[Skin, its appendages and secretions as matrixes for biological monitoring of toxic elements].
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Adult↗
Biomedical subjects
P Apostoli
Publications and source records attributed to P Apostoli.
[Does the decree 25/2002 still guarantee the health care of workers exposed to lead?].
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Humans↗
[Risk assessment as a tool for planning reconstruction or construction of hospitals].
The risk assessment procedure enables the Hospital General Manager to set up and plan the measures and programs for the health protection of workers, patients and visitors. This crucial procedure on the preventive scenario could also provide useful informations about strategic choices to which the general manager is often recalled such those about old building restructuration or a new building construction. Specific models for transferring and elaborating data to this new field for applicating the results of risk assessment appear therefore to be necessary and the authors suggest a discussion about these theoretical models.
Hospital Design and Construction↗
[On the legislative decree of 25/02: planned and necessary health surveillance for chemical risks].
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Environmental Monitoring↗
[First SIVR list of reference values: definitions, methodologic criteria and analytical strategies].
In this paper, a list of reference values for trace elements and some of the main organic xenobiotics and/or their metabolites in biological matrices (urine, serum or blood) is presented. This list has been made out taking into account several variables, such as sex, diet, alcohol and drugs consumption, smoking habits, living area, etc. and it is referred to as the 1st SIVR list 2001. In addition, the SIVR research activity is reassessed on the basis of the availability of multielement techniques and new analytical approaches. In particular, to define the reference values for PCB, selection criteria and analytical methodologies are discussed with a view to choosing the more significant congeners and the most suitable technique. In the end, the results from two SIVR projects concerning the determination of haematic Pb and urinary Hg are synthesized.
Chemistry, Clinical↗
[Reference values necessary for the interpretation of biological surveillance].
The paper presents an integrated system if guide values, represented by reference values, action levels, limit values, theoretically able to cover the interpretation of all the data from biological monitoring. This practice, requires in fact accurate values to which refer for demonstrating exposures to xenobiotics, and their early health effect. The procedures to select subjects, to control pre analytical and analytical factors, to apply correct statistical methods for establishing accurate reference values are recalled, and the relationship between the different guide values discussed.
Environmental Monitoring↗
[Significance of biological indicators of mercury exposure].
BACKGROUND: It was considered appropriate to update of the significance and use of the different mercury exposure indicators. OBJECTIVE: The aim of the this paper was to correctly select biological media and sampling time and to understand the toxic kinetics of mercury for assessment of accurate biological monitoring. RESULTS: It was confirmed that mercury in blood (B-Hg) is a good indicator of recent exposure, while urinary mercury (U-Hg) indicates current exposure when mercury reaches the renal steady state. B-Hg values are greatly influenced by fish consumption, while the variables influencing U-Hg values are amalgam fillings, commercial gamma-globulin preparations, vaccines, topical remedies, environmental pollution and hobbies, occupational exposure and, partly, fish consumption. The speciation of mercury (Hg0, Hg++, methylmercury and ethylmercury) in biological media, should provide additional and important information in evaluating mercury toxicity. CONCLUSION: It was stressed that the appropriate choice of exposure indicators has to take account of the different variability factors and the characteristics of the toxic kinetics of mercury. The results of biological monitoring must be compared with references values, which are generally in the order of several micrograms/g creatinine, and limit values such as ACGIH BEI (U-Hg 35 micrograms/g creatinine and B-Hg 15 micrograms/l) or the DFG BAT (U-Hg 100 micrograms/l and B-Hg 25 micrograms/l).
Animals↗
[Lead in the 90's: "new" rules for the "oldest" of environmental toxins?].
Present lead (Pb) exposures in working and general environments are undoubtedly lower than several decades ago so that mean blood lead levels (PbB) in the main industrial sectors using lead, such as ceramics and accumulator manufacturing, are now about 30 micrograms/100 ml and in the general population between 10 and 15 micrograms/100 ml and in some situations decidedly below 10 micrograms/100 ml. At the same time increasingly more accurate and sometimes original knowledge has been acquired on the effects of low-level Pb exposure, especially the effects on the nervous system, the cardiovascular system, the endocrine and immune systems, on heme-containing enzymes, and on the reproductive system. The question of a possible mutagenic and carcinogenic action of Pb is, however, still open. It is also clear that many of the above effects were observed for PbB levels considerably below the current limit levels. For certain effects, like those on heme, the central nervous system, and blood pressure, it has not been possible to establish a threshold below which they will not occur. With effects that are so different in nature and degree and with changed exposure conditions, a critical re-examination of the assumptions on which current knowledge and prevention models are based appeared appropriate. In particular, action models are proposed for discussion which, besides the priority aim of restricting use of Pb to those situations where there is no alternative and to those working environments which guarantee compliance with modern regulations and prevention procedures, have two differentiated objectives: the first is to eliminate the dose-dependent effects occurring at exposures higher than those in the general population; the second is to reduce to the lowest possible level the effects with no threshold or with as yet unestablished threshold, by means of actions in favour not only of occupationally exposed groups but also the general population.
Air Pollutants, Occupational↗
[Biological monitoring of occupational exposure to aluminum].
The meaning and usefulness of biological indicators in the study of occupational exposure to aluminium (Al) was assessed on the basis of the most recently acquired knowledge on the toxicokinetics of aluminium absorbed by inhalation, results of environmental and biological investigations recently carried out in industrial sectors with low risk of aluminium absorption (refining, casting and pressure moulding covering a total of 8 plants and 119 workers) and the results of investigations on a group of welders exposed to Al concentrations between 5 and 10 mg/m3. It was confirmed that not only the environmental Al concentrations but also certain chemical and physical characteristics (particle size, allotropic state, solubility), simultaneous exposure to other dusts, and mode of exposure (existence of exposure peaks) play a significant role in lung absorption of Al. Urinary Al (AlU) may be considered as an indicator of "recent" exposure with biphase excretion kinetics influenced also by duration of exposure, whereas Al in serum (AlS) can probably furnish indications both on overall exposure and on body burden. In low-level Al exposure (below 0.5 mg/m3), these indicators (especially AlU) permit differentiation of the exposed groups from the general population without, however, any clear relationship with the various environmental Al concentrations. It was also seen that AlU increased with increasing work seniority and was more marked in certain processes, such as casting, and in the first few months or years of work.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Can exposure to low doses have effects?].
This paper aims to discuss the scientific evidence to answer the question in the title. After a brief mention of the fundamental toxicological principles of risk assessment (hazard, exposure, susceptibility, risk), the concepts of dose-response, dose-effect and threshold-dose are presented. The difference between adverse effects with and those without a threshold is highlighted, together with the corresponding methodologies used in risk assessment for the definition of the limit values, i.e. the No Observed Adverse Effect Level (NOAEL) and Safety Factor (SF) method and the Virtually Safe Dose (VSD) method. The two methods correspond to two different types of effect, i.e. deterministic and stochastic, and to two different shapes of the dose-response curve at low doses. The various possible meanings (semantic, toxicological and practical) of the terms "low doses" are discussed: a dose (or concentration) may be low because it does not cause measurable adverse effects (as from Paracelsus' aphorism) or because it is too low to be (analytically) measurable or because it is close to or within the "normal" values of a reference population or because it is well below the exposure limit(s). These various concepts are presented also in relation with the controversial concept of "moderate risk" introduced by a recent Italian legislation (D. Lgs 25/02) on the protection of the workers against chemical risk. It would not be appropriate to set a level of risk simply based on the dose (or the level of exposure) without considering the two other components of risk, i.e. hazard and susceptibility, whose estimation also needs a careful and competent evaluation by the occupational physician. For a thorough discussion of the "moderate risk" concept see a specific paper in these Proceedings. So, clinical, epidemiological and toxicological evidence indicates that in some individuals, groups of the population or circumstances, adverse effects can be observed or expected even at low doses, at which the large majority of the population shows no effect. This is due to a number of factors including toxicological interactions, immunoallergic mechanisms, metabolic hypersusceptibility, both genetic (polymorphism) and acquired (phenotype), preexisting traits or diseases, living habits, diet and others. The Authors conclude therefore that to ensure the protection of all the workers' health and safety, the clinical, toxicological and epidemiological expertise of the occupational physician appears to be fundamental and unreplacable.
Dose-Response Relationship, Drug↗
[Implementation of parliamentary act D. Lgs 25/02 and definition of "moderate risk"].
This paper describes the position of the Joint Working Group of the Italian Association of Industrial Hygienists (AIDII), the Italian Society of Occupational Health and Industrial Hygiene (SIMLII) and the Italian Society of Toxicology (SITOX) on "Analysis of Parliamentary Act D.Lgs 25/02 and role of the Scientific Societies in the definition of Limit Values". The positive aspects of the new law which implements the European Directive 98/24 are discussed, including the abolition of the rigid periodicity of medical examinations as stated by the old rule D.P.R. 303/56. The Authors also address various parts of the law which appear to be unclear and controversial and highlight the expected difficulties arising for the employers and the safety and health professionals during the application of this new piece of legislation. Moreover, a number of discrepancies are noted between the new Italian law and the original Directive or other current Italian rules such as i. the translation of the term "slight risk", as from the original Directive, into "moderate risk", and the resulting non compulsoriness of health surveillance and biological monitoring of the workers in presence of a "moderate risk", ii. the concurrent exclusion, under the same circumstances, of the occupational physician from risk assessment procedures and iii. the upward modification of the previously established (D.Lgs 277/91) occupational exposure limits for lead. Moreover, the Authors examine and criticize--both in semantic and in toxicological terms--a recent proposal for the definition of "moderate risk" made by an ad hoc Consulting Committee of the Labour Ministry, in which the term "moderate" has been interpreted either as "low" or as "irrelevant for health effects", clearly two very different meanings. Besides, it would be inappropriate to define the conditions of a moderate risk based only on the level of exposure to the chemical (expressed as a fraction of the corresponding limit value), without considering the two other components of risk assessment for that chemical (hazard and susceptibility). Even worse would be the use of simplified models based on "algorithms", which might be useful in a preliminary phase of risk assessment, but easily could lead to an under- or over-estimation of risk, particularly when used by non professionals. In conclusion, the Working Group recommend that the new law be amended in order to clarify its most controversial aspects, whose misinterpretation could severely jeopardize the protection of the workers' safety and health at work.
Humans↗
[Excellency accreditation by the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII)].
BACKGROUND: The Italian Society for Occupational Health and Industrial Hygiene (Società Italiana di Medicina del Lavoro e Igiene Industriale)--SIMLII--has taken a systematic approach to the topic of permanent education of occupational health physicians over the last 4 years, developing its own project entitled "SIMLII Permanent Education and Excellency Accreditation". OBJECTIVES: The SIMLII Project, which is addressed to occupational health specialists and physicians authorized under Law 277/91, art. 55, is based on the participation of "obligatory" and "non-obligatory" educational activities and on assessment of professional activity. "Obligatory" educational activities are events organized directly by SIMLII and consist of a detailed study of the guidelines concerning specific occupational health topics. The "non-obligatory" events are those regarding occupational health that the physician chooses voluntarily, with accreditation by the Ministry of Health and/or by SIMLII. The occupational health physician who enrolls for the 3-year course must obtain a total of 180 SIMLII training credits in the 3 years (60 per year). Assessment of activity performed is made at the end of the 3 years of training according to criteria set out by SIMLII and approved by the membership, via a self-administered questionnaire. METHODS AND RESULTS: The SIMLII Project has laid great emphasis on drawing up guidelines on topics specific for occupational health. These guidelines are developed by groups of experts selected by SIMLII and deal with topics that the occupational health physician most frequently encounters in the course of his/her professional activity. There are 405 participants in the first 3-year training course covering the whole of Italy. The aim of the Italian Society for Occupational Health and Industrial Hygiene, via excellency accreditation and drawing up of guidelines for particularly important topics, is to provide useful tools to satisfy the training requirements of its membership, to improve the quality of professional services and to emphasize the uniqueness and specific nature of occupational health within the medical specialties.
Accreditation↗
[Relation of asthenopia and some ophthalmological, neuropsychological, and musculoskeletal parameters in workers assigned to video display terminals].
BACKGROUND: Since the use of video display units (VDU) has become widespread in the workplace, more and more research has been conducted to evaluate the possible onset of adverse effects. OBJECTIVES: We carried out a multidisciplinary investigation on a group of 660 VDU operators working for a service agency, aimed at analysing the relationship between ophthalmological, musculoskeletal and neuropsychological parameters and asthenopia. METHODS: In this study we propose a method for a qualitative and quantitative evaluation of the asthenopic syndrome based on data collected with an easy semi-structured questionnaire. RESULTS AND CONCLUSIONS: No relationship between asthenopia and refractive alteration was noted, whereas a significant association was observed between a lengthened convergence near point and the average time of daily VDU exposure. A significant relationship was also shown between asthenopia, cervical and lumbar disorders, and neuropsychological symptoms. The method for evaluation of asthenopia and the results of this study suggest useful implications in health surveillance programs. After an appropriate validation procedure, this method could represent a useful screening tool and a valid support for preventive interventions. The use of this instrument in longitudinal studies will also provide the opportunity of verifying the existence of long-term effects due to VDU exposure.
Adult↗
[Kinetics of PCBs in a population of 27 exposed individuals].
Because of the casual assumption of PCBs through contaminated foods produced by the family farm (meat, milk and by-product), 27 subjects (14 female and 13 male), whit a mean age of about 31 years (range 2-77), were submitted to a medical check-up. The results confirm the exposure of all the patients, related to the intake-level of contaminated foods, and the presence of a correlation between the age and plasmatic levels of PCBs, about which the authors discuss the possible reasons.
Adolescent↗
[Indicators of pulmonary epithelial damage among workers at a foundry exposed to airborne pollutants].
Foundry ambient air contains very high concentrations of noxious substances, such as particulate matter and gaseous pollutants, which can target the respiratory epithelium. Serum concentrations of the 16-kDa Clara cell protein (CC16-S) may reflect both the integrity of the epithelial barrier and smoke-induced Clara cell toxicity. To evaluate whether CC16-S is a sensitive biomarker of early respiratory disturbances, it was determined in a group of 35 foundry male workers (aged 41.1 +/- 6.9 years) examined both prior to and at the end of their work-shift (06:00 a.m.-02:00 p.m.). Exposure to inhalable/respirable dusts and PAH was characterized; urinary excretion of 1-hydroxypyrene (1-OH-P) and naphtol was measured to assess exposure to pyrene and naphthalene, respectively. CC16 serum levels decreased at the end of the shift (10.7 +/- 3.82 micrograms/L vs. 8.39 +/- 3.05 micrograms/L; p < 0.01); such decrements were significantly larger in more exposed workers. Although smokers had lower baseline values as compared to non smokers, both subgroups showed an average decrease of 30% in CC16-S concentrations at the end of shift. CC16-S was also negatively correlated with 1-OH-P, but not with naphtol concentrations. Decreased CC16-S levels can result from citotoxicity and would represent an useful biomarker of pneumotoxicity in foundry workers exposed to complex mixtures.
Air Pollution, Indoor↗
Metanalytical assessment of reference values for polychlorinated biphenyl in human blood.
Due to their physico-chemical characteristics, polychlorinated biphenyls (PCBs) are highly persistent in the environment and therefore easily measured in the biological matrices of more and more large groups of general population. For these reasons it would be useful to determine suitable Reference Values (RVs) for these xenobiotics. In this paper, a metanalysis to the published data on PCBs values in human blood is presented. This investigation was carried out in order to reach adequate information on their RVs and to focus some specific topics to be taken into account when producing directly RVs for PCBs. The PCBs RVs resulted between 1.2 e 8.28 microg/L for males and between 2.69 e 5.17 microg/L for females the general range varied from 0.9 to 56 microg/L. The main criticisms in the assessment of RVs for PCBs resulted: the number of examined subjects; the inclusion and stratification criteria; the analytical method adopted and their quality assurance; the type and number of congeners to be determined and their specific quantification; the calculation of blood PCBs concentration (weight/volume or weight/lipids); the statistical analysis and in particular the treatment of not detectable data.
Age Factors↗
[Survey on educational needs in occupational medicine in Italy].
The importance to correctly address continuing education among occupational health professionals in Italy has been particular in the focus of the Scientific and Professional Medical Community also in consideration of the recent regulations implemented in the field of Continuing Medical Education (CME). The Italian Society of Occupational Medicine recently developed an advanced programme of Continuing Medical Education for Occupational Physician. In order to correctly asses the education needs and collect valid information of Occupational Physicians in Italy we administered a target questionnaire among a group of them. The results are analyzed and discussed.
Adult↗
[Lead and cardiopathy].
BACKGROUND: The studies dealing with the relationship between cardiovascular disease and exposure to environmental and occupational chemical risks are out-dated and insufficient. However, this is not true of studies on lead. OBJECTIVES: This paper aims to investigate in particular the etiopathogenesis of the relationship between lead exposure and hypertension. METHODS: The studies published in the last decade concerning both the general population and occupationally exposed subjects were reviewed. RESULTS AND CONCLUSION: The effects due to high levels of exposure to lead are well known and have been studied for over a century. Knowledge on the chronic effects deriving from low and long-term exposure is still very controversial but is currently the most interesting topic; in particular lead hypertension is the topic of an increasing number of studies. Chronic exposure to low levels of lead can cause hypertension via several mechanisms. The most important are: oxidative stress associated with functional NO deficiency, elevation of sympathetic activity coupled with depressed vascular and increased renal beta receptor densities, activation of the renin-angiotensin-aldosterone system, rise in endothelin production, reduction in vasodilatatory prostaglandins and elevation of vasoconstrictive prostaglandins.
Aldosterone↗