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Objective: To estimate the incidence of, trends in and effect of change in reporting rules on occupational diseases (ODs) in the Italian agricultural sector., Methods: Over a 14-year period (2004-2017), ODs among Italian agricultural workers were diagnosed by physicians and reported to the National Institute for Insurance against Workplace Accidents and Occupational Diseases. OD was defined as a disease with a specific clinical diagnosis (International Classification of Diseases) and was predominantly caused by work-related factors. Trends in incidence and effects of changed eligibility criteria for reporting occupational musculoskeletal disorders (MSDs) and noise-induced hearing loss (NIHL) were estimated using a Poisson regression model., Results: In 2017, the incidence of all ODs was 1295 per 100 000 agricultural workers. MSDs (961 per 100 000 workers) were the most frequently occurring ODs. MSDs and NIHL showed statistically significant increasing time trends, 26% and 7% annual increase, respectively, during the 2004-2017 period. There was no statistically significant change in the incidence of occupational respiratory, skin and cancer diseases during the 14-year period. After changes in reporting rules, the incidence of MSDs showed an immediate increased effect, with an incidence rate ratio (IRR) of 2.9 (95% CI 2.65 to 3.14) and a significant annual decreasing trend of -9% (95% CI -6% to -12%) over the years after the changed reporting rules (from 2008 to 2017), and an immediate effect on NIHL with an IRR of 1.3 (95% CI 1.13 to 1.53)., Conclusion: In total, 1.3% of the Italian agricultural workers were diagnosed in 2017 as having an OD. Over a 14-year period, the annual incidence of ODs showed a considerable increasing trend consistent with changed eligibility reporting criteria for occupational MSDs and to a lesser extent for NIHL., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Breast cancer and its treatments can cause detrimental effects to function and quality of life (QoL). These patients do not conventionally receive physical therapy services until impairments and functional limitations have become extensive. Emerging treatment models advocate for early rehabilitation screenings and proactive interventions, which are termed prospective surveillance. The purpose of this case report was to describe two prospective surveillance screenings at initial diagnosis and survivorship and subsequent physical therapy episodes of care for a patient with breast cancer. A 39-year-old female was diagnosed with invasive ductal carcinoma of the right breast. Approximately three months after the initial diagnosis, the patient had a right nipple-sparing mastectomy and immediate reconstruction with an expander. In addition, one lymph node was removed and underwent a biopsy, which was negative for metastases. The patient was screened by a physical therapist after her initial cancer diagnosis at the breast multidisciplinary clinic. This was after her mastectomy with an expander; the therapist recommended an episode of outpatient physical therapy due to impairments in pain, fatigue, loss of range of motion, weakness, and limitations in performance of her activities of daily living. The patient was seen initially for five visits. She underwent her final reconstructive surgery one month after discharge from physical therapy. Six months after her final reconstructive surgery, she was screened by the same physical therapist in the cancer survivorship clinic. Once again, therapy was recommended due to pain as well as deficits to her range of motion, strength, and functional status. The second episode of care lasted 14 visits and the patient showed improvements in pain, range of motion, shoulder strength and gains in the patient-specific functional scale and upper extremity functional index. This case reflects the importance of prospective surveillance screenings to overall patient outcomes. This patient may not have otherwise received physical therapy and its associated benefits without the prospective screenings by the physical therapist., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Marsili et al.)

Introduction: In recent years, a phenomenon known as "vaccine hesitancy" has spread throughout the world, even among health workers, determining a reduction in vaccination coverage (VC).A study aimed at evaluating VC among healthcare workers (HCWs) in 10 Italian cities (L'Aquila, Genoa, Milan, Palermo, Sassari, Catanzaro, Ferrara, Catania, Naples, Messina) was performed., Materials and Methods: Annex 3 of the Presidential Decree n. 445 of 28 December 2000 was used to collect information on the vaccination status of HCWs. The mean and standard deviation (SD) were calculated with regard to the quantitative variable (age), while absolute and relative frequencies were obtained for categorical data (sex, professional profile, working sector, vaccination status). The connection between VC and the categorical variables was evaluated by chi-square method (statistical significance at p < 0.05). The statistical analyses were performed by SPSS and Stata software., Results: A total of 3,454 HCWs participated in the project: 1,236 males and 2,218 females.The sample comprised: physicians (26.9%), trainee physicians (16.1%), nurses (17.2%) and other professional categories (9.8%). Low VC was generally recorded. Higher VC was found with regard to polio, hepatitis B, tetanus and diphtheria, while coverage was very low for measles, mumps, rubella, pertussis, chickenpox and influenza (20-30%)., Conclusions: This study revealed low VC rates among HCWs for all the vaccinations. Measures to increase VC are therefore necessary in order to prevent HCWs from becoming a source of transmission of infections with high morbidity and/or mortality both within hospitals and outside.

Objective: The aim of this study is to evaluate inflammatory markers and pro-inflammatory CD14 and Toll-like Receptor 4 (TLR4) polymorphisms in workers exposed to flour dust., Methods: Polymorphisms in TLR4 and CD14 were identified in our study population of 167 workers that included 63 healthy subjects (HS), 45 atopic subjects (A), and 59 subjects diagnosed clinically with occupational asthma/rhinitis (OAR). Endpoint measures in this study included fractional exhaled nitric oxide and serum concentrations of interleukin IL-6, IL-8, and tumor necrosis factor-alpha (TNF-α)., Results: We identified a polymorphism in CD14 (rs2569190) that may be differentially expressed (P = 0.06). IL-6 concentrations in the serum were significantly higher in the A and OAR groups (P < 0.01) than in subjects in the HS group, while IL-8 concentrations were significantly elevated only in the OAR group (P < 0.01). Interestingly, TNF-α concentrations in the OAR group were significantly reduced when compared with subjects in the HS group (P < 0.01)., Conclusion: Cytokines are likely a defensive response in atopic and healthy workers. A protective genotype is hypothesized for occupational asthma.

Background: Hairdressers are exposed to irritants and allergenic compounds that may cause contact dermatitis, rhinitis and asthma., Objectives: In this paper we describe the case of a female, age 33 years, who developed contact dermatitis after 10 years of exposure to ammonium persulfate., Methods: After 7 months of progressively extensive and persistent skin lesions, respiratory symptoms appeared that were related to the occupational exposure (on-off test). SIDAPA and specific occupational patch test for hairdressers and occupational challenge with ammonium persulfate were performed. Clinical parameters of inflammation, ECP (eosinophil cationic protein) and exhaled nitric oxide (FeNO) were detected before and after the specific bronchial challenge., Results: The patch test was positive to ammonium persulfate (++), and bronchial challenge for ammonium persulfate showed a significant late response (FEV1 decrease--33%). Both FeNO and ECP showed a significant increase after 24 hours. Dermatitis, urticaria and angioedema occurred on the uncovered skin due to airborne contact. Topic steroids and anti-histaminic drugs resolved the clinical symptoms., Conclusions: Bronchial challenge is, in fact, considered to be the gold standard for the diagnosis of occupational asthma, although new inflammatory parameters can contribute to the diagnosis and can be useful for monitoring after a specific inhalation test with occupational agents. The described case summarizes the evolution from contact dermatitis to inhalation allergy, suggesting the occurrence of an allergic "march" for occupational allergy.

Contact dermatitis in pediatric population is a common but (previously) under recognized disease. It is usually divided into the allergic and the irritant forms. The diagnosis is usually obtained with the patch test technique after conducting a thorough medical history and careful physical examination but patch testing in infants may be particularly difficult, and false-positive reactions may occur. This study also provides an overview of the most common allergens in pediatric population and discusses various therapeutic modalities.

The Italian Board on Urticaria has prepared a document focusing on the definition and classification of urticaria, taking into account the recent progress in identifying the causes, eliciting factors, and pathomechanisms of this disease. As urticaria has a profound impact on the quality of life, effective treatment is important. Therefore, specific treatment options for the management of urticaria are evaluated on the basis of the recent literature. Non-sedating H(1) antihistamines are recommended as the first-line treatment as they have proven effective in several randomized double-blind controlled studies. Dosages higher than those recommended may be necessary in some cases. However, additional or alternative therapies may be required for different urticaria subtypes and in view of individual variations in the course of the disease and response to treatment. Immunosuppressive drugs such as corticosteroids are not recommended for long-term treatment due to unavoidable, severe adverse effects.

Skin disorders like rosacea, seborrhoeic dermatitis, non-specific erythema and acne can be VDU work linked. At present, many environmental and individual causes are involved in the development of these disorders, but the former appear to be the issue to investigate more in depth.

Serum immunoglobulins IgD and IgE have been determined by a single radial immunodiffusion technique and a radioimmunoassay method in serum samples from 95 rheumatoid patients, 5 subjects with Sjögren's syndrome and 50 healthy controls, and compared with levels of IgG, IgM and IgA fractions measured in the same subjects. The IgD and IgE serum content resulted similar in the rheumatoid, Sjögren's and control sera. No correlation of IgD and IgE values with changes of other immunoglobulins or with the activity and the duration of the rheumatoid disease was observed.

1045 subjects (427 males and 618 females) from the Siena area, aged 20-85, were screened for tetanus antitoxin by the means of a passive haemogglutination assay. 32% of subjects was found protected against tetanus (antitoxin titre greater than or equal to 0.1 I.U./ml), 34.7% resulted partially protected (titre greater than or equal to 0.01 - less than 0.1 I.U./ml), and 33.3% was found unprotected (titre less than 0.01 I.U./ml). The protection rate was higher among males (44.9%) than among females (23%) and showed a definite age-related decrease. Within each age group, the protection rate was higher among males. The lowest protection rate (3.2%) was observed among females aged 70 or more. Analysis of the protection rate according to the individuals' occupation showed the highest value (44.9%) among workmen and the lowest (12.1%) among housewives. The anamnestic criterion was found exceedingly unreliable to assess the individual's immune status. Results, which are consistent with present tetanus italian epidemiology, are discussed for their implications relating to a possible improvement of current antitenus immunization policy.

The effects of staphylococcal alpha toxin on regenerating liver of partially hepatectomized rats are studied. Sixty six rats are used. They are divided into three groups of twenty two animals each one. The first group included untreated animals, the rats of second and third group are injected with 0,1 UE of staphylococcal alpha toxin, respectively soon after hepatectomy (second group) and after twenty two hours (third group). As parameters we used: mitotic activity, percentage of hepatic regeneration, the contents of liver water and proteins. The results are: a low letality in all the animals, a lower mitotic activity in all treated animals than in the intact ones, the percentage of restoration, the contents of water and proteins are the same in all the animals of the three groups. The AA. conclude that staphylococcal alpha toxin has a little negative mitotic effect on partially hepatectomized rats liver.

After an short bibliographic records in the relation between the endotoxine and lipydic metabolism, the AA. expose an inquiry on the rabbit. Ten rabbits (weight 2500-3000 g) were traited with 10 U.E. (haemolitic units) of streptococcal toxine (1/10 of DL50 for the rabbit). A conspicous increase of all the fractions examined, was remarked in all traited animals. The total lipids and the triglycerides reached the biggest value at 24 hours. Even the two fractions of cholesterol have increased, but the biggest concentration was at 48 hours. An hypotesis of interpretation can be that the streptococcal toxine produce the modification of lipidemic outline with the iperincretion of catecolamine, as in first phase of all toxinfections processes.

The Authors have studied the variations of nucleic acids, proteins and histological aspect in the liver of rats, treated with 1 mg of E. coli ) 127 lipopolysaccharide and killed at 24th, 48th, 72th, 96th hour after the inoculation. The endotoxin determines an increase of nucleic acids and a reduction of hepatic proteic contents. The histological observation shows throw-back phenomenons of the hepatocyte with hyperplasy and hypertrophy of Kupffer cells at 24th hour, while at following intervals the phenomenous of hepatic rigeneration emphasize.

In the present study , the Authors have examined the effects of diphtheria and tetanus toxins on the lipid metabolism in the rabbit. Ten animals were treated with diphtheria toxin (five with 1 DL50 and five with 5 DL50 guinea pig). Ten animals were treated with tetanus toxin (five with 1 DL50 and 5 with 5 DL50 guinea pig). Finally, five animals were used as controls. The total lipids, the two cholesterol fractions, the total cholesterol, the triglycerides and the NEFA were measured 4, 24, 48, 72 and 96 hours after the beginning of the experiment. The animals treated with diphtheria toxin all died within 48 hours, and only those given the higher dose of toxin showed an increase in NEFA, found immediately before they died. The animals treated with tetanus toxin all survived and only those injected with the higher dose of toxin showed an increase in the esterificated fraction of cholesterol. The Authors conclude by affirming that the two toxins tested do not have significant influence on the lipid picture in the rabbit.

The effects of tetanus toxin on the rat liver, employing as parameters the DNA and protein contents, have been studied. In the animals treated with tetanus toxin the DNA and the total liver proteins appear to be increased in a statistically significant way to comparison with the controls.

Immunity against tetanus in newborn and in mother-newborn couples was studied in a sample of population from the Siena area, Italy. Mother-newborn antitetanus antibody transfer and the decrease of passively acquired antitoxin, in newborn after birth, were evaluated too. Antitetanus immunity was detected by a passive haemagglutination assay. A high rate of immunologically unprotected newborns was found owing to the low immunisation rate in mothers. The important role played by general prophylactic measures in neonatal tetanus prevention is remarked and a systematic antitetanus immunity screening, during pregnancy, is suggested in order to enhance antitetanus protection in newborns and mothers by immunisation practices.

After a short notice on the relations between the endotoxine and lipydic metabolism the AA. refer on the inquiry on 60 animals divided in three groups according to the dosis of the injected endotoxin. The dosis were 0.010-1-5 mg of the lypopolisaccaride from E. coli O-127; seven animals were appointed as controls. In the all animals were examined proofs of blood after 4, 12, 24, 36, 48, 60 and 72 hours from the start of experience. The total lipids, the triglycerides, the phospholypids, the NEFA, the free and esterified cholesterol were doses. The data of lethality and the value of determinations of the single fractions obtained were registered. In the all experienced animals, independently from the injected dosis, an independently from the injected dosis, an increase of the lypidic fractions was remarked: the free fatty acids were the first to rise, suived by triglycerides and phospholypids and denn by the two fractions of cholesterol. The highest dosis of endotoxine have comported a blok in the esterification of cholesterol. This early and persistent hiperlypemie can be caused initially by increased incretion of catecolamine.

The AA. have studied the effects provoques by alpha staphylococcal toxin in the lipidemic panel of the rabbit. Of 15 rabbits, five were injected with 0.25 emolitic units (U.E.) five with 1 U.E. and five ad control. The blood from heart was frequently with drawed and examined. In the animals traited with lowest dosis of toxin, the two fractions of cholesterol have increased with the maximum at the last control (96 hours). With a quadruple dosis of toxin increased also the total lipids and triglyceridis with the maximum at 48 hours. Remarked after all the different behaviour of the two fractions of cholesterol at the various dosis. The AA. conclude that the staphylococcal toxin provoque at low dosis only the modification on the cholesterol but at greater dosis also of the triglycerids and phospholipidis.