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Objective To evaluate the prevalence of drug use by elderly outpatients in Italy and to identify the association between drug use and gastrointestinal symptoms. Study design and setting The study was carried out by 133 general practitioners (GPs) who referred to 24 geriatric units in Italy. All consenting elderly patients seen at the GPs’ offices were evaluated for gender, age, disability, current medications, and upper gastrointestinal symptoms. Results The study included 5,515 elderly subjects. The prevalence of drug use was 91.6%, and the mean number of drugs taken was 2.86 per person. Both the prevalence and the mean number of drugs significantly increased with advancing age. Regarding gastrointestinal symptoms, 32.7% of patients reported at least one upper gastrointestinal symptom: 25% with indigestion syndrome, 16.2% with abdominal pain, and 14.2% with reflux symptoms. A significantly higher prevalence of symptoms was observed in females, patients who were taking a higher number of drugs, and those who had higher disability. Adjusted multivariate analysis demonstrated that the use of nonsteroidal antiinflammatory drugs, steroids, psycholeptics, diuretics, selective β2 adrenoreceptor agonists or adrenergics, and antiplatelet drugs was significantly associated with upper gastrointestinal symptoms. Conclusion The prevalence of drug use is very high in this elderly outpatient population. The number of drugs and the use of some specific drug classes are significantly associated with the presence of upper gastrointestinal symptoms.

Objective Personal exposure to airborne benzene is influenced by various outdoor and indoor sources. The first aim of this study was to assess the benzene exposure of a sample of urban inhabitants living in an inner-city neighborhood of Florence, Italy, excluding exposure from active smoking. The secondary objective was to differentiate the personal exposures according to personal usage patterns of the vehicles. Methods A sample of 67 healthy non-smokers was monitored by passive samplers during two 4-weekday campaigns in winter and late spring. Simultaneously, benzene measurements were also taken for a subset of participants, inside and outside their houses. A 4-day time microenvironment activity diary was completed by each subject during each sampling period. Other relevant exposure data were collected by a questionnaire before the sampling. Additional data on urban ambient air benzene levels were also available from the public air quality network. The passive samplers, after automated thermal desorption, were analyzed by GC-FID. Results Benzene personal exposure levels averaged 6.9 (SD = 2.1) and 2.3 (SD = 0.7) μg/m3 in winter and spring, respectively. Outdoor and indoor levels showed high correlation in winter and poor in spring. In winter the highest benzene personal exposure levels were for people traveling by more public transport, followed by users of only car and by users of only bus respectively. Conclusions The time spent in-transport for work or leisure makes a major contribution to benzene exposure among Florentine non-smoking citizens. Indoor pollution and transportation means contribute significantly to individual exposure levels especially in winter season.

The objective of this study is to optimize the evaluation of the exposure to N,N-dimethylformamide (DMF) in synthetic leather factories by diffusive samplers. The DMF exposure was monitored in synthetic leather factories by two sampler types: active and diffusive. Air measurements were carried out using two different personal air samplers, a diffusive and an active one. The diffusive sampling method, TK200 with charcoal filters, was examined in comparison with pumping through NIOSH silica gel tubes workplace air as with the currently available “gold standard”. The evaluation was carried out, in two different years but in the same season, for all the duration of the shift, i.e. 8 h on workers employed in five different factories in the district of Florence and Prato (Italy). The statistical and graphical analysis of data show a good correlation between active and passive samplers (r = 0.96, P

The aim of this study was to determine the amount of benzene present in soft drinks sold in Florence (Italy). We analyzed 28 different types of soft drinks, by measuring concentrations of benzoic acid, sorbic acid, ascorbic acid (using high performance liquid chromatography with UV detection) and benzene (using gas chromatography and mass spectrometry). Data was analysed by using SPSS 18.0.Traces of benzene were detected in all analyzed beverages, with a mean concentration of 0.45 µg/L (range: 0.15-2.36 µg/L). Statistically significant differences in mean benzene concentrations were found between beverages according to the type of additive indicated on the drink label, with higher concentrations found in beverages containing both ascorbic acid and sodium benzoate. Two citrus fruit-based drinks were found to have benzene levels above the European limit for benzene in drinking water of 1 µg /L. Sodium benzoate and ascorbic acid were also detected in the two drinks.In conclusion, not all soft drink producers have taken steps to eliminate benzoic acid from their soft drinks and thereby reduce the risk of formation of benzene, as recommended by the European Commission. Furthermore, the presence of benzene in trace amounts in all beverages suggests that migration of constituents of plastic packaging materials or air-borne contamination may be occurring.

The present study was performed to evaluate the role of hand and facial contamination in the absorption of soluble nickel compounds in 41 male subjects employed in electroplating operations in 25 small factories in the province of Florence (Italy). Personal exposure to airborne nickel ranged from 0.10 to 42 micrograms/m3; the median (range) urine, hands and face nickel levels were 4.2 (0.7-50) micrograms/l, 39 (1.9-547) micrograms, 9.0 (1.0-86) micrograms, respectively. Face nickel values explained the bulk of the variance in urine nickel levels (42%). In stepwise multiple regression analysis all other variables were not significant. The log-linear model can be expressed as: log (urine-Ni) = 0.295 + 0.593 log (face-Ni). Our results suggest that skin contamination, especially facial skin, plays an important role in nickel absorption in exposed workers.

The aim of this study was to verify the efficacy and applicability of the Ultracision Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) in pharyngolaryngectomy with radical neck dissection.This work evaluated the use of the Harmonic Scalpel in otolaryngology as a new and alternative method to overcome some complications of traditional surgery.The study was conducted with 20 patients in the ENT Department of the University of Genoa (Italy) between January 1, 2005, and December 31, 2006.A prospective, randomized study was undertaken on 20 pharyngolaryngectomies with radical neck dissection performed using a Harmonic Scalpel (10 patients) or traditional surgery (10 patients).The evaluation included operation time, intraoperative blood loss, postoperative seroma formation, and pattern of wound healing.In patients treated with Harmonic Scalpel, the mean operation time was significantly shorter, the blood loss was less, laryngeal and neck drainage on the first and second postoperative days was significantly smaller, and no postoperative complications were noted.The use of the Harmonic Scalpel during pharyngolaryngectomy and radical neck dissection led to diminished bleeding, shorter operative time, less seroma formation, and better wound healing in the postoperative period.

This article reports the results of a study, conducted in the framework of the scientific activities of the Italian Society for Reference Values, aimed at defining reference values of urinary trans,trans-muconic acid (t,t-MA) in the general population not occupationally exposed to benzene. t,t-MA concentrations detected in 376 subjects of the resident population in three areas of Italy, two in central (Florence and southern Tuscany) and one in northern Italy (Padua), by three laboratories, compared by repeated interlaboratory controls, showed an interval of 14.4-225.0 microg/L (5th-95th percentile) and a geometric mean of 52.5 microg/L. The concentrations measured were influenced by tobacco smoking in a statistically significant way: Geometric mean concentrations were 44.8 microg/L and 76.1 microg/Ll in nonsmokers (264 subjects) and smokers (112 subjects), respectively. In the nonsmoking population, a significant influence of gender was found when concentrations were corrected for urinary creatinine, geometric mean concentrations being 36.7 microg/g creatinine in males (128 subjects) and 44.7 microg/g creatinine in females (136 subjects). The place of residence of subjects did not seem to influence urinary excretion of the metabolite, although personal inhalation exposure to benzene over a 24-h period showed slightly higher concentrations in Padua and Florence (geometric means of 6.5 microg/m(3) and 6.6 microg/m(3), respectively) than in southern Tuscany (geometric mean of 3.9 microg/m(3)). Concentration of t,t-MA in urine samples collected at the end of personal air sampling showed little relationship to personal inhalation exposure to benzene, confirming the importance of other factors in determining excretion of t,t-MA when concentrations in personal air samples are very low.

Background and aims: Samples of nursing homes in Tuscany (Italy) classify their residents and determine their case-mix according to the Resource Utilization Groups System, Version III (RUG-III). Methods: A large sample of nursing homes was selected, based on willingness to participate, representation of both public and private institutions, and wide geographic representation. Two registered nurses assessed all residents using the RUG questionnaire. The information collected was then used to group residents into 44 RUGs, and facility-specific case-mix indices were calculated using the RUG-specific weights previously validated in Italy. Results: A total of 3981 residents from 93 nursing homes were assessed. Most residents were over 75 years old (87.4%) and women (68.6%). A large percentage was classified into RUGs within the following primary categories: reduced physical function (33.6%), impaired cognition (17.6%) and clinically complex (17.6%). The resulting nursing home case-mix indices ranged from 0.627 to 1.108 (mean 0.807±0.110). No significant association was found between type of facility, level of fees, or extent of staff in the nursing homes and their case-mix indices. Conclusions: RUG-III can provide information on types of nursing home residents and their care needs. This is useful for monitoring and evaluating long-term care services for the elderly, and allows for more effective planning and allocation of staffing and financial resources.

The wide use of barium (Ba), cesium (Cs), antimony (Sb) and tungsten (W) in many industrial and agricultural fields causes the increased release of these metals into the environment, laying the basis for health risk. To assess the exposure for the general population, the development of adequate and reliable analytical techniques becomes compulsory. This study refers to the quantification of urinary Ba, Cs, Sb and W levels by both quadrupole (Q) and sector field (SF) inductively coupled plasma mass spectrometry (ICP-MS). The two procedures were compared for their performances and their measurement uncertainties. The limits of detection were (Q and SF) 23.0 and 5.21 ng L(-1) for Ba; 21.1 and 7.52 ng L(-1) for Cs; 1.09 and 0.43 ng L(-1) for Sb; and 0.36 and 0.49 ng L(-1) for W. The trueness was better than 93.3% and the precision less than 12% for both techniques. Relative expanded uncertainties of the analytical procedures, at the median levels found in the general population, were below 5% for all the elements with both ICP-MS techniques. The uncertainties related to the calibration and repeatability were the parameters most influencing the final analytical performance. The urinary median values observed in healthy subjects from central Italy were 1146, 4301, 60.8 and 48.5 ng L(-1) for Ba, Cs, Sb and W, respectively.

The aim of this study, carried out from 1997 to 2000, was to evaluate the exposure to antiblastic drugs of hospital staff (38 nurses of 7 oncological Day Hospital care in Tuscany). To evaluate the internal exposure was used biological monitoring, in particular was determined the concentration of urinary cyclophosfamide (CF); pad was made to evaluate the skin contamination. The contamination of working surfaces was determinate, by wipe-test, to verify the decontamination procedures; were used, as markers, CF and 5-fluorouracil (5-FU). We assessed the permeability thorough gloves usually used by the staff and the degradative activity to these drugs by agents used to decontaminate the working surfaces. The results shows, in urine, value lower than the detection limits, although was found a diffused contamination of the working environment. The results confirmed that NaClO is the best product to decontaminate working surfaces and nitrile gloves the ones with less permeability.

This article presents a review of reference values for organic solvent biomarkers. Some of these results were obtained in the research activities of the Italian Society Reference Values (SIVR). Most experiences show data obtained from control groups during occupational exposures assessment investigations. We considered only data related to the following biomarkers: immodified solvents in blood and urine, their main urinary metabolites. The reference values of the following solvents are reported: benzene, toluene, xylene, nhexane, cyclohexane, trichloroethylene, perchloroethylene, methanol, acetone, N,N-dimethylformamide, carbon disulphide. In the text also the influence of some confounding factors is discussed.

This study assesses 2,5-hexanedione (2,5-HD) in the urine of subjects exposed to n-hexane solvent between 1991 and 1998, from details obtained from the Registry of Biological Monitoring (BM) at the Florence Local Health Unit, and its development over time. The Registry contains 15,925 samples from 6,650 subjects occupationally exposed to n-hexane, especially in leather (9,099 samples; 3,607 subjects) and shoe (3,865 samples; 1,938 subjects) production. Over the time span studied there was a total reduction of 31.9% in urinary 2,5-HD level. The yearly decrease over the entire period was 5.4%. Dividing the 8 years into three periods: before the introduction of the new legislation for health protection in the workplace (1991–1993), during its transition (1994–1996) and after its complete enforcement (1997–1998), respectively, we observed a marked decrease in the last period. Women and young people (under 30 years) experienced significantly higher absorption levels (respectively, 7.1% and 24.4%). The data suggest that monitoring was more frequent in subjects with higher starting values, and the greatest decrease was reported in this group. Reduction may be due to less n-hexane in the products used, better structural conditions in the factories, and the effectiveness of inspections carried out by the authority for hygiene and safety in the workplace. The results confirm the usefulness of the reporting of risk levels of exposure to industrial toxicants by routine biological monitoring.

In this study, the authors evaluated exposure to airborne polycyclic aromatic hydrocarbons (PAHs) in workers exposed to exhaust gas from cars, and they assessed the efficiency of urinary 1-hydroxypyrene as an indicator of exposure to pyrene and PAHs. The authors selected 2 groups of police who worked in 2 areas in the city of Florence: 1 group was highly exposed to high-density traffic emissions during the winter and summer of 1997, and the 2nd group experienced low exposure to traffic emissions during the same period. Ambient monitoring was achieved with personal sampling of airborne PAHs during each workshift. Eight hydrocarbons were used as indicators of pollution caused by PAHs (e.g., pyrene, benzo[a]pyrene, benzo[a]anthracene, dibenzo[a,h]anthracene). Biological monitoring was performed through dosing of 1-hydroxypyrene (pyrene metabolite) in urine samples taken at the end of each workshift. The ambient monitoring revealed that PAH concentrations were influenced by both season of sampling and varying intensities of traffic in the different areas. The median concentration of benzo[a]pyrene in winter was twice as high in the high-density traffic area as in the low-density traffic area (i.e., 4.1 ng/m3 versus 1.8 ng/m3). In summer, the high-density traffic area experienced benzo[a]pyrene concentrations that were 6 times higher than in the low-density traffic area (i.e., 1.2 ng/m3 versus 0.2 ng/m3). Benzo[a]pyrene was also correlated highly (r(s) = .92, p < .0001) with the mixture of total PAHs analyzed, thus confirming its function as a good indicator of exposure to PAHs in an urban environment. Levels of urinary 1-hydroxypyrene appeared to be generally influenced by the intensity of traffic, especially during the winter (i.e., median value in winter was 199.2 ng/gm creatinine in the high-density traffic area and 120.5 ng/gm creatinine in the low-density traffic area). An analysis of the general data revealed that 1-hydroxypyrene was, to some degree, related to pyrene, benzo[a]pyrene, and airborne total PAHs, whereas analysis of separate data for the area and the season revealed an emergence of a closer correlation during the winter in the high-traffic area. Therefore, 1 -hydroxypyrene can be considered a good biological indicator of exposure to airborne PAHs in the urban environment, especially in winter and in high-density traffic areas.

This paper presents the results of a polycentric study carried out in seven different areas, organized by the Italian Society of Reference Values (SIVR) for assessing reference values of lead in blood (B-Pb) at the current doses of the metal to general population. The estimated arithmetic mean for B-Pb in males was of 45.1 microg/l and 30.6 microg/l in females; the 95th centile was 100 and 60 for males and females, respectively. The main variables influencing B-Pb levels were gender, age, BMI, outside sport practice, alcohol consumption and smoking habits, while the geographic area and the urban residence did not affect the metal concentration in blood.

The aim of this study was to evaluate factors predicting length of stay in hospital of geriatric patients. Study participants were 402 patients (183 males and 219 females) consecutively admitted to four geriatric wards located in Chieti, Perugia, Pescara and Prato, Italy. Information on potential predictors of length of stay was collected; in particular, we assessed the presence and severity of specific chronic medical conditions, level of physical function, cognitive status, and depressive symptoms. Moreover, information on family and social support was obtained. In general, participants were old, often cognitively impaired and physically disabled. Average length of stay ranged from 9.4 +/- 3.3 days (Perugia) to 14.1 +/- 7.2 days (Chieti), and was statistically different across centers (p0.001). None of the specific medical diagnoses was associated with different length of stay. However, higher comorbidity score (p0.001), living alone (p0.01), lower MMSE score (p = 0.03), and poor functional status (p = 0.05) were all associated with longer length of stay. When these variables were included in a multivariate model predicting length of stay, differences between centers were no longer statistically significant. Findings of this study show that specific medical diagnoses are not adequate instruments to estimate length of stay in geriatric units. Other assessment systems based on extension of the social network, comorbidity, and the cognitive as well as the functional level need to be developed.

We report the results obtained in 1992 concerning the determination of blood lead levels (PbB) in 1321 subjects of the general population living in ten villages/towns of the Florence district characterised by the presence of artistic ceramic factories. We reported also the PbB values found in 2330 adults, 280 children, 39 pregnant women and their correspondent umbilical cords, who were examined during the second biological monitoring campaign against the risk of lead intoxication according to the DPR 496/82. Median PbB values were 92.5 micrograms/l (range 15-520 micrograms/l) for males and 62.5 micrograms/l (range 11-343 micrograms/l) for females. The lower PbB median values were found in the district of Livorno (76.25 micrograms/l and 48.25 micrograms/l in males and females, respectively) and Arezzo (80.5 micrograms/l and 52 micrograms/l in males and females, respectively). In comparison with the results obtained for the general Italian population during the previous biological monitoring campaign carried out in 1985-86 we observed PbB median values about 40% lower for both males and females and PbB median values about 55% lower for children. A significant statistic correlation (r = 0.53) was found between PbB of pregnant women and their umbilical cords.

We report the results of 24,475 blood lead determinations (PbB) performed by the Occupational Toxicology Laboratory of Florence between 1976 and 1995. Biological monitoring was carried out in 383 factories localized in the districts of Florence, Prato, Pistoia, Lucca and Pisa. The most represented production fields were colouring ceramic factories, artistic ceramics, transfer-pictures for ceramics, glass factories, typographies, glass decoration factories, chemical factories. In twenty years, the median values of PbB decreased from 48 to 17 micrograms/100 ml in males and from 40 to 8 micrograms/100 ml in females. The 95 degrees centile ranged from 84 to 46 micrograms/100 ml for males and from 63 to 42 micrograms/100 ml for females. In the 1988-95 period, we observed an increase of both the 95 degrees centile and the maximal values because of the inclusion of data from workers employed in factories where the "decorazione a scavo" technique, which is characterized by elevated environmental lead concentrations, was used. In the period 1991-93, the ranges of PbB observed in glass decoration factories were 13-160 micrograms/100 ml for males and 4-80 micrograms/100 ml for females, respectively.

Objective: Determination of the urinary levels of 2.5-hexanedione (2,5-HD) was performed in subjects belonging to the Italian general population to define the reference value for this metabolite. Materials and methods: Urine samples were collected from 123 healthy Italian subjects who had not been occupationally exposed to n-hexane or methyl-n-butyl ketone (60 men and 63 women; 53 living in urban areas and 70 living in rural areas; 36 smokers and 87 nonsmokers; 65 aged above 35 years and 58 aged below 35 years). The determinations were performed by a gas chromatography method using a flame ionization detector (FID). A quality-control step was realized by analysis of 78 of these samples by high-performance liquid chromatography (HPLC) with UV detection. Results and discussion: The distribution of 2,5-HD concentration was log-normal and the corresponding centiles at the 95% confidence interval were as follows: the 50th centile, 0.270 mg/l for men and 0.191 mg/l for women; the 75th centile, 0.352 and 0.330 mg/l, respectively, for men and women; and the 95th centile, 0.762 and 0.582 mg/l, respectively, for men and women. The reference value, calculated as the upper unilateral 95% tolerance interval at 95% of confidence, was 0.795 mg/l for men and 0.627 for women.

The paper describes the results of a polycentric study for the assessment of reference values of urinary chromium (U-Cr) in the Italian population.A total of 890 subjects (58.3% males and 41.7% females) were selected on the basis of standardized criteria in eight different areas of Italy. Urinary chromium was determined on morning spot samples collected using standardized procedures. The U-Cr was determined independently by three laboratories using an Electrothermic atomization-Atomic Absorption Spectrometry (ETA-AAS) method with a detection limit of 0.05 microgram/l, adopting-for the statistical analysis-the median value of the results of the three laboratories. The between-laboratories within-subjects standard deviation was 0.049 microgram/l. Due to the high proportion (approx, 28%) of undetectable chromium levels, the geometric mean (GM) and geometric standard deviation (GSD) were estimated using a procedure of linear interpolation. The analysis of the effects of some variables (sex, age, center, residence, smoking and drinking habits) on the U-Cr values, was also performed, by multiple regression analysis after logarithmic transformation, using GM and SD.The reference value of U-Cr was of 0.08 microgram/l as an estimated GM, whereas the expected distribution ranged from not detectable (nd) (95% CI = nd-0.06) to 0.24 microgram/l (95th percentile; 95% CI = 0.20-0.31). Among the variables studied, only geographical area and sex significantly influenced the U-Cr levels. In subjects selected in the provinces of Bari and Venice values of U-Cr were significantly lower than those determined in subjects residing in other areas.From our investigation the reference values for U-Cr were lower than those obtained in previous investigations. In addition it confirms a further reduction in U-Cr levels following the previous decline reported in the 1970s and 1980s. In over 20 years U-Cr values in the general population dropped from values greater than 1 microgram/l to values between 0.5 and 0.2 microgram/l. The reasons of this progressive decline cannot be attributed in our opinion to a reduced intake of the metal, but mainly to the improvement in analytical instrumentation and methods. A further decrease may be ascribed to a more accurate definition of the reference groups and to a better control of pre-analytical factors. Considering that the reference values for U-Cr are much lower than those determined some decades ago, toxicological studies in order to verify the significance of biological limit values currently suggested for chromium seem to be necessary.

The Authors have reviewed the most important literature available on the determination of blood lead level in non-occupationally exposed subjects, children and groups exposed to vehicular traffic (i.e. policemen, bus drivers, etc.). They have also collected data concerning lead concentration in air (mcg/m3) and in gasoline (g/l). The results show that the gradual decrease of gasoline lead concentrations gives a consistent decrease of blood lead level in the general population. In Italy, in the nonoccupationally exposed subjects, the mean blood lead level in 1974 was 32 mcg/dl and in 1991 was 8,4 mcg/dl. The mean value in children is presently about 8,3 mcg/dl. The values in workers exposed to vehicular traffic are higher than those found in non-exposed population.

Results of an interlaboratory precision comparison programme of blood lead determination are presented. The samples consisted of bovine haemolyzed whole blood to which were added in pool small quantities of lead nitrate aqueous solutions to obtain two different concentrations of the metal (i.e. about 30 and 70 micrograms/dl). After each pool was well mixed it was divided into 15 ml portions in screw-top linear polyethylene vials and stored at -25 degrees C. The analytical methods used by the five public health laboratories participating in the programme were based on atomic absorption spectrophotometry. Three laboratories used methods which incorporate discrete sampling techniques (i.e. tantalum boat, electrothermal atomisation) and the remaining two, a method incorporating a sample preconcentration by solvent extraction and flame atomisation. During the six months period of the programme, fifty five results were obtained for each of the two pools of blood. Common statistical methods and the graphic system devised by Youden were used for data analysis. An acceptable agreement among results from the five laboratories has been obtained. The usefulness of this type of programme in improving analytical proficiency has been confirmed.

A survey was carried out in 15 leather goods manufactures in the Florence's Province in order to indicate the parameters for the evaluation of the exposure due to solvents by personal samplings. N-esano concentration was correlated to the following parameters: ventilation, volume of the premises, gluing surface of the articles, gluing process and relative methods. Aim of the survey was to point out the more useful parameters, to assess the glue users exposure, in order to effect improvements in the working process and premises of the workshops in the whole area. As a final result of the survey the parameter with the best correlation to n-hexane concentration was the one indicated as "gluing method". Some prevention advises are indicated.

The aim of the study was to evaluate which characteristics of geriatric patients account for readmission to hospital, 6 months after discharge. All patients (203 females, 176 males) consecutively admitted over a two-month period to four acute geriatric care units, located in the cities of Chieti, Perugia, Pescara and Prato, participated in the study. Data that could potentially explain early and late readmissions were collected for each patient. Prevalence of diseases and comorbidity were assessed with the Cumulative Illness Rating Scale (CIRS); physical function by self-report (ADL, IADL) and objective (Stand and Walking Speed) measures; cognitive level by MMSE; and depressive symptoms by the Geriatric Depression Scale (GDS). Information on family and social support were also obtained. After discharge, data on hospital readmissions were collected for six months. For each readmitted patient (cases), medical records were reviewed, and supplementary information was obtained from families and general practitioners. Readmissions were classified as "early" (within the first three months), "late" (within the third and sixth month), and "multiple" (2 or more readmissions irrespective of the period). Patients not readmitted (alive at home) were considered as controls. Systematic differences between centers and between periods of readmissions were evaluated using one-way analyses of variance, and Pearson's chi 2 test. Factors related to early, late, and multiple readmission were identified in multivariate logistic regression models. On univariate analysis, patients readmitted over the first three-month period were sicker than controls (CIRS classes 3-4: 52.1% vs 34.1%), had more social problems or behavioral symptoms, and were more functionally impaired (ADL dependencies 3.3 +/- 0.4 vs 2.1 +/- 0.2). Patients who were readmitted between the third and the sixth month after discharge had a significantly higher CIRS total score (p = 0.006). Patients with multiple readmissions had more severe diseases, and more social problems. On multivariate analysis, early readmission was associated with unsatisfactory social conditions, living alone, severity of diseases and cognitive impairment, while late readmission was associated with comorbidity only. Multiple readmissions were related only to social factors, and to hospital admission before the baseline evaluation. The findings of this study suggest that interventions aimed at improving unfavorable social conditions may reduce the rate of rehospitalization in geriatric patients.

Purpose of the present study is to determine the qualitative and quantitative composition of nine biogenic amines (BA) in 153 samples of epigeal spontaneous mushrooms (Boletus edulis and Amanita Caesarea), sampled at large and small food retail shops in the Florence area. Each BA has been identified and quantified using a liquid chromatography system with a reversed phase, C18 column and post-column derivatization with o-oftalaldeide. The results have shown a widespread presence of each amine, although with varying frequency and concentration, and an increasing concentration of tyramine and putrescine in samples with poor organoleptic quality than those in good conditions.

The study assesses the time trend in exposure to nickel among factory workers in Florence, via data on biological monitoring. A data-base of nickel in urinary samples (Ni-U mg/l) was created for the period 1991 to 1998.The data-base contained 2.138 samples, measured by atomic absorption (GF-AAS),from 893 workers. Subjects came from 157 factories in various manufacturing sectors, especially electroplating, mechanical workshops, jewellery.Ni-U levels were correlated with manufacturing sector. The highest levels were found among workers from electroplating industries, where exposure was mainly due to water-soluble nickel compounds. The eight-year time trend showed a statistically significant decrease in Ni-U values, with a sharper drop during the last two-year period. Age, sex and number of samples per subject were not statistically related to this trend.The observed Ni-U decrease could be related to the efficacy of new legislation introduced in Italy during the study period (Law 626/94 and subsequent laws), but also to the intense labour inspection activities that officials of National Health Service performed, which were rightly focused on nickel exposure in different manufacturing sectors. This study confirms the usefulness for occupational risk evaluation of a biological monitoring data-base of routinely collected data.

Aims and background Several chemical compounds included in the group of polycyclic aromatic hydrocarbons (PAH) and benzene are well-known human carcinogens present in the atmosphere of polluted urban areas. Major sources include vehicle traffic and industrial emissions, but also cigarette smoke. Genotoxic damage derived from exposure to PAHs can be measured in healthy adults by specific assays as PAH-DNA adducts. In the frame of EPIC-Italy, we recently carried out a cross-sectional study in different areas of the country (Palli et al., Int J Cancer, 87: 444-451, 2000) and showed that mean DNA adduct levels varied considerably among different centers, being highest in Florence (a large metropolitan area in Tuscany) and lowest in Ragusa (a small town in Sicily). Methods A subgroup of EPIC volunteers, representative of these two local cohorts, agreed to collect 24-h urine samples, and we measured the excretion of two potential biomarkers of exposure to environmental pollutants: t,t-muconic acid (MA), a metabolite of benzene, and 1-hydroxypyrene (1-OHP), a metabolite of pyrene. Overall, 69 24-h urine samples were available for analyses. Results The absolute amounts of 1-OHP and MA excreted in the 24-h urine samples were 169.6 ng and 33.8 μg, respectively. Urinary excretion of both metabolites did not vary according to age or area of residence. Strongly significant differences emerged when current smokers were compared to non-smokers for 1-OHP (P = 0.0001) and MA (P = 0.01), thus confirming that smokers are directly exposed to PAHs and benzene from tobacco smoke, with a dose-dependent effect particularly evident for MA. Multivariate analyses showed positive associations of 1-OHP excretion with male sex, low education and being overweight but not with residence in two areas with contrasting levels of urban pollution; MA excretion tended to be higher in Florence. Conclusions These two urinary metabolites are strongly related to tobacco smoke and do not appear to represent reliable biomarkers of exposure to environmental pollutants in the general population.