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Biomedical subjects

P Apostoli

Publications and source records attributed to P Apostoli.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

[Biological monitoring: concepts and applications in public health].

This study provides an overview of the theoretical discussion on potential uses for biological monitoring of exposure to chemical substances as related to human health, considering different concepts: definitions, uses, and limitations of internal dose and biological effect indicators and their availability for the substances to be quantified; knowledge of reference values, action levels, and limits based on health and negotiated patterns in biological monitoring interpretation and perspectives; and ethical and social problems in practice and within different preventive practices and their use in public health. Biological monitoring is the result of an exposure situation with conclusions based on scientific and consensus values, rules, and legislation. Biological monitoring as a continuous process and related to actually observed cases has helped establish technological exposure reference values and consensus levels as indicators for improving the environment and the workplace. As a step in the decision-making process in risk analysis, biological monitoring needs to be critically assessed as to its ethical aspects in light of the end use of results and values, which are references for application of this methodology.

Biomarkers↗
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Long-term exposure to "low levels" of manganese oxides and neurofunctional changes in ferroalloy workers.

Occupational exposure to manganese can cause early neurobehavioral effects in low- or a-symptomatic workers. A battery of neuropsychological tests was administered to a group of 61 ferroalloy male workers and 87 controls. The average (geometric mean) manganese concentrations in total dust at the plant have changed from 1981 to 1997 respectively from 1597.03 micrograms/m3 to 239 micrograms/m3 at the furnace area; from 151.53 to 255.76 micrograms/m3 at the casting area; from 167 to 54.7 micrograms/m3 at the maintenance (welding operations), yielding a current overall value of 54.25 micrograms/m3. A cumulative exposure index was calculated for each alloy worker and the average value (geometric mean) resulted to be 1204.87 micrograms/m3 x years, which divided by the average length of exposure (15.17 years), showed the concentration of 70.83 micrograms/m3 of manganese in total dust. Blood and urinary manganese geometric means resulted significantly higher in the exposed workers (9.18 micrograms/l and 1.53 micrograms/g creatinine, respectively) than in controls (5.74 micrograms/l and 0.40 microgram/g creatinine, respectively). A positive correlation was observed between the airborne manganese concentrations in total dust and blood manganese (n = 55; R = 0.36; R2 = 0.13; p = 0.0068), whereas no association resulted between cumulative exposure index and both blood manganese and urinary manganese. Higher prevalence of symptoms reporting was observed in the alloy workers concerning irritability, loss of equilibrium and rigidity. Tremor parameters including the central frequency and its dispersion, resulted to be statistically different in the exposed workers compared to the controls. Motor functions exploring the coordination of rapid and alternating movements and memory functions resulted to be impaired in the manganese workers. Dose-effect relationships were observed between the cumulative exposure index and some of the test results, whereas no relationship was found with the airborne manganese concentrations and the biological indicators of exposure. These findings are consistent with the existing knowledge of a cumulative mechanism of action of manganese, which must be carefully considered when setting safe exposure levels. In order to be protective for the entire working life, the average annual exposure level should be lower than 100 micrograms/m3.

Adult↗
PubMedDate not supplied

[Reference values in occupational and environmental medicine].

Origin, significance, production and use of reference values (RV) in environmental and occupational medicine are discussed. The concept of RV was established in last sixties to correctly interpret data from modern clinical chemistry, but its acceptance in occupational medicine was neither immediate nor easy. These difficulties were mainly due to the nature and biological fate of analytes for which RV were requested, quite different from those of clinical chemistry. For this reason specific procedures to select the subjects, to control the pre analytical factors and to set up analytical methods are necessary. The Italian Society of Reference Values (SIVR) attempted to achieve concepts and practice for RVs and proposed RVs produced by specific investigations for some metals and organic compounds. Furthermore in this paper two provisional lists of RVs for metals and organic substances are proposed. Finally the relationship between RVs and other more familiar guide line values such as action levels and limit values is discussed.

Environmental Medicine↗
PubMedDate not supplied

[Risk assessment in health care facilities].

Risk assessment in health care facilities. The risk assessment is an important procedure in occupational medicine, also due to the international and domestic regulations and recommendations. In hospitals and other health care facilities too, the risk assessment could enable the identification of hazards, the characterization of risk and thus the programme of adequate preventive measures. In this paper some theoretical and methodological aspects of risk assessment practice and related documentation in health care facilities are focussed and the strict relation between preventive activities, quality system and accreditation standards for hospitals and other health services is finally discussed.

Accidents, Occupational↗
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[Risk assessment concerning hospital personnel participating in the preparation and administration of antineoplastic drugs].

24 workers (10 involved in the preparation and 14 in administration) exposed to cyclophosphamide (CP) and ifosfamide (IF) in two Italian hospitals were monitored. The extent of exposure was assessed by the analysis of air samples, wipe samples, pads and gloves. Urinary excretion at the beginning and at the end of the work shift was also measured by liquid-liquid extraction and analysis by HPLC-MS/MS. 3 out of 24 air samples resulted to be positive for CP or IF. In wipe samples, CP concentrations ranging from < 0.001 to 82.4 micrograms/dm2 in Hospital A (32 samples) and from 0.2 to 383.3 micrograms/dm2 in Hospital B (17 samples), were found. IF concentrations varied from < 0.001 to 90.9 micrograms/dm2 in Hospital A and from 0.01 to 141.5 micrograms/dm2 in Hospital B. Pads (from 11 to 13 for each operator) were contaminated with CP and IF especially on arms, legs and chest. The use of a plastic-backed liner on the working tray in the laminar flow hoods was demonstrated to compromise the containment properties of the hood. Urine samples were positive for CP in 50% of the workers (range: 0.1-2.1 micrograms/L), whereas IF was detected in 2 subjects only (range: 0.1-0.8 microgram/L). The results from this investigation demonstrated that vertical laminar airflow hoods, when incorrectly used, might represent a source of contamination and that higher risk may depend on lack of educational programmes and observance of preventive guidelines.

Adult↗
PubMedDate not supplied

[Organization of health and safety activities in health care centers].

The paper proposes a model for health and safety organization in health care units and hospitals which takes account of the risk assessment procedures required by law and the quality assessment of the measures thus taken. A redefinition is given of the role of Medical Director and of the functions, aims and standards on which health and safety service and the services of an authorized occupational health physicians must be based.

Hospitals↗
PubMedDate not supplied

[Proposal of a computerized system for chemical risk management at biomedical laboratories].

The current italian and european directives require as an essential part of preventive procedures the risk assessment in every work setting. This procedure may be however difficult to be applied because of variability and specificity of work environment, work organisation, chemicals ect. It is true for the biomedical laboratories when the attention is focused on the identification and exposure evaluation of chemicals related to the analytical process, i.e. the first step to reach an accurated risk assessment. The starting point often has been the list of theoretically used compounds, which could be not exhaustive, or they could not reflect type and amount of chemicals really used. The proposed system is directly managed by the laboratory workers, by an labeling and reading bare code system. By the software, information about type, location, storage of the compounds present in the laboratory and amount used by each laboratory worker (by a personal card) are easily available. The proposed system should ensure precision and method in recording type and amount and in approximating the contact--absorption of the compounds used by each operator. By improving the chemical exposure assessment, a more accurate health and epidemiological surveillance would be possible. Finally, the system, by enabling the management of purchase, storage, utilization, waste of chemicals, could become an useful device for the quality assurance procedures.

Biology↗
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[Occupational exposure to glutaraldehyde during its use in chemical disinfection of endoscopes].

BACKGROUND: To evaluate the air pollution experimentally produced by different solutions of glutaraldehyde due to the activity of chemical disinfection in a flexible endoscopy unit. METHODS: The glutaraldehyde environment concentrations due to the use of 3 solutions (2% solution and its 1:5 and 1:20 dilutions) were measured by liquid chromatography after sampling on specific cartridges and by fotoacoustic method. RESULTS: Only after the use of the most concentrated solution it was possible to detect glutaraldehyde in the environment air, with values between 0.2 and 0.3 mg/m3 and during specific activities such as after shaking the disinfecting solutions. CONCLUSIONS: When the usual preventive recommendations are respected, the use of 1:5 and 1:20 solution of 2% glutaraldehyde products does not produce air concentrations of the aldehyde exceeding the current, even restrictive, limits proposed by industrial hygienists.

Air Pollutants, Occupational↗
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[Guidelines for assessment and management of risks caused by benzene for workers at gas stations].

The European regulations classify gasoline as "carcinogenic agent" because of its content of benzene (> 0.1%). Consequently the preventive and protective actions towards the petrol station attendants prescribe, before all, the elimination of the agent or the reduction of the exposure and the risk to the minimum. Well known are currently a series of preventive measures able to produce appreciable reduction of the risk: reduction of the benzene content of gasoline, vapor recovery systems, self-areas or do-it-yourself, specific procedures for working. Exposure assessment is an essential step in order to establish the need for further preventive measure and to verify their efficacy. The exposure levels to gasoline of the petrol station attendants can be influenced by a variety of factors other than benzene air concentrations and therefore biological monitoring can give some sensible advantage in respect to air monitoring. Dosage of benzene in expired air, in urine, or in blood give a very good estimation of the exposure to benzene but they are not test largely practicable today, because analytical, economical, organizational reasons. Recent studies suggest that the dosage in urine of trans,trans muconic acid (ttMA) or phenil mercapturic acid can be useful biomarkers of recent exposure, even at low levels of exposure such as in filling stations. Exposure conditions to gasoline vapors in filling stations are rapidly changing thanks to some technological innovations and legal restrictions and the exposure levels are much below the occupational air standards, Toxicological and epidemiological data (although not yet conclusive at low doses) suggest to carry out however health and epidemiological surveillance programs for the working population. A program for the health surveillance and biological monitoring is here proposed: a clinical examination, integrated with haematological tests and biological monitoring tests, must be carried out in pre-employment and subsequently repeated yearly in the highest exposure conditions. When the exposure levels should decrease the examinations could be carried out every two years.

Benzene↗
PubMedDate not supplied

[Musculoskeletal disorders caused by repetitive trauma of the upper limbs: a paradigm of the development of occupational diseases and industrial medicine].

The work related musculoskeletal disorders (WMSDs) are a wide range of inflammatory and degenerative disease and disorders that result in pain and functional impairment. All available definitions for WMSDS are non consistent and require in each individual case and in each group study careful identification of symptoms, signs and findings. WMSDs, as a mutifactorial work related disease, are associated to physical and psychosocial factors at work and other individual, sociocultural factors. They are therefore good paradigm for the changing occupational risks and illness and for the new methods that the occupational medicine and the preventive disciplines have to set up. The research and standardization needs appear to be more evident for framing pathogenesis, biological response and pathology of WMSDs and mainly for risk factors assessment, since suitable analytical methods are still not available. The agreement of valid standardised methods (guide lines) for the evaluation of working conditions and assessment of risk factors is required, taking due regard to the multidisciplinary approach both in biological and medical areas and in poly technical ones. Finally attention would be paid to the strategy for prevention, implementing ergonomic programmes, health surveillance, adequate training to work, aimed to primary prevention of WMSDs.

Arm Injuries↗
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[The Italian version of "OREGE" (Outil de Repérage et d'Evaluation des Gestes) of the INRS (Institut national de recherche et de sécurité) for the assessment of musculoskeletal disorders of the upper limb].

The upper extremity work-related musculoskeletal disorders (UEWMSDs) are a heterogeneous group of disorders not yet standardised mainly epidemiological criteria for case definition. They are multifactorial, often they are work related even if sometimes they show an individual origin. In recent years they show a rapid increase but it's worth noting that this trend is also affected by a more widespread and easy recognition as work related diseases. There are many ergonomic analysis tools, currently available, that claim to accurately measure variables associated with UEWMSDs. They are essentially based on biomechanical, epidemiological and physiological approaches and identify work activities at risk of developing: OSHA's checklist, Strain Index, OCRA Index, ACGIH (Hand Activity Level). A method for the study of musculoskeletal disorders of the upper limb has been proposed by French INRS (National de Recherche et de Sécurité). It is defined as a project based on ergonomics applied to occupational medicine and it includes: (1) OSHA's checklist as a screening tool; (2) MSDs questionnaire for standardised record of symptoms and of worker's opinions (3) OREGE, (Outil de Repérage et d'Evaluation des Gestes) a exhaustive evaluation tool to be used by ergonomics-trained personnel, aimed to identify risk factors to be considered for preventive and corrective actions. OREGE includes: force evaluation through Latko's scale (which take into account: weight of objects and tools, kind of hold, pressure, vibration, temperature, use of gloves), articular position analysis, repetition analysis, synthesis of the different biomechanical risk factors, calculation of an index of risk. The authors have considered of interest to provide occupational physicians and ergonomic professionals with an Italian version of OREGE. The expected results are: a critical review of the method, a comparison with the other most known evaluation methods and the selection of the best method for specific work activity.

Arm↗
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[Teleworking].

Explore the source record for details and available documents.

Humans↗
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[Introduction: scope and purpose of the multicenter project " Assessment of effects due to low doses in inorganic mercury following environmental and occupational exposure: human and in vitro studies on specific toxicity mechanisms"].

The principal aims of the project financed by the Italian Ministry of University and Scientific and Technological Research were: to verify if at the current limit values early biological effects can be demonstrated; to identify the levels of internal dose that can cause early effects; to evaluate the non-occupational factors that can contribute to the levels of internal dose. In particular, the mercury intake derived from dental amalgams and fish consumption was considered. The internal dose was measured with the traditional biological indicators (urinary and blood mercury) and with the speciation of a large percentage of biological samples by ICP-MS. The central nervous system, neuroendocrine function, kidney and the immune system were considered as target organs and were examined using previously standardized indicators of effects. Two groups of subjects were included in the study: workers with occupational exposure to inorganic mercury in different industrial settings and control subjects identified from the general population. The first group was characterized by an exposure level to inorganic mercury clearly below the current limit values; whereas the HgU levels of a relevant number of control subjects were similar to those measured in the exposed subjects. The in vitro studies covered several issues: the percutaneous absorption of mercury using skin derived from human post-mortem samples in a standardized model; the release of the metal from dental amalgams in different physiological conditions of the oral cavity; the effects of increasing doses of mercury chloride on tubular renal cells. The project was realized with the cooperation of seven Research Units from six Italian Universities. Researchers belonging to Departments of Occupational Medicine, Industrial Hygiene, General Pathology, Biochemistry, Odontology, and Biostatistics were involved to achieve a multidisciplinary approach. The results of this research project are described and discussed in the following papers.

Absorption↗
PubMedDate not supplied

[Evaluation of the dose of mercury in exposed and control subjects].

OBJECTIVES: The aim of this paper was to analyse the concentrations of HgU and HgB in three different groups: 122 workers exposed, 18 workers formerly exposed and 196 subjects not occupationally or environmentally exposed to mercury. METHODS: All the subjects filled out a questionnaire concerning personal data, lifestyle, occupational or non-occupational exposure to Hg and medical history. The amalgam fillings area was measured by a standardised method. RESULTS: Urinary mercury excretion was significantly greater in the group of the exposed workers respect to the group of subjects not occupationally exposed (Median value of 8.3 micrograms/g creatinine and the 5 degrees and 95 degrees percentile respectively of 2.66 e 23.50 micrograms/g creatinine against Median value of 1.2 micrograms/g creatinine and the 5 degrees and 95 degrees percentile respectively of 0.18 and 5.42 micrograms/g creatinine). U-Hg in formerly exposed workers were comparable to U-Hg in non-occupationally exposed subjects, with a median value of 1.6 micrograms/g creatinine. B-Hg values were similar in the three groups: the median value was 3.1 micrograms/l in the non-occupationally exposed, 4.0 micrograms/l in the exposed workers and 3.9 micrograms/l in the past exposed. These value were not significantly different. Among the considered variables (amalgam fillings, fish consumption, age, sex, alcohol intake, chewing-gum and smoking) dental amalgam and fish consumption were significantly related with the Hg urinary excretion and the B-Hg levels. This is particularly true considering the subjects altogether: for the exposed workers, indeed, the occupational exposure was the most relevant variable. CONCLUSIONS: The results of the present research confirmed that the U-Hg excretion in non-occupationally exposed subjects is influenced by amalgam dental fillings. Furthermore, in our study Hg urinary excretion was significantly related with fish consumption. This fact can be explained, according to several recent experimental human and animal trials, considering that methylmercury contained in fish is partially converted, through breakage of the carbon-Hg bond, into Hg inorganic forms, which accumulate in the kidney and have a urinary excretion pathway.

Absorption↗
PubMedDate not supplied

[In vitro study of the nephrotoxic mechanism of mercuric chloride].

OBJECTIVES: Mercury (Hg), one of the most diffused and hazardous organ-specific environmental contaminants, exists in a wide variety of physical and chemical states, each of which with unique characteristics of target organ specificity. Exposure to Hg vapour and to organic mercurials specifically affects the CNS, while the kidney is the target organ for inorganic Hg compounds. Despite the increasing number of studies, the molecular bases of the nephrotoxic potential of Hg has not, up to now, been clarified, even if there is evidence suggesting that the ability of the metal to interact with proteins (thiol groups) or to generate oxygen radicals may play a major role. Within this context, the aim of the present study was to investigate, in vitro, the mechanism(s) of the early nephrotoxic potential of mercury chloride (HgCl2), one of the most diffused and biologically active mercury (Hg2+) compounds. For this purpose, two kidney-derived in vitro systems (the MDCK and the LLC-PK1 cell lines) were tested for their sensitivity to the salt, and MDCK was chosen as the most suitable in vitro model for our study. As possible biological markers of the organ-specific toxicity of the metal we analysed: i) critical biochemical parameters related to oxidative stress conditions (effect of Hg2+ on the anti-oxidant status of the cell), and ii) gap-junctional function (GJIC). METHODS: Classical toxicity tests (MTT and NR) were used for assessing the sensitivity (IC50) of LLP-CK1 and MDCK cell lines to the mercuric salt. Complete solubilisation of the salt in the culture media was verified by inductively coupled plasma mass spectrometry (ICP-MS). The influence of the metal on cell growth rate and viability were evaluated by conventional proliferation assays. For the following mechanistic studies, cells were exposed for different time periods (4 to 72 hours) to non-cytotoxic (0.1-50 microM) HgCl2 concentrations. The biochemical analysis of the pro-oxidant properties of the mercuric compound was performed by the measurement of anti-oxidant cellular defences against H2O2 [catalase (Cat), glutathione peroxidase (Gpx), and total glutathione (GSH)]. The influence of the metal on the GJIC capacity of MDCK cells was assessed by the "microinjection/dye-coupling" assay. RESULTS: Among the two kidney-derived in vitro systems, MDCK cell line was the most specifically sensitive to the toxic effect of HgCl2: it was, consequently, chosen as a "tubular cell model" for the following experimental steps. Tested for various time periods at increasing concentrations, the HgCl2 effect on MDCK cell proliferation and viability was found to be time- and dose-related. For concentrations < or = 50 microM, HgCl2 inhibits MDCK cell growth rate, being this effect significant (> 50% in respect to untreated controls) from the 24th from the beginning of the treatment, while, for concentrations > 50 microM, the metal causes cell death. Concerning the influence of HgCl2 on MDCK anti-oxidant defences, the most interesting results were obtained by analysing the influence of the mercury salt on the GSH cell content and Gpx activity. Both were, in fact, significantly affected by the presence of the mercury ion. HgCl2 also induced a rapid, dose- and time-related inhibitory effect on the GJIC capacity of the cells. CONCLUSIONS: Even if further investigations are needed to better clarify the possible causal relationship between our findings, they indicate that: a) MDCK cells represent a suitable in vitro model for the study of Hg nephrotoxicity; b) GJIC function is, among those considered in our study, one of the most sensitive biological endpoints for investigating the mechanism(s) of Hg2+ specific toxicity.

Animals↗