• Dario Consonni1

  1. Clinica del lavoro, Milano
Dario Consonni -

Ricerca bibliografica periodo dal 1 aprile 2013 al 15 giugno 2013

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Stringa: ("occupational exposure"[MeSH Terms] OR "occupational diseases"[MeSH Terms]) OR "occupational health"[MeSH Terms]) OR "workplace"[MeSH Terms]) OR "accidents, occupational"[MeSH Terms]) OR "employment"[MeSH Terms]) OR occupation[Title/Abstract]) OR occupational[Title/Abstract]) OR worker[Title/Abstract]) OR workers[Title/Abstract]) AND ("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2013/04/01"[PDAT] : "2013/06/15"[PDAT])

Di ogni articolo è disponibile l'abstract. Per visualizzarlo basta cliccare sul titolo.

Breve commento a cura di Dario Consonni
In questo trimestre segnaliamo tre studi di tipo caso-controllo su fattori occupazionali e tumori. Il primo (d’Errico et al.), condotto in Piemonte, ha riscontrato una relazione tra papillomi invertiti delle cavità naso-sinusali ed esposizione a solventi organici e fumi di saldatura. Il secondo (Miligi et al.) nel contesto dello studio multicentrico italiano SETIL, ha evidenziato associazioni tra leucemie infantili e linfomi non-Hodgkin ed esposizioni paterne a sostanze chimiche (tra cui, idrocarburi, oli minerali, fumi diesel, solventi e piombo). Il terzo (Oddone et al.) ha studiato il tumore della mammella in Lombardia, riscontrando rischi relativi elevati tra le donne che avevano lavorato nei settori della produzione di materiali elettrici, carta, gomma e tessile. L’articolo dal punto di vista metodologico è interessante perché ha applicato metodi per tenere conto dell’effettuazione di confronti multipli, un argomento ancora dibattuto e in continua evoluzione.

1. d'Errico A, Zajacova J, Cacciatore A, Baratti A, Zanelli R, Alfonzo S, Beatrice F. Occupational risk factors for sinonasal inverted papilloma: a case-control study. Occup Environ Med. 2013 Jun 5. [Epub ahead of print]
Epidemiology Department, Local Health Unit, ASL TO3, , Grugliasco, Italy.

OBJECTIVES: Sinonasal inverted papilloma (IP) is an uncommon benign tumour characterised by frequent recurrence and, in approximately 10% of cases, by neoplastic transformation. IP aetiology is unknown but human papillomavirus is detectable in about one quarter of tumours. As some occupational hazards have been reported to be possible risk factors for IP, the aim of this study was to assess risk for sinonasal IP associated with prior exposure to suspected occupational risk factors for sinonasal malignancies. METHODS: Between 1996 and 2007, data on incident cases were collected from hospitals throughout the Piedmont region of Italy by the regional sinonasal cancer registry. A questionnaire on occupational history, completed by 127 cases and 337 hospital controls, was used to assign previous exposure to a list of 17 occupational hazards. The relationship between IP and cumulative exposure to these hazards was explored using unconditional logistic regression to statistically adjust for age, sex, area of residence, smoking and co-exposures. RESULTS: The risk of IP was significantly increased for ever exposure to welding fumes (OR 2.14) and organic solvents (OR 2.11) after controlling for potential confounders. For organic solvents only, a significant association with continuous cumulative exposure and a significant trend in risk across ordered cumulative exposure categories was found. CONCLUSIONS: The present study revealed a significant association and a significant dose-response relationship between occupational exposure to organic solvents and IP. The lack of a dose-response relationship for welding fumes suggests that the observed association with ever exposure should be interpreted with caution.

2. Miligi L, Benvenuti A, Mattioli S, Salvan A, Tozzi GA, Ranucci A, Legittimo P, Rondelli R, Bisanti L, Zambon P, Cannizzaro S, Kirchmayer U, Cocco P, Celentano E, Assennato G, Merlo DF, Mosciatti P, Minelli L, Cuttini M, Torregrossa V, Lagorio S, Haupt R, Risica S, Polichetti A; SETIL Working Group, Magnani C. Risk of childhood leukaemia and non-Hodgkin's lymphoma after parental occupational exposure to solvents and other agents: the SETIL Study. Occup Environ Med. 2013 Jun 1. [Epub ahead of print]
Collaborators: Monetti D, Veneto IO, Gafà L, Luzzatto LL, Michelozzi P, Forastiere F, Gelli L, Assennato G, Pannelli F, Chiavarini M, Lippi A, Bernini G, Nardi M, Acquaviva A, Adesi FB, Cavariani F, Belletti I, Troeschel L, Calisti R, Silvestri S, Sommani L, Miceli G, Farioli A. Occupational and Environmental Epidemiology Unit, ISPO Cancer Prevention and Research Institute, , Florence, Italy.

AIM: In the context of the Italian Multicentric Epidemiological Study on Risk Factors for Childhood Leukaemia and Non-Hodgkin's Lymphoma (SETIL), the risk of childhood cancer was investigated in relation to parental occupational exposures. METHODS: All cases of childhood leukaemia and non-Hodgkin's lymphoma (NHL) in children aged 0-10 years were identified. Controls were chosen at random from the local population in each region. Parents were interviewed using a structured questionnaire. The collected data were blindly reviewed by expert industrial hygienists in order to estimate exposure to a list of agents. Statistical analyses were performed for each agent using unconditional multivariable logistic regression models, taking into account timing of exposure. RESULTS: 683 cases of acute childhood leukaemia, 97 cases of NHL and 1044 controls were identified. Increased risk of childhood leukaemia was found for maternal exposure to aliphatic (OR 4.3) or aromatic hydrocarbons (OR 3.8) in the preconception period, and for paternal exposure to diesel exhaust (OR 1.4), lead exposure (OR 1.4) and mineral oils (OR 1.7). Risk of NHL appeared to be related to paternal exposure to oxygenated solvents (OR 2.5) and petrol exhaust (OR 2.2). CONCLUSIONS: We found increased risk for childhood leukaemia associated with maternal occupational exposure to aromatic and aliphatic hydrocarbons, particularly in the preconception period; increased risks were also observed for paternal exposure to diesel exhaust fumes, mineral oils and lead. The risk of NHL appeared to be related to paternal exposure to oxygenated solvent and petrol exhausts.

3. Oddone E, Edefonti V, Scaburri A, Vai T, Crosignani P, Imbriani M. Female breast cancer in Lombardy, Italy (2002-2009): A case-control study on occupational risks. Am J Ind Med. 2013 May 30. doi: 10.1002/ajim.22205. [Epub ahead of print]
Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.

BACKGROUND: The role of occupational exposures in breast cancer development is still uncertain and, to our knowledge, no studies have been recently carried out in Italy to provide a comprehensive estimation of this possible risk. METHODS: Based on administrative data, a case-control study was carried out recruiting all incident cases of female breast cancer in the period 2002-2009, aged between 35 and 69 years, residing in Lombardy, Italy. Controls were randomly sampled from all women residing in Lombardy as of December 31, 2005. Occupational histories, including blue-collar status, were available from 1974 through record linkage with a social security pension database, and were obtained for 11,188 cases and 25,329 controls. Adjusted odds ratios (ORs) and corresponding 90% confidence intervals (CIs) were calculated using multiple unconditional logistic regression models, including terms for sectors of longest employment and for duration of employment. Multiple comparisons were accounted for according to the Benjamini-Hochberg method. RESULTS: The ORs for female breast cancer were modestly but significantly increased for employment in electrical manufacturing (OR 1.12, 90%CI 1.04-1.21), textile (OR 1.08, 90%CI 1.02-1.15), paper (OR 1.25, 90%CI 1.06-1.46) and rubber (OR 1.26, 90%CI 1.03-1.54) industries. Analysis by duration of employment within sectors showed significantly increased ORs for electrical manufacturing and rubber industries. After adjustment for multiple comparisons no estimates remained statistically significant. CONCLUSIONS: Although with several limitations, our results point to a possible role of exposures in electrical manufacturing, textile, paper and rubber industries in the process leading to breast cancer. An in-dept study for the electrical manufacturing industry has been already planned. Am. J. Ind. Med. 2013. © 2013 Wiley Periodicals, Inc.

4. Monaco M, Pedroni P, Sanchini A, Bonomini A, Indelicato A, Pantosti A. Livestock-associated methicillin-resistant Staphylococcus aureus responsible for human colonization and infection in an area of Italy with high density of pig farming. BMC Infect Dis. 2013 Jun 3;13:258. doi: 10.1186/1471-2334-13-258.
Department of Infectious, Parasitic and Immuno-mediated Diseases, Istituto Superiore di Sanità, viale Regina Elena, 299, Rome, Italy.

BACKGROUND: Livestock-Associated MRSA (LA-MRSA) belonging to ST398 lineage, common among pigs and other animals, emerged in Central and Northern Europe, becoming a new risk factor for MRSA among farm workers. Strains belonging to ST398 can be responsible for human colonization and infection, mainly in areas with high livestock-farming. The aim of this study was to investigate the occurrence of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) human colonization and infections in an area of the Lombardy Region (Italy), the Italian region with the highest density of pig farming. METHODS: In the period March-April 2010, 879 nasal swabs were taken from subjects at admission to a local hospital serving an area of the Lombardy Region devoted to agriculture and farming. In the period March 2010-February 2011, all MRSA strains from community-acquired infection (CAI) observed in the same hospital, were collected. Molecular characterization of the isolates included SCCmec typing, spa typing and multilocus sequence typing (MLST). RESULTS: Out of 879 nasal swabs examined, 9 (1%) yielded MRSA. Five strains were assigned to sequence type (ST)398 (spa t899, 3 isolates; t108 and t2922, 1 isolate each) and were therefore categorized as LA-MRSA. The other 4 isolates were likely of hospital origin. No strains were positive for Panton-Valentine Leukocidin genes. Twenty MRSA isolates were detected from CAI, 17 were from skin and soft-tissue infections and 3 from other infections. An MRSA isolate from otitis externa was t899/ST398 and PVL-negative, hence categorized as LA-MRSA. Four isolates were assigned to t127/ST1. Eight strains were PVL-positive community acquired (CA)-MRSA and belonged to different clones, the most frequent being ST8. CONCLUSIONS: In an area of Italy with high density of pig farming, LA-MRSA is able to colonize the population and rarely to produce infections. Typical CA-MRSA is more common than LA-MRSA among CAI.

5. D'Alessandro D, Agodi A, Auxilia F, Brusaferro S, Calligaris L, Ferrante M, Montagna MT, Mura I, Napoli C, Pasquarella C, Righi E, Rossini A, Semeraro V, Tardivo S; GISIO Prevention of healthcare associated infections: Medical and nursing students' knowledge in Italy. Nurse Educ Today. 2013 May 29. pii: S0260-6917(13)00168-8. doi: 10.1016/j.nedt.2013.05.005. [Epub ahead of print]
Dept. Civil Building and Environmental Engineering, Sapienza University, Via Eudossiana, 18-00186 Rome, Italy; Post-graduate School of Public Health, Sapienza University of Rome, P.le Aldo Moro, 5, 18-00185 Rome, Italy. Electronic address:

BACKGROUND: The training of health workers is a key issue for the prevention of healthcare associated infections. OBJECTIVES: To evaluate knowledge of nursing and medical students concerning the prevention of healthcare associated infections. DESIGN: A cross-sectional study. SETTING: University hospitals in nine Italian cities. PARTICIPANTS: One thousand four hundred sixty one healthcare students (607 medical students and 854 nursing students). METHODS: The study was performed using a questionnaire investigating 3 areas, each having different possible points: standard precautions=12; hand hygiene=8; healthcare associated infections=5, for an overall perfect score of 25. Scores that met a cutoff ≥17.5 were considered to be indicative of an acceptable level of knowledge. Factors associated with an acceptable level of knowledge were analyzed using a logistic regression model. RESULTS: Mean overall score (±SD) was 18.1±3.2. Nursing students (18.6±2.9) obtained a higher overall score than medical students (17.4±3.5) (p<0.001). Weighed scores (±SD) by area were: 10.3 (±2.0) for standard precautions, 5.0 (±1.3) for hand hygiene and 2.8 (±1.1) for healthcare associated infections. Knowledge level concerning the three areas was different between medical and nursing students (p<0.001). The probability of finding acceptable knowledge was smaller for medical students (OR: 0.54 p<0.0001) and for students aged ≥24years (OR: 0.39 p<0.0001). CONCLUSION: The overall score showed an acceptable level of knowledge for the whole sample; but, considering separately the two curricula, only nursing students reached the minimum acceptable score. It seems important to investigate what is working better in nursing than in medical education in order to implement and validate new teaching approaches.

6. Larese Filon F, Bochdanovits L, Capuzzo C, Cerchi R, Rui F. Ten years incidence of natural rubber latex sensitization and symptoms in a prospective cohort of health care workers using non-powdered latex gloves 2000-2009. Int Arch Occup Environ Health. 2013 May 23. [Epub ahead of print]
Unità Clinico Operativa di Medicina del Lavoro, Dipartimento di Scienze di Medicina Pubblica, Università degli Studi di Trieste, Via della Pietà, 19-24120, Trieste, Italy,

OBJECTIVES: To assess the incidence of sensitization and gloves-related symptoms in 10-year follow-up in a group of health care workers (9,660 person-years) using non-powdered latex gloves from 2000 to 2009 and to examine related factors. MATERIALS AND METHODS: We studied 2,053 health care workers in Trieste Hospitals by means of skin prick test for latex extract, patch tests and medical examinations. We report the incidence of latex sensitization among workers using non-powdered latex gloves. RESULTS: The incidence of latex sensitization, rhinitis, asthma, urticaria, irritant and allergic contact dermatitis were 1.0; 0.12; 0.21; 0.72; 2.39 and 2.50 cases per 1,000 person-years, respectively. Respiratory symptoms and urticaria were positively related with latex sensitization (OR = 8.0; 95 % CL 1.27-48.6), with common allergic respiratory symptoms (OR = 4.19; 95 % CL 1.04-16.8) and with familial atopy (OR = 4.47; 95 % CL 1.1-17.9). CONCLUSION: The incidence of latex sensitization and latex-related symptoms were very low but subjects with allergic symptoms related to common allergens are at higher risk. The use of non-latex gloves is suggested for them.

7. Olivieri M, Biscardo CA, Palazzo P, Pahr S, Malerba G, Ferrara R, Zennaro D, Zanoni G, Xumerle L, Valenta R, Mari A. Wheat IgE profiling and wheat IgE levels in bakers with allergic occupational phenotypes. Occup Environ Med. 2013 May 17. [Epub ahead of print]
Unit of Occupational Medicine, Department of Public Health and Community Medicine, University of Verona, , Verona, Italy.

OBJECTIVES: To characterise occupational wheat allergic phenotypes (rhino-conjunctivitis, asthma and dermatitis) and immunoglobulin (IgE) sensitisation to particular wheat allergens in bakers. METHODS: We conducted clinical and immunological evaluations of 81 consecutive bakers reporting occupational symptoms using commercial tests (skin prick test (SPT), specific IgE, ISAC microarray) and six additional dot-blotted wheat allergens (Tri a 39, Tri a Trx, Tri a GST, Tri a 32, Tri a 12, Tri a DH). RESULTS: Wheat SPT resulted positive in 29 bakers and was associated with work-related asthma (p<0.01). Wheat IgE was detected in 51 workers and was associated with work-related asthma (p<0.01) and rhino-conjunctivitis (p<0.05). ISAC Tri a 30 was positive in three workers and was associated with work-related dermatitis (p<0.05). Wheat dot-blotted allergens were positive in 22 bakers. Tri a 32 and Tri a GST were positive in 13 and three bakers, respectively, and both were associated with work-related dermatitis (p<0.05). This association increased (p<0.01) when Tri a 32, Tri a GST and Tri a 30 were analysed together (p<0.01). Wheat IgE levels were associated with work-related dermatitis (p<0.01). CONCLUSIONS: Wheat IgE levels and wheat microarrayed allergens may be associated with some occupational allergic phenotypes. The extension of the panel of wheat allergens may be promising for discriminating the clinical manifestations of baker's allergy.

8. Barbadoro P, Santarelli L, Croce N, Bracci M, Vincitorio D, Prospero E, Minelli A. Rotating shift-work as an independent risk factor for overweight italian workers: a cross-sectional study. PLoS One. 2013 May 10;8(5):e63289. doi: 10.1371/journal.pone.0063289. Print 2013.
Department of Biomedical Science and Public Health, School of Medicine-Università Politecnica delle Marche, Ancona, Italy.

BACKGROUND: A job-related factor is attracting a growing interest as a possible determinant of body weight gain in shift-workers. OBJECTIVE: The aim of the study was to reinvestigate the issue of overweight between rotating shift workers and daytime workers, taking into consideration possible confounding covariate factors. METHODS: This is a cross-sectional study, conducted by reviewing data from subjects participating in an occupational surveillance program in 2008. Participants answered a self-administered questionnaire to retrieve information about socio-demographic factors and working conditions (job schedule type, job-related physical activity, time in job), subjective health status, health care visits during the previous year, and lifestyle factors (dietary habits, leisure time physical activity, alcohol consumption). Participants underwent a medical examination for measurement of BMI, and acquisition of medical history. RESULTS: Compared to daytime workers (N = 229), rotating shift workers (N = 110) displayed higher BMI (mean BMI was 27.6±3.9 and 26.7±3.6 for shift workers, and daytime workers, respectively; p<0.05). Logistic regression analysis allowed to highlight the role of rotating shift-work as an independent risk factor for increased body weight (OR 1.93, 95%CI 1.01-3.71), being aged between 35 and 54 years was a major determinant of increased BMI (OR 2.39, 95%CI 1.14-5.00). In addition, family history of obesity was the strongest determinant of overweight/obesity (OR 9.79, 95%CI 1.28-74.74). Interestingly, no significant association was found between overweight and other potentially relevant factors, such as diet quality and food choices, alcohol consumption, levels of occupational and leisure-time physical activity. CONCLUSIONS: Present findings seem to support the notion that rotating shift work is an independent risk factor for overweight, regardless of workers' dietary habits and physical activity levels.

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