the main theoretical aspects of RA procedure in Occupational Health activities. Emphasis is given to the role of the Occupational Medicine Physician, who have a formal training and experience in toxicology epidemiology and industrial hygiene as well as in human physiology and clinical medicine. For these reasons the Occupational Medicine Physicians are in a unique position not only to give specific contributions in some steps of RA (mainly in risk identification and in risk characterization) but also to bridge the gaps between the various technical figures involved in the RA procedure and therefore to guarantee the adoption of correct and accurate preventive measures.

Accidents, Occupational↗

PubMedDate not supplied

[Speciation of metals in occupational medicine].

The identification and quantification of elements as such (that make up the historical analytical method used in toxicological studies) are necessary but not sufficient, in all cases, to understand and evaluate the mechanism of interaction between elements and biological targets. In fact, in order to approximate the factors that control the concentrations of elements in environmental or biological media, we need to know the occurrence of species of the elements themselves. This is element speciation, i.e. the capability of separating, identifying and determining the species in which an element is present and/or transformed. There are few, although increasing in latter years, examples of element speciation able to confirm the importance of this research approach in toxicological studies. Some basic information from these studies have found specific application in selecting the most appropriate indicators and the most representative matrices for biological monitoring. Furthermore, element speciation provides additional and often essential information in evaluating metal toxicity. The toxicity of the three oxidation states of Mercury differ considerably. For arsenic, a decreasing order of toxicity arsenite > arsenate > monomethylarsonic (MMA) > dimethylarsenite (DMA) has been proposed. However, the use of speciation in investigating toxicokinetic aspects appears to be difficult to apply to many other metals, mainly due to the lack of information about the existence and significance of species whose determination would be worthwhile and to the lack of analytical methods enabling us to measure species in biological media. Nonetheless, the horizon for speciation is more extensive and less linear than expected since about 15 elements, 20 oxidation states, and 25 organic compounds have been just involved in speciation. Problems might arise for biological monitoring practices, and the following topics should be considered: (i) identification of species and determination of their concentration; (ii) knowledge about the specific (relevant) role in physiologic and pathologic processes in which the element is involved; (iii) availability of analytical methods responding to acceptable quality requisites; (iv) feasibility and ethics of sampling.

Environmental Monitoring↗

PubMedDate not supplied

The influence of amalgam fillings on urinary mercury excretion in subjects from Apulia (southern Italy).

The purpose of this study was to assess the role of dental amalgams and diet upon urinary mercury (U-Hg) excretion. 98 subjects (50 men and 48 women) not exposed to inorganic mercury, for either occupational or environmental reasons, and living in coastal and inland districts of Apulia (Southern Italy) were considered. All the subjects were administered a questionnaire with questions concerning life style, medical history, and occupational activity. Dental amalgams were evaluated with respect to their number and their surface areas. Urinary mercury was measured by the cold vapour atomic absorption technique. Expressed in terms of arithmetic mean, U-Hg excretion was found to amount to 1.03 micrograms/g creatinine (5th and 95th percentile: 0.31 and 2.40; range 0.30-3.25). Multiple linear regression analysis showed that, of the several tested independent variables (dental amalgams, age, body mass index, consumption of tuna, bass, swordfish, etc.), only the number of amalgam fillings (T = 5.25; p = 0.025) and the number of restored surfaces (T = 2.33; p = 0.020) were found liable to affect urinary mercury excretion in a significant manner. In conclusion, the results of this study confirm the primary role of amalgam fillings in affecting urinary mercury excretion in those subjects who are not occupationally exposed to inorganic mercury, The resulting urinary mercury levels can no doubt be taken as the reference values for the population of Apulia.

Adolescent↗

PubMedDate not supplied

[The toxicology and prevention of the risks of occupational exposure to aromatic polycyclic hydrocarbons. I. Guide lines for the prevention of the risks of occupational exposure to aromatic polycyclic hydrocarbons. Società Italiana Valori di Riferimento and Cattedra di Medicina del Lavoro, Università di Brescia].

These guidelines mainly deal with prevention of carcinogenic effects following occupational exposure to polycyclic aromatic hydrocarbons (PAH). After some toxicological remarks, the guidelines define a possible method to demonstrate and evaluate occupational exposure to PAH. In particular, it is illustrated the strategy of environmental monitoring and indicated which PAH should be measured, with suggestion about the most appropriate analytical techniques. As regards biological monitoring, the 1-OH-pyreneseems to be currently the most useful indicator since it reflects the recent and global exposure to PAH. The guidelines also give elements to interpret monitoring data, taking into account environmental and biological reference and limit values suggested by some authors, Associations, or current regulations. The most important health effects are carcinogenic and excess risks have been described mainly for lung, bladder and skin cancer in some PAH exposed workers. The studies on cytogenetic effects showed contradictory results. On the basis of such information and current regulations, the guidelines show how to perform health surveillance in preventive and periodical examinations and how to proceed for the information and formation of exposed workers. It is not advisable, on the basis of the current scientific data, to screen asymptomatic PAH exposed workers for early diagnosis of lung or bladder cancer, nor it is opportune the use of tumor markers for health surveillance nor is genetic screening applicable for individual susceptibility evaluation outside research programs.

Carcinogens↗

PubMedDate not supplied

[The toxicology and prevention of the risks of occupational exposure to aromatic polycyclic hydrocarbons. II. Toxicology. Exposure assessment. Environmental and biological monitoring].

The evaluation of exposure to polycyclic aromatic hydrocarbons (PAH) should firstly comply with current regulations (D.Lgs. 626/94), that is, identify the compounds and exposed subjects, quantify exposure, adopt preventive measures and health and epidemiological surveillance. Environmental monitoring should take into account the technological cycle and the tasks with higher PAH exposure risk, and the main sources of emissions. In the case of skin contamination, it should be considered the measure of skin PAH by means of sampling or removal techniques; moreover, the determination of urinary hydroxypyrene (1-HP) should be performed. It is mandatory to analyse (Benz[a]) anthracene; Benzo[b]fluroanthene; Benzo[j]fluoranthene; Benzo[k]fluoranthene; Benzo[a]pyrene; Dibenzo[a,h]anthracene, i.e. the PAH marked with the R45-R49 phrase. When 1-HP determination is planned, Pyrene should be added. Biological monitoring has been addressed mainly to hydroxylated metabolites of pyrene and among these 1-HP, the main metabolite of pyrene, although non occupational factors, such as tobacco smoking and consumption of smoked foods are potentially confounding. Urinary mutagenicity tests which are heavily influenced by non occupational factors such as tobacco smoking and diet are not advisable. The determination of DNA and protein adducts is a promising test for evaluation of metabolic active dose but at the moment it is not suitable for routine use in occupational medicine. In order to interpret environmental and biological data, it will be useful to consider appropriate reference values ("limit" "guide", "operative", "maximum admissible") such as 0.1 mg/m3 for total PAH extracted with benzene, 5 micrograms/m3 for the mixture of 15 PAH listed by US NTP, the limits varying from 0.1 to 5 micrograms/m3 for Benzo[a]pyrene, and 2.7-4.4 micrograms/g creat, for 1-HP.

Carcinogens↗

PubMedDate not supplied

[Industrial hygiene and toxicology at the hospital department of occupational medicine].

In the Hospital Services of Occupational health stated in Lombardy Region from seventies, among the other sections laboratories of Industrial Hygiene and Toxicology have been organized. These laboratories performed the routinary analyses and some of them deepened specific toxicological aspects (metals in Brescia, solvents in Pavia, neurotoxicants in Milan). During 1996 about 50,000 analytical determinations and several investigations and researches have been carried out. The laboratories, moreover, took active art in several national and international quality control programs. They might be identified therefore as reference units for promoting and controlling the analytical quality in Occupational Hygiene and Toxicology.

Hospital Units↗

PubMedDate not supplied

[Occupational medicine and quality].

The discipline of occupational medicine has always maintained a closed relationship with the quality system, starting from the well known quality assurance practices, up to the quality of health services, and the concept of prevention and health promotion as essential components of quality programs. The quality of health care has emerged as an area of high interest and concern, driven by the consideration of public policy and the desire of health care government to maximize the value of their investments. However, when we move to apply quality principles to health service some difficulties emerge. For example the introduction of DRFs system makes uneconomical the diagnosis in occupational medicine, since the costs are determined by the type and the number of hazards to be identified and assessed and not only by the risk factors of by the worker's pathology. Moreover, resources are necessary for the correct evaluation of non occupational pathologies often present, both for deontological and legal reasons. The attention to the role of occupational medicine in quality programs has been increased by the recognition of the adverse impact of preventable or controllable risk factors in health benefit and disability costs and employee productivity. By this way prevention and health promotion will become an essential part of quality procedures able to guarantee and maintain quality objectives.

Humans↗