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The study aims to investigate the influence of exposure to low concentrations of benzene on urinary biomarkers of nucleic acid oxidative damage and methylation. Benzene exposure was characterized for 93 coke production workers by measuring both airborne benzene and S-phenylmercapturic acid (SPMA) and unmodified benzene (U-B) in urine samples, collected at the end of the shift (ES) and at the next morning before shift (next BS). In the same urinary samples, biomarkers of nucleic acid oxidative damage and methylation were determined. Urinary concentrations of cotinine and creatinine were also determined to evaluate the smoking effect and to normalize urinary concentrations of analytes, respectively. The biomarkers of benzene internal dose, of oxidative damage (8-hydroxyy-7,8-dihydroguanine, 8-hydroxy-7,8-dihydroguanosine and 8-hydroxy-7,8−2'deoxyguanosine) and some of the biomarkers of nucleic acid methylation (5-Methyl-Cytosine, 1-Methyl-Guanine and 7-Methyl-Guanine) were higher in the ES than the next BS samples. Positive associations between ES 5-Methyl-Cytosine and both SPMA and U-B were found. In conclusion, occupational exposure to low levels of benzene seems to be related to urinary ES 5-Methyl-Cytosine that could be a possible biomarker to evaluate the changes of the nucleic acid methylation status.

Background: Short-term exposure to air pollution, as well as to climate variables could be linked to a higher incidence of respiratory viral diseases. The objective of the study is to assess the short-term impact of air pollution and climate on COVID19 incidence in Lombardy (Italy), during the initial outbreak. Methods: The daily number of COVID19 cases in Lombardy from February 25th to March 10th 2020, and the daily average concentrations of particulate matter (PM10, PM2·5), O3, SO2, and NO2 together with climate variables (temperature, relative humidity – RH%, wind speed, precipitation), were analyzed. A mixed model with a logarithm transformation as link function was applied to evaluate the relationship between all the variables. Additionally, change points (Break Points; BP) in the relationship between incident cases and air pollution or climatic factors were estimated. Findings: The analysis showed a two-phase effect of PM10 on COVID19 incidence, with a negative association at the beginning of the examined period and a positive one later on, while a positive relationship was observed for O3. The COVID19 spread in Lombardy showed to be influenced positively by RH%, and negatively by wind speed. A BP at 40 µg/m3 was observed for PM10 at lag8, and for O3 at lags 3-8 and 10. Interpretation: PM10, O3, RH% and wind speed showed a short-term association with the COVID19 incidence. Air pollution and climate conditions should be considered as part of an integrated approach when containment measures against SARS-CoV-2 are adopted. Funding: The study did not receive any fund. Declaration of Interests: The Authors declare no conflict of interest.

Objectives: The study aims to investigate occupational exposure to carbon fibers impregnated with epoxy resins (carbon fiber reinforced [CFR]) in workers at an airplane fuselage section construction plant, by environmental and biological monitoring. Materials and methods: Determination of airborne CFR was done by environmental sampling with active samplers, 11 of which were stationary and 19 personal samplings. The subsequent analyses were performed in the scanning electron microscope fitted with an X-ray microanalysis system (SEM-EDXA). Biological monitoring was carried out by determining CFR in exhaled breath condensate (EBC) collected from 19 male workers who wore personal environmental samplers (exposed workers) and from 10 male workers at the same factory who had no occupational exposure to CFR (internal controls). CFR analysis was done by SEM, applying the method used for determining asbestos fibers in aqueous samples. Results: The airborne CFR concentrations were found to be significantly higher (p = 0.03) at personal samplings (median value 7.01 ff/L, range 1.24–11.16 ff/L) than stationary samplings (median value 1.93 ff/L, range 0.55–10.09 ff/L). The aerodynamic diameters calculated starting from the length and geometric diameter of the sampled CFRs were always higher than 20 µm. CFR was not found in any of the EBC samples collected from the exposed workers and controls. Conclusions: Despite the evidence of occupational exposure to low concentrations of CFR, the absence of such fibers in the EBC in the exposed workers confirms their non-respirability, as expected based on their aerodynamic diameter.

Short-term exposure to air pollution, as well as to climate variables have been linked to a higher incidence of respiratory viral diseases. The study aims to assess the short-term influence of air pollution and climate on COVID19 incidence in Lombardy (Italy), during the early stage of the outbreak, before the implementation of the lock-down measures. The daily number of COVID19 cases in Lombardy from February 25th to March 10th 2020, and the daily average concentrations up to 15 days before the study period of particulate matter (PM10, PM2.5), O3, SO2, and NO2 together with climate variables (temperature, relative humidity – RH%, wind speed, precipitation), were analyzed. A univariable mixed model with a logarithm transformation as link function was applied for each day, from 15 days (lag15) to one day (lag1) before the day of detected cases, to evaluate the effect of each variable. Additionally, change points (Break Points-BP) in the relationship between incident cases and air pollution or climatic factors were estimated. The results did not show a univocal relationship between air quality or climate factors and COVID19 incidence. PM10, PM2.5 and O3 concentrations in the last lags seem to be related to an increased COVID19 incidence, probably due to an increased susceptibility of the host. In addition, low temperature and low wind speed in some lags resulted associated with increased daily COVID19 incidence. The findings observed suggest that these factors, in particular conditions and lags, may increase individual susceptibility to the development of viral infections such as SARS-CoV-2.

Aim The Italian Society of Occupational Medicine (SIML), the Italian Diabetes Society (SID) and the Association of Diabetologists (AMD) joined a working group that produced a consensus paper aimed to assess the available evidence regarding the interplay between specific working conditions, including shift- and night-time work, working activities at high risk of accidents and work at heights, working tasks requiring high-energy expenditure, working activities at extreme temperatures and diabetes. Data synthesis Diabetes is a group of metabolic disorders caused by defects in insulin secretion and/or action affecting millions of people worldwide, many of whom are or wish to be active members of the workforce. Although diabetes, generally, does not prevent a person from properly performing his/her working tasks, disease complications can significantly compromise a person's ability to work. Therefore, it appears evident the need to understand the relationship between occupational risk factors and diabetes. The working group included in the document some practical recommendations useful to ensure diabetic workers the possibility to safely and effectively undertake their jobs and to adequately manage and treat their disease, also in the workplace. In this perspective concerted action of all the workplace preventive figures, occupational physicians and diabetologists should be strongly encouraged. Conclusions Further studies are necessary to define workplace-based interventions, which should be minimally invasive towards the work organization, allowing diabetic workers to fully realize their work skills while improving their wellbeing at work.

The study investigated the influence of genetic polymorphisms of the enzymes for DNA repair and detoxification of reactive intermediates on spontaneous and bleomycin-induced (BLM) genotoxic damage in 43 workers exposed to very low doses of ionizing radiation (IR) (mean cumulative dose 5.31 mSv) and 43 subjects with no occupational exposure to IR (controls). In all the subjects examined, the frequency of chromosome aberrations (CAs) and micronuclei (MN), both spontaneous and BLM-induced, the Comet assay parameters (tail intensity), the genotypic variants of the DNA repair enzymes XRCC1 (Arg194Trp, Arg280His, Arg399Gln), XRCC3 (Thr241Met), XPD (Lys751Gln), and of the detoxification enzymes GSTM1 and GSTT1 (null genotype) and BLMH (A1450G) were determined. Among the biomarkers considered, only the frequency of total CAs (p &lt, 0.05), and in particular of chromosome breaks (p &lt, 0.01), was found to be significantly higher in the exposed workers than the controls. The frequency of spontaneous MN was higher in subjects with at least one allelic variant in XRCC1 than in carriers of the wild-type, but again only in exposed workers (p = 0.046). Linear regression analysis showed a positive dependency of the frequency of spontaneous chromosome breaks on occupational exposure, and a dependency of the frequency of BLM-induced MN negative on occupational exposure and positive on alcohol consumption and the null GSTM1 genotype. In conclusion, the frequency of chromosome breaks seems to be a useful cytogenetic biomarker for exposure to very low doses of IR, while only the combined effect of different gene variants or genetic, occupational, and lifestyle habits factors seems to be able to modulate the genotoxic effect of very low doses of IR.

Introduction DNA repair enzymes could modulate the individual susceptibility to the genotoxic effect of exposure to ionising radiation (IR). Methods The influence of polymorphisms of XRCC1, XRCC3 and XPD genes on the onset of chromosomal and DNA damage has been investigated in 43 workers exposed to low levels of IR, including 36 healthcare professionals and 7 industrial radiologists (exposed workers), and 43 subjects not occupationally exposed to IR (controls), matched for age. Chromosomal aberrations (CA) and micronuclei (MN) frequencies in peripheral blood lymphocytes were measured according to standard procedures and used as cytogenetic biomarkers, while Tail Intensity (TI) was the parameter of the Comet test used to evaluate oxidative DNA damage. Genotypic variants Arg194Trp, Arg280His and Arg399Gln for XRCC1, Thr241Met for XRCC3 and Lys751Gln for the XPD genes were analysed using the restriction fragment length polymorphism technique. Results Both total CA and chromosome breaks frequencies were significantly higher in the exposed workers than controls (p Discussion Chromosome breaks frequency resulted a valid cytogenetic biomarker for the monitoring of workers exposed to low doses of IR. The presence of single genetic variants reducing the activity of DNA repair enzymes does not seem to determine an increased risk of genotoxic effects of low doses of IR.

Since 1988, the International Agency for Research on Cancer (IARC) has classified radon among the compounds for which there is scientific evidence of carcinogenicity for humans (group 1). The World Health Organization (WHO) recommends a reference radon level between 100 and 300 Bq/m³ for homes. The objective of this study is to measure the radon concentrations in 401 workplaces, different from the patient rooms, in 28 different buildings of the university hospital in Bari (Apulia region, Southern Italy) to evaluate the exposure of health care workers. Radon environmental sampling is performed over two consecutive six-month periods via the use of passive dosimeters of the CR-39 type. We find an average annual radon concentration expressed as median value of 48.0 Bq/m³ (range 6.5-388.0 Bq/m³) with a significant difference between the two six-month periods (median value: February/July 41.0 Bq/m³ vs. August/January 55.0 Bq/m³). An average concentration of radon lower than the WHO reference level (100 Bq/m³) is detected in 76.1% of monitored environments, while higher than 300 Bq/m³ only in the 0.9%. Most workplaces report radon concentrations within the WHO reference level, therefore, the risk to workers' health deriving from occupational exposure to radon can be considered to be low. Nevertheless, the goal is to achieve near-zero exposures to protect workers' health.

This survey aimed to evaluate the applicability of the Nordic Occupational Skin Questionnaire (NOSQ) as a preliminary screening tool to investigate the presence of contact dermatological disorders in sea fishermen. The Italian version of the NOSQ was administered to 143 male fishermen working at an Apulia (Southern Italy) Fisheries, and 136 male workers who had never worked as sea fishers (controls). A significantly higher rate of frequency of transient itchy wheals on the hands, wrists, and forearms was recorded in the fishermen as compared to the controls (49.6% vs. 8.1%; p < 0.001), while there was no significant difference in the frequency of eczema (8.4% vs. 6.6%). In 46.1% of the fishermen, the onset of transient itchy wheals was associated with contact with specific agents and the most common causes were algae and aquatic plants (49.3%) and seabed sludge (25.3%). In conclusion, the administration of the NOSQ can be useful in preliminary screening for dermatitis in fishermen, although it could show a possible overestimation of the prevalence of transient itchy wheals.

DNA damage and cellular repair capacity were studied in 18 male fuel tanker drivers and 13 male filling-station attendants exposed to low and very low concentrations of benzene, respectively, and compared to 20 males with no occupational exposure (controls). Exposure to airborne benzene was measured using passive personal samplers, and internal doses were assayed through the biomarkers t,t-muconic acid, S-phenylmercapturic acid and urinary benzene. DNA damage was evaluated using tail intensity (TI) determined by the comet assay in peripheral lymphocytes. Urinary 7-hydro-8-oxo-2'-deoxyguanosine (8-oxodG) was measured as a biomarker of oxidative damage. DNA repair kinetics were assessed using the comet assay in lymphocytes sampled 20 and 60 min post H2O2 exposure. Benzene exposure differed significantly between the drivers (median 246.3 µg/m(3)), attendants (median 13.8 µg/m(3)), and controls (median 4.1 µg/m(3)). There were no differences in TI and 8-oxodG among the three groups, or between smokers and non-smokers. DNA repair kinetics were similar among the drivers, attendants and controls, although the comet assay on H2 O2 -damaged lymphocytes after 60 min revealed significantly lower levels of TI only in drivers. The DNA repair process in smokers was similar to that observed in drivers. In conclusion, this study found no relationship between low levels of benzene exposure and DNA damage, although there was evidence that exposure interferes with DNA repair kinetics. The biological impact of this finding on the onset of genotoxic effects in exposed workers has still to be ascertained.

The contribution of biological and environmental monitoring to the risk assessment of occupational exposure to lead (Pb), arsenic (As), and antimony (Sb) was studied in 18 workers at a birdshot factory (Exposed) and in 18 control workers (Controls) by the determination of both airborne Pb (PbA) and airborne As (AsA) only in the exposed workers and blood Pb (PbB), erythrocytic zinc protoporphyrin (ZPP), urinary Sb (SbU), and the urinary As species in exposed workers and controls. PbA (12–42 μg/m3) and AsA (1–4 μg/m3) were strongly correlated (r = .95). PbB, ZPP, and the sum of As3+As5+MMA were significantly higher in the exposed workers. As3 was higher than the limit of detection in 14 exposed workers and 1 control, As5 only in 1 exposed worker, SbU in all the exposed workers and in 4 controls. Monitoring for more metallic elements reveals a wider spectrum of exposures than can be achieved by lead surveillance alone and is preferable for characterizing occupational risk wherever possible.

Several experimental and clinical studies have shown that a variety of ototoxic agents (such as drugs, industrial chemicals and noise) can cause sensorineural hearing loss. The most common ototoxic drugs used in clinical practice include: aminoglycoside and macrolide antibiotics, quinoline anti-malarials, platinum analog antineoplastics, loop diuretics, and acetylsalicylic acid. Among chemical agents with potential ototoxic properties are: organic solvents, heavy metals, organotins, nitriles, asphyxiants, and pesticides/herbicides. Acoustic exposure to high intensity and/or prolonged noise can also cause permanent threshold shifts in auditory perception. Ototoxic agents can influence auditory function by different mechanisms: RO S overload, inhibition of mitochondrial protein synthesis, DNA/RNA damage, activation of the apoptotic pathways, excessive calcium influx, increase of proinflammatory cytokines, interference with fluid and electrolyte balance of the endolymph, atrophy of the stria vascularis, changes in blood-labyrinth barrier and overstimulation of the stereocilia of the ear cells. Since noise exposure and many drugs or chemical compounds frequently share the same ototoxic mechanisms, this may explain why hearing loss can be potentiated by combined exposure to these agents. However, a great variability in the individual’s response to a given xenobiotic exists and depends on a complex interplay between endogenous and exogenous factors.

Context Urinary S-phenylmercapturic acid (SPMA) and benzene (U-Ben) are usually measured at the end of the work shift (ES), although their kinetic of elimination is not clearly known. Objective To investigate SPMA and U-Ben elimination 16 h after the ES, in 93 coke production workers exposed to low benzene concentrations. Materials and methods Airborne benzene (A-Ben) was measured by passive samplings, while SPMA, U-Ben, methyl-tert-butyl ether (U-MTBE), cotinine (U-Cot) and creatinine were determined on urine samples collected at ES and before the beginning of the next work shift (next BS). Results Median A-Ben concentrations were 17.2 µg/m3 in the personal and 34.7 µg/m3 in the stationary samplings. SPMA was always detectable, whereas U-Ben was below the limit of quantification in 26.7% of the ES and 35.6% of the next BS samples, and U-MTBE in more than the 80.0% of the samples. At both the sampling times, SPMA and U-Ben showed a positive dependence on personal A-Ben, as well as on creatinine and U-Cot values. Discussion and conclusion SPMA and U-Ben at the next BS were dependent on the exposure to low benzene concentrations suffered in the previous work shift, prompting a reconsideration of the urine sampling time recommended by the American Conference Governmental Industrial Hygienists (ACGIH).

The phenomenon of accidents at work was investigated among the resident physicians of the School of Medicine, Bari University, by a self-administered anonymous questionnaire probing personal details and inquiring about any accidents at work experienced during the training period, and by a comparison with the accidents reported to the Hospital Accidents Registry. At least 1 biological accident was reported by 18.2% of the 450 participants, this percentage being significantly higher in the surgical area (33.3%), where biological accidents were much more rarely reported to either the Residency School Director or the Accidents Registry. In conclusion, despite an overall reduction compared with the past, the frequency both of biological accidents and of underreporting is still high among resident physicians, particularly in the surgical area.

The risk to public health from the large number of dog stools present on streets of urban areas is cause for concern. Dog faeces may be a serious hazard because they may contain microorganisms that are both pathogenic to humans and resistant to several classes of antibiotics. The aim of this study was to evaluate the potential for zoonotic infections and for the presence of antibiotic resistant bacteria in canine faeces which contaminates the urban environment. A total of 418 canine faecal samples were collected from streets in seven areas of Bari, Southern Italy. We have isolated multi-drug resistant Enterococci and meticillin-resistant Staphylococcus aureus from these dog faecal samples. The presence of the resistant bacteria in an urban environment may represent a public health hazard which requires control measures by competent authorities. No Salmonella, Yersinia or Campylobacter species were isolated. Giardia cysts were detected in 1.9% of the samples. The predominant Enterococcus species were E. faecium (61.6%), E. gallinarum (23.3%) and E. casseliflavus (5.5%). Other species, including E. faecalis were also isolated. These strains were resistant to clindamycin (86.3%), tetracycline (65.7%), erythromycin (60.27%) and ampicillin (47.9%). High-level aminoglycoside resistance (HLAR) was found in 65.7% of enterococci. Resistance to three or more antibiotics and six or more antibiotics were observed in 67.12% and 38.4% of Enterococcus spp., respectively. Resistance to vancomycin and teicoplanin was not detected in any of the Enterococcus spp. isolated. Methicillin-resistant Staphylococcus aureus was isolated in 0.7% of the faecal samples. Canine faeces left on the streets may represent a risk factor for transmission of microorganisms and a reservoir of multidrug- resistant bacteria thus contributing to the spread of resistance genes into an urban area.

Objective: To evaluate the variation of some biomarkers related to the level of enzymatic activity dependent on the different polymorphisms. Methods: We studied 27 butadiene-exposed workers and 37 controls using different biomarkers of the genotoxic effect. The genotypes were determined using polymerase chain reaction and restriction fragment length polymorphism-polymerase chain reaction techniques; the subjects were assigned to a specific group based on the microsomal epoxide hydrolase (mEH) activity predicted by their genotype (low, intermediate, high). Results.. The studied biomarkers were not able to discriminate between exposed and control individuals, but sister chromatid exchange (Sa,) and high frequency cells were influenced by smoking habits. Smokers having fast microsomal epoxide hydrolase activity showed higher SCE frequency (7.61) respect to those presenting intermediate (5.86) or slow (6.65) enzymatic activity. Conclusions: On the basis of these results, can we suppose the existence of an "intermediate genotype" advantage (at least for induction of SCE)? (J Occup, Environ Med. 2009;51:811-821)

DNA damage and cellular repair capacity were studied in 18 male fuel tanker drivers and 13 male filling-station attendants exposed to low and very low concentrations of benzene, respectively, and compared to 20 males with no occupational exposure (controls). Exposure to airborne benzene was measured using passive personal samplers, and internal doses were assayed through the biomarkers t,t-muconic acid, S-phenylmercapturic acid and urinary benzene. DNA damage was evaluated using tail intensity (TI) determined by the comet assay in peripheral lymphocytes. Urinary 7-hydro-8-oxo-2'-deoxyguanosine (8-oxodG) was measured as a biomarker of oxidative damage. DNA repair kinetics were assessed using the comet assay in lymphocytes sampled 20 and 60 min post H2O2 exposure. Benzene exposure differed significantly between the drivers (median 246.3 μg/m3), attendants (median 13.8 μg/m3), and controls (median 4.1 μg/m3). There were no differences in TI and 8-oxodG among the three groups, or between smokers and non-smokers. DNA repair kinetics were similar among the drivers, attendants and controls, although the comet assay on H2O2-damaged lymphocytes after 60 min revealed significantly lower levels of TI only in drivers. The DNA repair process in smokers was similar to that observed in drivers. In conclusion, this study found no relationship between low levels of benzene exposure and DNA damage, although there was evidence that exposure interferes with DNA repair kinetics. The biological impact of this finding on the onset of genotoxic effects in exposed workers has still to be ascertained. Environ. Mol. Mutagen. 57:151-158, 2016.

Lead (Pb) may affect humoral and cellular immunity, acting on lymphocytes as well as on granulocytes and monocytes. Cytokines and nitric oxide (NO) play a central role in the immune balance. In this study, plasma levels of nitrites and nitrates (NOx), IL2, IL4, IL6, IL10, TNF-α and INF-γ, were measured in healthy workers with very low (Pb-B =3.2 -18.0 μg/dL) and low (Pb-B = 9.1 -46.0 μg/dL) Pb-exposure compared to non-exposed workers. Low Pb-exposed workers (Pb-B =9.1 -46.0 μg/ dL) were found to have significantly higher plasma IL-10 levels, and tendentially higher plasma TNF-α levels compared to non-exposed workers. This is the first report of a significant increase of plasma IL-10 levels in Pb-exposed workers. Plasma IL-10 increase was influenced by blood Pb levels even after correction for main confounding factors. No difference was found in plasma NOx levels between Pb-exposed and non-exposed workers, which is in agreement with previous findings exclusively regarding groups in the general population. Low Pb-exposure can induce an increase of pro-inflammatory cytokines, such as TNF-α, with a consequent increase of other cytokines, such as IL-10, considered a T cell cross-regulatory factor, suggesting possible interference of Pb in the system of immunophlogosis. Human & Experimental Toxicology (2007) 26, 551 - 556

Background: Inorganic lead can interfere with humoral and especially cell-mediated immunity even at frequently occurring (

1,3-Butadiene (BD), a probable carcinogen to humans, has been shown to have an ill-defined genotoxicity in occupationally exposed workers. In the present study, the influence of exposure to very low doses of BD and to cigarette smoking was investigated on some cytogenetic endpoints, namely, sister chromatid exchanges (SCE), chromosomal aberrations (CA) and cells with a high frequency of SCE (HFC), in peripheral blood lymphocytes. Twenty-seven male workers employed in a petrochemical plant and 26 matched controls were included in the study. As regards the airborne BD values, there was a significant difference between exposed (median BD value 1.5, min-max 0.2-69.0 microg/m3) and non-exposed workers (median BD value 0.4, min-max0.1-3.8 microg/m3). Genotoxic biomarkers were not able to distinguish between the two groups. The frequency of SCE was higher in smokers than in non-smokers (p=0.001), with a positive correlation between the number of cigarettes smoked per day and both SCE (r=0.4; p=0.004) and HFC frequency (r=0.3; p=0.04). Multiple regression analysis confirmed the influence of cigarette smoking on the level of SCE and HFC, while these parameters were not affected by personal exposure to BD. Overall, the biomarkers of genotoxic effect investigated in our study were not able to discriminate between workers with a very low exposure to BD and controls, while it was possible to distinguish between smokers and non-smokers on the basis of SCE.

OBJECTIVE: To examine the influence of shift work on metabolic and cardiovascular risk factors in subjects working in an industry sited in Apulia, Southern Italy. DESIGN: Cross-sectional study of metabolic effects of shift work in glucose tolerant workers in a chemical industry in southern Italy. SUBJECTS: The subjects included 319 glucose tolerant male individuals, aged 35–60 y. MEASUREMENTS: Anthropometric parameters (body mass index (BMI) and waist-to-hip ratio (WHR)), fasting concentrations of glucose, insulin, and lipids (total cholesterol, HDL-cholesterol, triglycerides), the sum of glucose levels during 75 g-oral glucose tolerance test (Σ-OGTT), and systolic and diastolic blood pressure (SBP and DBP, respectively). RESULTS: The prevalence of obesity was higher among shift workers compared to day workers, whereas body fat distribution was not different between the two groups. Shift workers had higher BMI than day workers, and shift working was associated with BMI, independently of age and work duration. Shift workers had significantly higher SBP levels, which were independently influenced by BMI, but not by shift work, thus suggesting that the difference in SBP may well be mediated by the increased body fatness. CONCLUSION: In workers of an industry sited in Southern Italy, shift work may be directly responsible for increased body fatness and is indirectly associated with higher blood pressure levels and some features of metabolic syndrome.

A latent variable model was applied to the results of an Italian multicenter nation-wide cross-sectional study to assess the earliest health effects due to mercury (Hg) exposure caused by occupation, dental amalgams (DENTAM) and fish eating (FISH). The studied population included subjects recruited from four different geographical areas. A total number of 122 workers from chloroalkali plants and production of thermometers and neon lamps formed the occupationally exposed group, whereas 196 subjects, recruited from the same areas and not occupationally exposed to mercury, formed the control group. Neuropsychological functions were assessed with neurobehavioral testing including vigilance, motor and cognitive function, tremor measurements, and with symptoms concerning neuropsychological and mood assessment. Neuroendocrine function was examined with the measurement of prolactin (PRL) level. Parameters of immunological and renal function were also measured. The target population was characterized by the number and surface of dental amalgams and consumption of fish. In the exposed workers the average urinary mercury (U-Hg) was 10.4+/-6.9 (geometric mean 8.3, range 0.2-35.2) microg/g creatinine, whereas in the control group it was 1.9+/-2.8 (geometric mean 1.2, range 0.1-33.2) microg/g creatinine. The preliminary results indicated that finger tapping (FT) and the Branches alternate movement task (BAMT) coordination test were associated with the occupational exposure (OCCEXP). PRL was significantly decreased among the exposed workers, and inversely related to U-Hg. Among the immunological and renal parameters, cytokine serum interleuchin-8 (sIL8) and beta(2) micro globulin (beta(2)MG) were lower in the exposed group and negatively correlated to U-Hg. Small-size fish consumption was associated to a beneficial effect on symptoms reporting. No effects were observed concerning dental amalgams. After first evaluating the relationship between mercury exposure and each indicator of effect, further assessment was performed to identify the earliest effects related to mercury exposure among those who resulted in being associated in the preliminary elaboration. Two latent variables "exposure" and "effect" were identified, integrating respectively the different forms of exposure (occupational, due to dental amalgams and fish consumption) and the indicators of effects (FT, BAMT, PRL, sIL8, beta(2)MG). Confounding factors (age, alcohol, body mass index (BMI)) were considered in the same model. This further analysis showed that an inverse association of occupational exposure to mercury with PRL and BAMT, with Hg-U mediating the effect on PRL, was predominant with respect to the other form of mercury exposure, the other indicators of effect and the confounders. In conclusion, this study supports the finding of alterations of neuroendocrine secretion and motor coordination at very low occupational exposure levels of inorganic mercury, below the current ACGIH Biological Exposure Index. These changes occur at lower levels than other subtle effects on the renal function and the immunitary system. On the contrary, dental amalgams and small-size fish consumption do not seem to be associated to any adverse health effect at these exposure levels.

A method for risk assessment of occupational exposure to strontium chromate (SrCrO4) in painters employed in the aeronautical industry is described.Assessment was made of 21 male workers of the painting division, potentially exposed to SrCrO4 (exposed), and 20 male workers of the tests and warehouse divisions (controls). All participants completed a questionnaire about work tasks, lifestyle habits, hobbies and diet. Personal active sampling for the determination of Cr and Sr was performed both during paint-spraying and during other operations in the painting division area. On the same day as environmental sampling, urine samples were collected at the beginning and end of the work shift in exposed workers to determine urinary chromium (CrU), and only at the end of the shift in controls. In the second half of the shift, a blood sample was taken in 10 exposed workers and 10 controls, to determine Cr in plasma (CrP) and in red blood cells (CrRBC).During paint-spraying, Cr concentrations ranged between 1.38 and 17.10 microg/m3, versus 0.02 to 0.07 microg/mi in the painting division area, while the Sr concentration was 22.90 microg/m3 in the paint-spray booth versus 0.07 microg/m3 in the painting division area. CrU at the end of the work shift, CrP and CrRBC, did not show significant differences between exposed workers and controls. Moreover, in exposed workers there were no differences between CrU measured at the beginning and at the end of the work shift.This approach, consisting of simultaneous environmental and biological monitoring, suggested no absorption of chromium in the painters thanks to the efficacy of the technical, organizational and personal protection measures adopted. However, the evident exposure to high levels of SrCrO4 during paint-spraying highlights how absolutely essential it is to ensure strict compliance with all the preventive measures foreseen by the EU and national regulations for occupational exposure to carcinogens.

Hemoglobin adducts were determined as biomarkers of 1,3-butadiene (BD) in 30 workers and 10 controls from an Italian BD plant and in 14 diesel-exposed miners. N-(2,3,4-trihydroxybutyl)valine (THBVal), an N-terminal valine globin adduct of reactive butadiene metabolites, was analyzed by gas chromatography/high resolution mass spectrometry after a modified Edman degradation and further acetylation. The BD exposure for the plant workers was 31 microg/m(3) (personal sampling). Whereas there was no detectable difference in hemoglobin adduct levels (range 17.7-61.4 pmol/g globin) between the total group of exposed and controls, slight but significant differences could be found between two subgroups of workers from different production units as well as one subgroup and controls (P

Lymphocyte differentiation, maturation and peripheral functions are affected by the thymic protein hormone thymulin. Mercury at very low concentrations has been seen to impair some lymphocytic functions causing subclinical manifestations in exposed workers. The present study was performed to test in vitro the effect of mercury on the production kinetics of thymulin using cultures of whole thymuses from young mice. Exposure to mercury (10 −8 M and 10 −6 M) added to the cultures, reduced kinetic thymulin production at all time intervals considered (1, 2, 4, 5 and 6 h) as compared to kinetic thymulin production of thymuses from young control mice. After the first hour the inhibition is more evident at the highest mercury concentration. Thymulin production decreased by 70, 74, 82 and 86% and by 55, 66, 73 and 81% for mercury concentrations of 10 −6 M and 10 −8 M, respectively, after 2, 4, 5 and 6 h. Mercury toxic effect on thymulin kinetics may be directly exerted to thymulin synthesis in epithelial cells, although it is less dramatic than that of cycloheximide (CHX), known as a potent inhibitor of protein synthesis in such cells. The toxic effect of mercury on thymic endocrine activity might cause the subclinical effects on cell-mediated immunological status observed in mercury exposed workers.

The aim of this study was to determine whether occupational noise exposure is a risk factor that may favour a chronic increase of diastolic and systolic blood pressure and a higher prevalence of arterial hypertension. A cross-sectional study was performed on 1372 workers employed in 11 cement plants in central and southern Italy. In 1985 the workers were subjected to a medical examination during which blood pressure was measured and information about personal features, occupational activity, diseases, family history of hypertension, use of antihypertensive drugs, smoking habit and alcohol intake were also gathered by questionnaire. For each worker noise exposure (dBA) was estimated using a series of indicators representing both the levels of exposure at the time of study and loud energy previously absorbed during the occupational life spent in the industry considered. 41.4% of the examined workers were hypertensive, according to the World Health Organization (WHO) definition (i.e. systolic blood pressure (SBP) levels ≥140 and/or diastolic blood pressure (DBP) levels ≥90 mmHg and/or reported antihypertensive treatment). Linear regression analysis showed a positive influence of age, BMI and use of antihypertensive drugs for both systolic and diastolic blood pressure. Noise exposure, independent of the indicators, was negatively associated with diastolic blood pressure only. The logistic regression analysis of the different variables contributing to high blood pressure showed a positive influence of age, BMI and family history of hypertension, while only some indicators of noise exposure were found to be negatively associated with arterial hypertension. Noise exposure, as assessed by all the different indicators used in the study, does not seem to influence systolic arterial pressure, but does have a negative influence on diastolic pressure. The prevalence of arterial hypertension, as defined by WHO criteria, appears negatively associated with noise exposure. The results obtained could be related both to a physiological variation of blood pressure following chronic noise exposure and to an unfavourable combination of elements further accentuated by the limitations of the cross-sectional study. Copyright © 1999 John Wiley & Sons, Ltd.

Cyanamide is a chemical substance used in the treatment of chronic alcoholism as well in agriculture as a fertilizer. We report the case of a 28-year-old healthy non-atopic man that developed a severe skin eruption after the accidental penetration of a small amount of Dormex® (a plant growth regulator containing cyanamide) through the patient's gloves. Patch tests revealed positive reactions to Dormex® 1% pet. and cyanamide at a dilution of 0.1% pet. and 1% pet. We discuss the causes of sensitization in a patients that regularly used protective measures during anti-parasites treatments.

The frequency of chromosome aberrations (CA) and micronuclei (MN) was investigated in the peripheral lymphocytes of workers occupationally exposed to low or very low concentrations of benzene. The study included 43 exposed workers (all males), namely 19 fuel-tanker drivers and 24 filling-station attendants, and 31 male subjects with no occupational exposure to the toxicant (controls). Benzene exposure was verified by means of environmental monitoring with passive personal samplers (Radiello ® ), and through biological monitoring, i.e. by measurement of urinary trans , trans -muconic acid, S -phenylmercapturic acid and benzene. The frequency of CA and MN in peripheral lymphocytes was determined according to standard procedures. Exposure to benzene was found to be significantly higher for fuel-tanker drivers (median 246.6 μg/m 3 ) than for filling-station attendants (median 19.9 μg/m 3 ). Both groups had significantly higher exposure than controls (median 4.3 μg/m 3 ). No increased frequency of CA and MN was observed in either fuel-tanker drivers or filling-station attendants compared with controls. In all subjects examined as a single group, the frequency of MN was significantly dependent on age. Only in the fuel-tanker drivers was the frequency of MN found to depend not only on age, but also on exposure to benzene. In conclusion, the frequency of MN, but not of CA, could be influenced by exposure to benzene concentrations of up to one order of magnitude lower than the threshold limit value (time-weighted average).

To define protocols for health surveillance of workers in the marine fishing sector for specific occupational risk factors, considering the latest and most advanced scientific knowledge.The specific literature was analyzed to identify the occupational risk factors to which fishermen are exposed. Then, for each risk factor a protocol for the relative health checkups and their time schedule was defined.The risk factors to which fishermen are exposed are essentially noise, vibrations, solar and ultraviolet radiation, climatic agents (heat, cold, wind, rain, damp), chemical agents, shifts, work rate, night work, physical strain, stress, manual handling of loads, upper limb repetitive tasks, incongruous postures. The health protocols stipulate the health screening investigations to be carried out in all workers of a homogeneous group, and in-depth diagnostic investigations to be carried out in symptomatic workers. Complementary health investigations must be focused on a functional exploration of the organs specifically exposed to the risk factor. For hearing impairments due to noise exposure, the medico-legal measures with which the occupational health physician must comply, in cases of occupational disease, are indicated.

To study the urinary excretion of As, Cr, Mn, Co, Ni, Cu, Zn, Cd, Sn, Ba, Hg, Pb, Sb in workers at the Taranto integrated-cycle steel foundry and in subjects from the general population of Taranto, to assess the health risk posed by occupational exposure and environmental exposure, respectively, to these metals.The study included 49 steel foundry workers (exposed), working in the minerals and agglomerates pools, steel processing plants 1 and 2 and maritime plants, and 50 subjects belonging to the general population of Taranto resident at various distances from the factory (controls), randomly selected from the exposed subjects and controls enrolled in previous research conducted in 2005. A questionnaire was administered to all participants, enquiring into general characteristics, lifestyle, diet, and any medical conditions. Informed written consent to take part in the study was obtained from all subjects before enrolment. The results of environmental monitoring performed in 2005 in the workers' sectors, consisting of determining As, Cr, Mn, Ni, Cu, Zn, Cd and Pb in the respirable dust, revealed by both samplers applied in fixed positions and personal samplers, were considered. Urine samples were obtained from all participants on a Friday, to determine As and Cr by AAS and all the other metal elements by a multielement technique with ICP-MS. Urinary creatinine was also determined to make any necessary adjustments. All urine analyses were performed in 2005 within one month of urine collection.In the respirable dust, As and Cd were always within the LOD, whereas Cr, Mn, Ni, Cu and Pb were 1-2 orders of magnitude below the respective TLV-TWA of the ACGIH. Mn was the only metal element that presented significantly higher urinary concentrations in exposed subjects as compared to controls, although the values in both groups were in any case within the Italian reference range. Co, Cu, Zn, Sn and Sb showed significantly higher urinary concentrations in controls than in the exposed subjects, while there were no differences in As, Cr, Cd, Ba, Hg and Pb between the two groups. Ni was within the LOD in the 60% of the subjects in the two groups. Multiple stepwise regression showed a dependence of Cr on age, of As on the number of days since the last meal of mollusks and crustaceans, of Zn on the consumption of mollusks, and of Cd and Pb on smoking expressed as the number of pack/year.The research did not reveal higher urinary excretion of the metal elements in the steelworkers than in the subjects from the general population of Taranto resident at different distances from the factory, except for Mn, that was anyway within the reference range. This allows us to consider that there is no relevant health risk posed by occupational exposure to metal elements in the steelworkers, nor by environmental exposure to the same elements in the residents of the city of Taranto. In particular, no pollution of the living environment by metal elements of industrial origin was demonstrated, whereas other non occupational factors seem to condition the intake of these metal elements.

Approximately 2 weeks after accidental overexposure to X-ray radiation, a worker developed acute radiodermatitis on fingers of both hands. Exposure simulation indicated that total ionizing radiation absorbed by his fingers amounted to about 20 Gy. After 2 years, acute radiodermatitis evolved to chronicity of lesions with presence of atrophic skin, teleangiectasia, alopecia, and dyskeratosis on three right-hand fingers. Cytogenetic dosimetry of peripheral blood lymphocytes, performed 2 months after acute radiation, showed an increase of micronuclei (7% vs. 1 +/- 0.4% according to laboratory reference data). The increase was ascribed to the high dose of ionizing radiation absorbed by circulating lymphocytes in the vessels of overexposed tissues. The cytogenetic examination was repeated 27 months after acute irradiation; it was found that the percentage of micronuclei had been restored to within reference levels. The possibility of using cytogenetic dosimetry, following acute partial exposure to X-rays, not just as an indicator of previous exposure, but also as an indicator of the absorbed radiation dose is examined. Lastly, the possible stochastic effects that may set in on the skin of the affected fingers and the need for periodically monitoring the evolution of chronic skin lesions, are discussed.

Agricultural exposure to the organomanganese fungicide MANEB (manganese-ethylene-bis-dithiocarbamate) may induce an extrapyramidal syndrome resembling parkinsonism. To evaluate the relative role of manganese (Mn) and ethylene-bis-dithiocarbamate (EBDTC) in the hazard of organomanganese fungicides, we studied the effects of MANCOZEB (Mn-Zinc-EBDTC) and ZINEB (Zinc-EBDTC) on serumless dissociated mesencephalic-striatal primary coculture. High affinity 3H-dopamine (DA) and 14C GABA uptakes as well as immunocytochemical staining of tyrosine hydroxylase (TH)-containing cells were used as specific functional markers of DA and GABA neuron viability. Both MANCOZEB and ZINEB, at 10 and 50 microM concentrations, dose dependently reduced DA and GABA viability parameters. These data suggest that EBDTC rather than Mn may be primarily responsible for the cytotoxicity of organomanganese fungicides on neuronal systems relevant to the pathophysiology of parkinsonism.

Exposure to elevated levels of Manganese (Mn) can result in an irreversible brain disease characterized by extrapyramidal signs and symptoms resembling Parkinson's disease. To identify the neuronal target of Mn neurotoxicity, MnCl2 was added to serumless dissociated mesencephalic-striatal cultures from rat embryo on day 4 in vitro. High affinity 3H-dopamine (DA) and 14C-GABA uptakes were assessed as specific functional markers of DAergic and GABAergic cell viability, respectively. After 60-min exposure, MnCl2 at 0-200 microM did not modify the morphologic appearance of the cultures, specific DA and GABA uptakes, or the number of DA neurons visualized by immuno-cytochemical staining with tyrosine hydroxylase. In contrast, culture exposure to 20 microM MnCl2 for 24 h selectively reduced specific GABA uptake without affecting specific DA uptake or the number of DA neurons. The exposure to a higher MnCl2 concentration was accompanied by signs of general toxicity. Striatal GABA neurons seemed to be more susceptible to Mn toxicity than mesencephalic GABA neurons. Overall, our data suggest that striatal neurons rather than mesencephalic DA neurons may be the main target of Mn neurotoxicity.

Polychlorinated biphenyls (PCB) have been shown to exert some immune effects. Here we analysed their effects also on immune parameters not previously studied such as TCR alpha-beta, TCR gamma-delta and regulatory T cells (Treg), taking into account the specific and cumulative interference of smoking and alcohol. The study subjects consisted of 26 male workers in a steel works factory, employed in the electrical maintenance sector, with previous exposure to a mixture of PCB (exposed subjects), and 30 male workers with no occupational exposure to PCB (controls). All subjects were given a questionnaire and peripheral venous blood samples were taken to determine serum PCB (33 congeners), total cholesterol and triglycerides, leukocytes, total lymphocytes and the T lymphocyte subpopulations (TCR alpha-beta, TCRgamma-delta, CD4+ and Treg lymphocytes). PCB, even though at a very low concentration, were significantly higher in exposed subjects than controls, and were significantly correlated with age. Monocytes% and CD4+ were significantly reduced in the exposed subjects as compared to the controls. The serum concentration of PCB positively correlated with TCR alpha-beta, and negatively with TCRgamma-delta. Treg lymphocytes showed a positive dependence on tobacco smoking, while the monocytes percentage and CD4+ showed a negative and positive dependence, respectively, on alcohol intake. Our results seem to show some effects of slight exposure to PCB in particular reducing the relative concentration of TCRgamma-delta. This effect can favour indirectly the increase in Treg induced by smoking, the anti-inflammatory or proinflammatory/fibrogenetic/angiogenetic effect of which, exerted by produced cytokines, particularly TGF-beta, deserves further clarification.

The effects of occupational exposure to low concentrations of polychlorobiphenyls (PCBs) on the urinary excretion of corticosteroid hormones were evaluated, taking into account the influence of cigarette smoking. The study included 26 males working as electrical maintenance staff in a steel factory, previously exposed to a mixture of PCBs (exposed workers), and 30 male workers with no occupational exposure to PCBs (controls). Serum PCBs (33 congeners), urinary 17-hydroxycorticosteroids, 17-ketosteroids (KS) and pregnanes, and their respective glucuronidated and sulfonated compounds, were determined for each subject. PCBs were significantly higher in the exposed workers than controls, and were correlated with age. Both the urinary concentrations of the total 17-KS and pregnanes, and those of some single steroids and their glucuronidated compounds, were significantly lower in the exposed workers than controls, but higher in smokers than the non-smokers + ex-smokers. Two-way analysis of variance showed a negative association between serum PCBs and both total glucuronidated 17-KS and total and glucuronidated pregnanes, and a positive association between cigarette smoking and both total and glucuronidated 17-KS. PCBs seem to act as endocrine disruptors by reducing the urinary excretion of corticosteroid hormones, particularly of the glucuronidated fraction. Cigarette smoking could boost these effects of PCBs in smokers.

The risk to public health from the large number of dog stools present on streets of urban areas is cause for concern. Dog faeces may be a serious hazard because they may contain microorganisms that are both pathogenic to humans and resistant to several classes of antibiotics. The aim of this study was to evaluate the potential for zoonotic infections and for the presence of antibiotic resistant bacteria in canine faeces which contaminates the urban environment. A total of 418 canine faecal samples were collected from streets in seven areas of Bari, Southern Italy. We have isolated multi-drug resistant Enterococci and meticillin-resistant Staphylococcus aureus from these dog faecal samples. The presence of the resistant bacteria in an urban environment may represent a public health hazard which requires control measures by competent authorities. No Salmonella, Yersinia or Campylobacter species were isolated. Giardia cysts were detected in 1.9% of the samples. The predominant Enterococcus species were E. faecium (61.6%), E. gallinarum (23.3%) and E. casseliflavus (5.5%). Other species, including E. faecalis were also isolated. These strains were resistant to clindamycin (86.3%), tetracycline (65.7%), erythromycin (60.27%) and ampicillin (47.9%). High-level aminoglycoside resistance (HLAR) was found in 65.7% of enterococci. Resistance to three or more antibiotics and six or more antibiotics were observed in 67.12% and 38.4% of Enterococcus spp., respectively. Resistance to vancomycin and teicoplanin was not detected in any of the Enterococcus spp. isolated. Methicillin-resistant Staphylococcus aureus was isolated in 0.7% of the faecal samples. Canine faeces left on the streets may represent a risk factor for transmission of microorganisms and a reservoir of multidrug- resistant bacteria thus contributing to the spread of resistance genes into an urban area.

a b s t r a c t The environmental and biological monitoring of benzene exposure is crucial to prevent the toxic effects of this solvent in workers. The degree of correlation, however, between the two and of different biomark- ers among them varies, particularly at low levels of exposure, depending on various factors, including variability in metabolizing enzymes and smoking habits. To investigate these further, a cohort of 28 petrochemical workers (6 smokers and 22 non smokers) was monitored throughout ten consecutive days, on two occasions, two years apart, by collecting in total 173 environmental and biological samples. The airborne benzene levels, the urinary t,t-muconic acid (t,t-MA) and S-phenylmercapturic acid (S-PMA) concentrations, and the glutathione S-transferases (GST) M1 and T1 genotypes were measured. S-PMA was the only metabolite statistically correlated with airborne benzene levels (r = 0.447, P < 0.0001), par- ticularly in non smokers (r = 0.667, P < 0.0001), the smoking habit being the only variable influencing metabolite excretion. Finally, a reduced S-PMA excretion was found to be associated with the GSTT1, but not the GSTM1, null genotype. In conclusion, the results show that S-PMA, but not t,t-MA, is able to mon- itor exposure to low benzene concentrations and confirm that the GSTT1 null genotype has a significant influence on metabolite excretion. The influence of the GSTT1 null genotype, however, was low, even when studying each subject with several urine samples.

The aim of the work was to compare H. pylori clarithromycin-resistance according two methods. Etest was performed on H. pylori isolated from gastric biopsy samples. TaqMan Real-Time-PCR (RT-PCR) was performed on paraffin-embedded gastric biopsy samples of the same patients. Forty-seven out of 88 strains were resistant to clarithromycin by Etest, whereas RT-PCR detected this resistance on paraffin-embedded specimens of 50 patients. RT-PCR performed on paraffin-embedded biopsy specimens of 47 patients infected with H. pylori resistant to clarithromycin as detected by Etest, revealed the presence of a resistant strain only in 40 samples. RT-PCR performed on samples of 41 patients harbouring clarithromycin-susceptible H. pylori strains showed the presence of 31 susceptible and 10 resistant strains. RT-PCR detected 18 cases with heteroresistant status. The difference between the two tests in detecting clarithromycin-resistance was not statistically significant even if RT-PCR detected more resistant cases. The genotyping resistance on paraffin-embedded gastric biopsy specimens may be used to establish resistance to clarithromycin before the treatment when culture and susceptibility testing are not available. In case of failure of an empirical clarithromycin-based triple antimicrobial treatment, RT-PCR performed on paraffin-embedded biopsy sample will establish the primary resistance to clarithromycin. In addition, this test can be useful for epidemiological investigation as well as for monitoring the evolution of clarithromycin resistance along the time.

In view of the widespread ubiquity of benzene in the environment and of its carcinogenic effects on man, this toxicant poses a public health problem that has prompt nations to undertake active measures to contain environmental concentrations below the limit judged to be an acceptable risk threshold for the general population (World Health Organization [WHO], 2000). In the occupational field, until the 1950s benzene was the solvent most commonly employed in some industrial processes, and especially in rubber, printing and shoemaking industries, because of its chemico-physical properties and low cost. This caused exposure of these workers to high benzene concentrations that induced toxic effects and acute non lymphocytic leukemia (Agency for Toxic Substances and Disease Registry [ATSDR], 2007; WHO, 1993). Due to these adverse effects, its use in industrial processes was then abandoned, replacing benzene firstly by hexane, but this proved to provoke peripheral neuropathies, and then by less toxic solvents such as heptane. In Italy the use of benzene as a solvent is banned by Law 245/1963, although traces below 2% are permitted in solvents of a different chemical nature (Italian Parliament, 1963). Benzene is still used as a raw material or intermediate product in the chemical industry, mainly to synthesize ethylbenzene, cumene and cyclohexane, and to a limited extent as a

To study the effect of eating foods with a high arsenic (As) content on the intra and inter-individual variability of urinary concentrations of the As species, daily urine samples were collected for 10 consecutive days from 12 healthy male subjects. A daily food diary was kept throughout the study period. Personal exposure to airborne As was measured once during the study. As(3), As(5), monomethylarsonic acid (MMA), dimethylarsinic acid (DMA) and arsenobetaine were determined in all urine samples by inductive coupled plasma mass spectrometry, and the sum of As(3)+As(5)+MMA+DMA (iAs) by hydride generation-atomic absorption spectrophotometry. Exposure to airborne As was below the limit of detection in all samplings. As(3) was found in only 19.2% and As(5) in only 3.3% of the urine samples, whereas high urinary concentrations of arsenobetaine were observed. With the exception of arsenobetaine, expressed as a percentage, a significant inter-individual variability was observed for all species of As, for iAs and for the MMA/DMA ratio (p0.001). Instead, the intra-individual variability was significant only for the MMA/DMA ratio (p0.001). Among foods with a high As content, only a heavy consumption of seafood was shown to influence inter-individual variability of DMA%, arsenobetaine expressed as μg g(-1) creatinine and iAs. In conclusion, even in populations with a high intake of organic As through foods, the finding of a significant inter-individual but no significant intra-individual variability of urinary species confirms the usefulness of urinary As speciation for biological monitoring of exposure to As.

The urinary excretion of t,t-muconic acid (t,t-MA), S-phenylmercapturic acid (SPMA) and urinary benzene and the influence of a smoking habit and of exposure to urban traffic on the urinary excretion of these biomarkers were investigated in 137 male adults from the general population. All subjects were not occupationally exposed to benzene and resident in two cities in Puglia (Southern-Italy). Environmental exposure to benzene was measured using passive personal samplers. The biomarkers t,t-MA, SPMA and urinary benzene were determined in urine samples collected from each subject at the end of the environmental sampling. The percentage of cases above the limit of detection was higher for SPMA and urinary benzene in smokers than in non-smokers, and for airborne benzene and urinary benzene in subjects exposed to urban traffic. Airborne benzene was correlated with the time spent in urban traffic during the environmental sampling. Among the biomarkers, urinary benzene was found to be correlated with airborne benzene only in non-smokers, and with the time spent in urban traffic, both in smokers and non-smokers considered together, and in non-smokers only. Finally, multiple regression analysis showed that the urinary excretion of all the biomarkers was dependent on the number of cigarettes smoked per day and, for urinary benzene, also on the time spent in urban traffic. In conclusion, urinary benzene seems to be a more valid biomarker than t,t-MA and SPMA to assess environmental exposure to extremely low concentrations of benzene. Cigarette smoking prevailed over traffic exhaust fumes in determining the internal dose of benzene.

This study was aimed to identify useful biomarkers of exposure and effect in workers exposed to low levels of benzene, and to evaluate any correlations existing between these parameters. Benzene exposure was measured in 33 petrochemical industry operators (PIO), 28 service station attendants (SSA), 21 gasoline pump maintenance workers (GPMW) and 51 non-exposed controls by GC-FID analysis. Samples were collected with personal passive samplers (Radiello ® ). End-shift urine samples were collected for t,t-muconic acid (t,t-MA) determination by HPLC and for S-phenylmercapturic acid (S-PMA) measurement by HPLC-MS/MS. The alkaline version of the comet assay and, in a subgroup of 19 SSA and 16 control subjects, chromosomal aberrations (CA) and glutathione (GSH) levels were measured in peripheral blood lymphocytes. Personal benzene exposure was significantly higher in PIO, SSA and GPMW as compared to controls. The urinary excretion of the two metabolites showed a significant increase in SSA (p = 0.0258 and p = 0.0001, for t,t-MA and S-PMA, respectively) and in PIO (p = 0.0013 and p = 0.0001, for t,t-MA and S-PMA, respectively) as compared with the control group, while no such increase was observed for GPMW, for whom occupational exposure was not continuous and occurred on specific working days only. Significant increases of DNA damage were found by the comet assay for tail moment (TM) and tail length (TL) in SSA (p < 0.0001 and p = 0.008, for TM and TL, respectively) and PIO (p < 0.0001 and p < 0.0001, for TM and TL, respectively) when compared with controls. The PIO group also displayed a significant increase in the number of cells with comet (p < 0.0001). Smoking habits did not appear to interfere with these results in any of the groups. No difference was found in percentage of CA between exposed workers and controls. Significant correlations were found, in all groups, between benzene exposure and the more representative comet parameter TM (r = 0.509, p = 0.007; r = 0.525, p = 0.017 and r = 0.420, p = 0.046 in SSA, GPMW, and PIO, respectively). A trend of negative correlation was observed between DNA damage and either GSH or urine S-PMA for exposed workers. In summary, in present study urinary S-PMA and DNA damage by the comet assay were both sensitive to exposure to low levels of benzene, and GSH seems to play an important defence role against benzene-dependent DNA damage.

Objectives This study analyzes the validity of new, more sensitive and speciWc urinary biomarkers of internal dose, namely, urinary benzene for benzene and urinary toluene and S-benzylmercapturic acid (SBMA) for toluene, to assess their eYcacy when compared to traditional biomarkers for biological monitoring of occupational exposure to low concentrations of these two toxic substances. Methods Assessment was made of 41 workers occupationally exposed to benzene and toluene, 18 fuel tanker drivers and 23 Wlling-station attendants, as well as 31 subjects with no occupational exposure to these toxic substances (controls). Exposure to airborne benzene and toluene was measured using passive Radiello® personal samplers worn throughout the work shift. In urine samples collected from all subjects at the end of the workday, both the traditional and the new internal dose biomarkers of benzene and toluene were assessed, as well as creatinine so as to apply suitable adjustments. Results Occupational exposure to benzene and toluene resulted signiWcantly higher in the fuel tanker drivers than the Wlling-station attendants, and higher in the latter than in controls. SigniWcantly higher concentrations of t,t-muconic acid (t,t-MA), S-phenylmercapturic acid (SPMA), urinary benzene, SBMA and urinary toluene were found in the drivers than the Wlling-station attendants or the controls. Instead, urinary phenol and hippuric acid were not diVerent in the three groups. In the entire sample, airborne benzene and toluene values were signiWcantly correlated, as were the respective urinary biomarkers, showing coeYcients ranging from 0.36 to 0.98. Subdividing the subjects by smoking habit, higher coeYcients were evident in nonsmokers than in smokers; at multiple regression analysis t,t-MA, SPMA and urinary benzene and toluene were dependent on the number of cigarettes smoked daily and on airborne benzene and toluene, respectively. Instead, SBMA was dependent only on airborne toluene. Conclusions Our research conWrmed the validity of t,t-MA and SPMA for use in the biological monitoring of exposure to low concentrations of benzene. Urinary benzene showed comparable validity to SPMA; both parameters are aVected by smoking cigarettes in the hours before urine collection, so it is best to ask subjects to refrain from smoking for 2 h before urine collection. Urinary toluene was found to be a more speciWc biomarker than SBMA.

In order to characterize the different sources of exposure to arsenic (As), urinary excretion of total As, the sum of inorganic As+MMA+DMA determined by the hydride generation-atomic absorption spectrophotometry technique, and the species As3, As5, monomethylarsonic acid (MMA), dimethylarsinic acid (DMA) and arsenobetaine were determined in 49 workers at a steel foundry, with presumed occupational exposure to As, and 50 subjects from the general population, all males. No evidence of occupational exposure to As resulted from environmental monitoring performed in the foundry, although the analysis of minerals used as raw materials showed the presence of As, particularly in fossils and fine ores. The urinary concentrations of As3, MMA, DMA, the sum of inorganic As+MMA+DMA and total As were not different in the two groups, while arsenobetaine appeared significantly higher in the controls than in the workers. The different species of urinary As were all significantly correlated. Urinary excretion of As3 was associated with the consumption of mineral water and with residence in an industrial zone, while MMA, DMA, arsenobetaine, the sum of inorganic As+MMA+DMA and total As urinary excretion were associated with the consumption of crustaceans and/or shellfish 3 days or less before urine collection. Multiple regression analysis confirmed these results. In conclusion, in populations with a high consumption of seafood, living in areas characterized by coastal/marine As pollution, only speciation of As can identify a prevalent role of environmental sources, like the consumption of seafood contaminated by As, in determining urinary As excretion, and exclude an occupational origin of the exposure.

The effects of low exposure to inorganic mercury on psychological performance was investigated: the study groups included eight chronically exposed workers and 20 who were only occasionally exposed. These were compared with a control group of 22 subjects from the same plant who were not exposed to mercury. All subjects were administered the WHO test battery to detect preclinical signs of central nervous system impairment: the battery includes the Santa Ana (Helsinki version) test, simple reaction time, the Benton test, and the Wechsler digit span and digit symbol. In addition, the Gordon test was used to study personality profiles and the clinical depression questionnaire. Urinary mercury was used as indicator for internal dose. To this effect, urinary mercury observed in workers examined from 1979 to 1987 was evaluated. Of the pyschic functions explored by behavioural tests, only short term auditory memory was found to be impaired in the chronically exposed workers (p less than 0.05 compared with the controls). The chronically exposed workers were also found to be more depressed than those in the two other groups. No changes of visual motor functions were observed. The personality of the occupationally exposed workers was found to be considerably changed compared with that of the control group. On the basis of the results obtained and in view of urinary mercury mean concentrations in the exposed group which were 30-40 micrograms/l over the years, it is suggested that the TLV-TWA for mercury should be lowered to 0.025 mg/m3 and that the biological urinary exposure indicator for biological monitoring should be 25 micrograms/l.

In Europe, continuing medical education is one of the main instruments for improving physicians' performance and ensuring adequate health care for citizens. Recent regulations have made such continuing education compulsory in Italy. Considering the particular features of occupational medicine, the Italian Society of Industrial Medicine and Industrial Hygiene (S.I.M.L.I.I.) recently set up a specific education and accreditation programme for occupational physicians, called the "Excellence Accreditation Scheme". The programme is based on the findings of a survey among occupational physicians, carried out in collaboration with the National Institute of Occupational Safety and Prevention (I.S.P.E.S.L.), which enquired into their training and continuing education needs. The programme started in 2003, and its first edition-presented here-involved more than 400 physicians specialising in occupational health.

Urinary benzene is used as biomarker of exposure to evaluate the uptake of this solvent both in non-occupationally exposed population and in benzene-exposed workers. The quantitative determination of benzene in urine is carried out in a three steps procedure: urine collection, sample analysis by head space/solid phase microextraction/gas chromatography/mass spectrometry and analyte quantification. The adopted quantification method influences the initial step, hence the whole procedure. Two quantification approaches were compared as regards precision and accuracy: the calibration curves and the standard addition method. Even if calibration curves obtained by using urine samples from different subjects were always linear, their slopes and intercepts showed noteworthy variations, attributable to the influence of the biological matrix on benzene recovery. The standard addition method showed to be more suitable for compensating matrix effects, and a three-point standard addition protocol was used to quantify benzene in urine samples of 11 benzene-exposed workers (smokers and non-smokers). Urine from occupationally exposed workers was collected before and after work-shift. Besides urinary benzene, the applicability of the method was verified by measuring the urinary concentration of the S-phenylmercapturic acid, a specific benzene metabolite, generally adopted as biomarker in biological monitoring procedures. A similar trend of concentration levels of both analytes measured in urine samples collected before work-shift with respect to the after work-shift ones was found, showing the actual applicability of the standard addition method for biological monitoring purposes.

The primary prevention programmes carried out in the 1950's and 1960's in industrialized countries brought about a significant reduction in the incidence of pneumoconiosis. Nevertheless, it is still possible to diagnose new cases, perhaps in relatively unusual working activities.To describe a case of q 2/2 pneumoconiosis associated with mixed powder containing less than 1% quartz that occurred in a 37 year-old female worker, who had been previously employed (1987-1994) in manually spraying a primer solution on the bottom of non-stick aluminium pans.The manufacturing firm supplied details of the composition of the primer. The physiological, pathological and occupational history was obtained for the worker, who also underwent: respiratory functional exploration, chest radiographs and HRCT of the thorax, fibrobronchoscopy, with transbronchial biopsy and BAL collection. The lung tissue sample was examined via light microscopy and scanning electron microscope analysis.The primer contained 6.8% talc, free from asbestos or silica, 3.8% iron oxides and 0.6% bentonite which, in turn, contained less than 1% crystalline silica. The job was performed in a semi-confined environment, with an inefficient aspiration system. The worker had never complained of respiratory symptoms. Radiographs and HRCT showed widespread micronodulation. Light microscopy of pulmonary tissue showed multinucleate giant cell granulomas with intracytoplasmatic inclusions. Scanning electron microscope analysis revealed that these consisted of agglomerated particles, microanalysis of which showed the presence of a silicate.Particular jobs performed up to few years ago in Italy in a semi-confined environment can still involve exposure to doses of mineral dusts such as to cause pneumoconiosis. This is the first case of mixed powder pneumoconiosis described in a worker employed in the production of non-stick aluminium pans.