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I dati dell'Agenzia europea per la sicurezza e la salute sul lavoro, diffusi in occasione della Campagna Europea 2007 dedicata alle malattie muscolo scheletriche, indicano che nei 27 stati membri dell'Unione Europea i disturbi muscolo-scheletrici sono le patologie più diffuse tra quelle correlate all'attività lavorativa: il 25% dei lavoratori europei soffre di mal di schiena (es. affezioni dei dischi intervertebrali) e il 23% lamenta dolori muscolari (es. tendiniti). Anche le dimensioni del fe nomeno infortunistico sono preoccupanti, specialmente tra i giovani: in Italia secondo l'Istituto Nazionale per le Assicurazioni contro gli Infortuni sul Lavoro (INAIL) i lavoratori nella fascia di età fino ai 34 anni, nel 2010, sono stati i protagonisti del 31% degli infortuni sul lavoro. Questo dato evidenzia come permangano criticità in merito alla formazione in materia di salute e sicurezza sul lavoro (SSL) non solo a livello dei percorsi universitari ma anche scolastici, confermando la necessità di promuovere tali conoscenze sin dalle prime classi della scuola dell'obbligo, per aiutare i ragazzi a sviluppare la capacità di prendere decisioni consapevoli nei riguardi del proprio benessere, in difesa del proprio equilibrio fisico, psichico e sociale, promuovendo una corretta percezione dei rischi e l'adozione di comportamenti che diventino parte integrante dello stile di vita e quindi di lavoro. A seguito di queste premesse l'INAIL ex ISPESL raccogliendo l'imput normativo (come previsto dall'art.9 comma 2f del D.lgs 81/08) sta promuovendo iniziative per supportare le Istituzioni Scolastiche in questo nuovo ed importante compito educativo, attraverso anche lo sviluppo di "percorsi formativi interdisciplinari" e strategie formative che possano insegnare oggi ai ragazzi cosa significa essere lavoratori domani. In questo contesto nasce il programma educativo sull'ergonomia scolastica, per fornire agli insegnanti delle scuole primarie strumenti didattici che, facendo leva sulla creatività dei bambini, siano in grado di sensibilizzare gli alunni sui problemi derivati da comportamenti ergonomici sbagliati, attraverso lo studio delle proprie esperienze e di alcuni semplici concetti di ergonomia. [ABSTRACT FROM AUTHOR]

Healthcare workers (HCWs) played an essential role in managing the COVID-19 pandemic. The Italian Workers' Compensation Authority (INAIL) and the Italian National Institute of Health (ISS) developed a retrospective study to analyze and understand trends and characteristics of infections among HCWs during the first wave of the pandemic. Between May and September 2020, Italian Regions retrospectively collected anonymous data regarding HCWs infected from the beginning of the pandemic until 30 April 2020 from their administrative sources through a questionnaire asking for socio-demographic and occupational information about the characteristics of contagion and disease outcome. Almost 16,000 valid questionnaires were received. Logistic regression was performed to ascertain the effect of age, gender, geographical macro area, profession, and pre-existing health conditions on the likelihood of HCWs developing more severe forms of COVID-19 (at least hospitalization with mild symptoms). All predictor variables were statistically significant. HCWs at higher risk of developing a more severe disease were males (OR: 1.90; 95% CI: 1.44-2.51), older than 60 years of age (OR: 6.00; 95% CI: 3.30-10.91), doctors (OR: 4.22; 95% CI: 2.22-9.02), working in Lombardy (OR: 55.24; 95% CI: 34.96-87.29) and with pre-existing health conditions (OR: 1.90; 95% CI: 1.43-2.51). This study analyses the main reasons for the overload put on the National Health Service by the first wave of the pandemic and the risk of infection for HCWs by age, gender, occupational profile and pre-existing health conditions. Improved knowledge, availability of personal protective equipment (PPE) and a tight vaccination campaign for HCWs strongly changed the trend of infections among HCWs, with substantial elimination of serious and fatal cases.

The objectives of the systematic review were to: identify the work sectors at risk for exposure to formaldehyde; investigate the procedures applied to assess occupational exposure; evaluate the reported exposure levels among the different settings. An electronic search of Pubmed, Scopus, Web of Science and ToxNet was carried out for collecting all the articles on the investigated issue published from January 1, 2004 to September 30, 2019. Forty-three papers were included in the review, and evidenced a great number of occupational scenarios at risk for formaldehyde exposure. All the included studies collected data on formaldehyde exposure levels by a similar approach: environmental and personal sampling followed by chromatographic analyses. Results ranged from not detectable values until to some mg m -3 of airborne formaldehyde. The riskiest occupational settings for formaldehyde exposure were the gross anatomy and pathology laboratories, the hairdressing salons and some specific productive settings, such as wooden furniture factories, dairy facilities and fish hatcheries. Notice that formaldehyde, a well-known carcinogen, was recovered in air at levels higher than outdoor in almost all the studied scenarios/activities; thus, when formaldehyde cannot be removed or substituted, targeted strategies for exposure elimination or mitigation must be adopted., (© 2021 The Authors. Indoor Air published by John Wiley & Sons Ltd.)

Background: Formaldehyde, classified as a carcinogen in 2004, as of today is widely used in many work activities. From its classification, further studies were performed to evaluate its carcinogenicity. The aim of the systematic review is to update the evidence on occupational exposure to formaldehyde and cancer onset., Methods: The review, in accordance with the PRISMA statement, includes articles in English reporting original results of studies conducted on workers exposed to formaldehyde, considering all types of cancer, published from 1 January 2000 to 30 July 2021 and selected from the Pubmed and Scopus databases. The studies' quality was assessed by the Newcastle-Ottawa Scale., Results: A total of 21 articles were included, conducted in different European, American, and Asian countries. The most investigated occupational areas are those characterized by a deliberate use of formaldehyde. Some studies evaluated all types of cancer, whereas others focused on specific sites such as thyroid and respiratory, lymphohematopoietic, or central nervous systems. The results showed weak associations with lung cancer, nasopharyngeal cancer, leukemia, and non-Hodgkin's lymphoma., Conclusions: The results demonstrate the need for further original studies carried out on representative samples of workers exposed to measured levels of FA. These studies should be designed to reduce the bias due to co-exposure to other carcinogens.

Background: In recent decades, there has been an increase in male infertility, and in many cases, the etiology remains unclear. Several studies relate male hypo-fertility to xenobiotic exposure, even if no data exist about multiple exposure at the environmental level., Methods: The study involved 86 males with diagnosis of idiopathic male infertility (IMI), and 46 controls with no alteration in sperm characteristics. Seminal plasma (SP) and urine samples were analyzed by liquid chromatography tandem mass spectrometry (LC-MS/MS) to quantify biomarkers of exposure (the main metabolites of benzene, toluene, 1,3-butadiene, 3-monochloropropanediol, styrene, and naphthol) and effect (oxidized products of nucleic acids)., Results: Biomarker concentrations were similar in subjects with IMI and controls even if a stronger correlation between biomarkers of exposure and effects were observed in SP. Data show that, both in SP and urine, most metabolites were inter-correlated, indicating a simultaneous co-exposure to the selected substances at the environmental level. Principal component analysis showed in SP the clustering of mercapturic acids indicating a preferential metabolic pathway with Glutathione (GSH) depletion and, consequently, an increase of oxidative stress. This result was also confirmed by multivariable analysis through the development of explanatory models for oxidized products of nucleic acids., Conclusions: This study highlights how oxidative stress on the male reproductive tract can be associated with a different representation of metabolic pathways making the reproductive tract itself a target organ for different environmental pollutants. Our results demonstrate that SP is a suitable matrix to assess the exposure and evaluate the effects of reproductive toxicants in environmental/occupational medicine. The statistical approach proposed in this work represents a model appropriate to study the relationship between multiple exposure and effect, applicable even to a wider variety of chemicals., Competing Interests: The authors declare no conflict of interest.

Ultra-fine particles have recently been included among the risk factors for the development of endothelium inflammation and atherosclerosis, and cobalt (CoNPs) and titanium oxide nanoparticles (TiNPs) have attracted attention because of their wide range of applications. We investigated their toxicity profiles in two primary endothelial cell lines derived from human aorta (HAECs) and human umbilical vein (HUVECs) by comparing cell viability, oxidative stress, the expression of adhesion molecules and the release of chemokines during NP exposure. Both NPs were very rapidly internalised, and significantly increased adhesion molecule (ICAM-1, VCAM-1, E-selectin) mRNA and protein levels and the release of monocyte chemoattractant protein-1 (MCP-1) and interleukin 8 (IL-8). However, unlike the TiNPs, the CoNPs also induced time- and concentration-dependent metabolic impairment and oxidative stress without any evident signs of cell death or the induction of apoptosis. There were differences between the HAECs and HUVECs in terms of the extent of oxidative stress-related enzyme and vascular adhesion molecule expression, ROS production, and pro-inflammatory cytokine release despite the similar rate of NP internalisation, thus indicating endothelium heterogeneity in response to exogenous stimuli. Our data indicate that NPs can induce endothelial inflammatory responses via various pathways not involving only oxidative stress., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: In light of recent developments in nanotechnologies, interest is growing to better comprehend the interaction of nanoparticles with body tissues, in particular within the cardiovascular system. Attention has recently focused on the link between environmental pollution and cardiovascular diseases. Nanoparticles <50 nm in size are known to pass the alveolar-pulmonary barrier, enter into bloodstream and induce inflammation, but the direct pathogenic mechanisms still need to be evaluated. We thus focused our attention on titanium dioxide (TiO₂) nanoparticles, the most diffuse nanomaterial in polluted environments and one generally considered inert for the human body., Methods: We conducted functional studies on isolated adult rat cardiomyocytes exposed acutely in vitro to TiO₂ and on healthy rats administered a single dose of 2 mg/Kg TiO₂ NPs via the trachea. Transmission electron microscopy was used to verify the actual presence of TiO₂ nanoparticles within cardiac tissue, toxicological assays were used to assess lipid peroxidation and DNA tissue damage, and an in silico method was used to model the effect on action potential., Results: Ventricular myocytes exposed in vitro to TiO₂ had significantly reduced action potential duration, impairment of sarcomere shortening and decreased stability of resting membrane potential. In vivo, a single intra-tracheal administration of saline solution containing TiO₂ nanoparticles increased cardiac conduction velocity and tissue excitability, resulting in an enhanced propensity for inducible arrhythmias. Computational modeling of ventricular action potential indicated that a membrane leakage could account for the nanoparticle-induced effects measured on real cardiomyocytes., Conclusions: Acute exposure to TiO₂ nanoparticles acutely alters cardiac excitability and increases the likelihood of arrhythmic events.

The INSuLa project consisted of a national survey on health and safety at work involving all the relevant actors such as workers, employers, occupational physicians (MC), worker safety representatives (RLS), prevention and safety service in the workplace (SPSAL). The survey aimed, on one hand, at investigating workers' risk perceptions at the workplace and, on another hand, at exploring the general level of awareness about the enforcement of the Legislative Decree 81/2008 and subsequent amendments. The survey was conducted on a stratified sample of8000 workers representative of the national situation taking into consideration some of the most important socio-demographic and occupational variables, such as gender, geographic area, age, type of contract and sector of activity. The analysis of the results presented here and the subsequent secondary analyses will contribute to identify the needs and critical issues for implementing preventive interventions at the workplaces, also in consideration of the emerging risks and changes in the world of work.

Objectives: To evaluate the association between environmental exposure to benzene and oxidative damage to nucleic acids in children, also considering the role of Environmental Tobacco Smoke (ETS)., Methods: 396 children living in central Italy were recruited in districts with different urbanization and air pollution. All biomarkers were determined in spot urine samples by mass spectrometric techniques to assess exposure [benzene (U-Benz), and its metabolites (t,t-muconic and S-phenylmercapturic acids, t,t-MA and S-PMA, respectively), cotinine] and nucleic acid oxidation [8-oxo-7, 8-dibydro-2'-deoxyguanosine (8-oxodGuo), 8-oxo-7, 8-dihydroguanosine (8-oxoGuo), and 8-oxo-7, 8-dihydroguanine (8-oxoGua)]., Results: Biomarkers of exposure and nucleic acid oxidation increased with urbanization and were correlated with each other (r > 0.18, p < 0.005). In a multiple linear regression model, benzene exposure, assessed by S-PMA and t,t-MA, was associated (p < 0.0001) with both 8-oxodGuo (R2 = 0.392) and 8-oxoGuo (R2 = 0.193) in all areas of residence, with similar slopes., Conclusions: (i) Biomarkers of exposure to benzene increased as a function of environmental air pollution and urbanization level; (ii) U-Benz clearly distinguished both exposure to ETS and areas of residence, whereas benzene metabolites were associated only with the latter; (iii) the variance of 8-oxodGuo and 8-oxoGuo was accounted for by environmental benzene exposure, thus suggesting that benzene is a good tracer of other components of complex mixtures of pollutants causing oxidative damage to nucleic acids.

Benzene is a widespread air pollutant and a well-known human carcinogen. Evidence is needed regarding benzene intake in the pediatric age group. We investigated the use of urinary (u) trans,trans-muconic acid (t,t-MA), S-phenylmercapturic acid (SPMA), and unmodified benzene (UB) for assessing exposure to low concentrations of environmental benzene and the role of living environment on benzene exposure in childhood. u-t,t-MA, u-SPMA, u-UB and u-cotinine were measured in urine samples of 243 Italian children (5-11 years) recruited in a cross-sectional study. Analytical results were compared with data obtained from questionnaires about participants' main potential exposure factors. u-UB, u-t,t-MA and u-SPMA concentrations were about 1.5-fold higher in children living in urban areas than in those in the rural group. Univariate analyses showed that u-UB was the only biomarker able to discriminate secondhand smoke (SHS) exposure in urban and rural children (medians=411.50 and 210.50 ng/L, respectively); these results were confirmed by the strong correlation between u-UB and u-cotinine in the SHS-exposed group and by multivariate analyses. A regression model on u-SPMA showed that the metabolite is related to residence area (p<0.001), SHS exposure (p=0.048) and gender (p=0.027). u-UB is the best marker of benzene exposure in children in the present study, and it can be used as a good carcinogen-derived biomarker of exposure to passive smoking, especially related to benzene, when urine sample is collected at the end of the day. In addition, it is important to highlight that SHS resulted the most important contributor to benzene exposure, underlining the need for an information campaign against passive smoking exposure., (Copyright 2010 Elsevier Ltd. All rights reserved.)

This study investigated nucleic acid oxidation associated with exposure to benzene at low levels in 239 workers recruited among traffic policemen, taxi drivers and gasoline pump attendants of the city of Parma (Italy). Biomarkers of exposure, namely urinary t,t-muconic acid (t,t-MA) and S-phenylmercapturic acid (S-PMA), urinary cotinine, and urinary biomarkers of nucleic acid oxidation, namely 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodGuo), 8-oxo-7,8-dihydroguanosine (8-oxoGuo) and 8-oxo-7,8-dihydroguanine (8-oxoGua) were determined by liquid chromatography-tandem mass spectrometry. Relevant polymorphisms of NAD(P)H:quinone oxidoreductase (NQO1), glutathione S-transferases M1-1 (GSTM1), T1-1 (GSTT1), and A1 (GSTA1) were characterized by polymerase chain reaction-based methods in a subgroup of subjects. Biomarkers of nucleic acid oxidation were correlated with each other (r> or =0.32, p<0.0001) and with exposure biomarkers (r> or =0.28, p<0.0001). Multiple linear regression models including age, sex and smoking habits as independent variables demonstrated that benzene exposure is associated with oxidation damage to nucleic acid, particularly to RNA (p<0.0001) and is modulated by the NQO1 polymorphism. The study confirmed a significant modulating effect of GSTM1 (p=0.010), GSTT1 (p=0.023) and GSTA1 (p=0.048) polymorphisms on S-PMA excretion, with a significant interaction between GSTM1 and both GSTT1 and GSTA1 (p=0.006 and p=0.037, respectively)., (2010 Elsevier Ireland Ltd. All rights reserved.)

A comparative evaluation of urinary biomarkers was carried out to characterize benzene exposure in a group of 100 traffic policemen of the city of Parma (Italy). All subjects were monitored once, in two consecutive days characterized by similar climatic conditions but preceded by two windy days. Benzene ambient concentration measured by municipal air monitoring stations was 1 microg/m(3) (Day 1) and 2 microg/m3 (Day 2). Personal exposure to ambient concentrations of benzene, toluene, ethylbenzene and xylene (BTEX) was assessed by using Radiello((R)) passive-diffusive samplers in a subgroup of 24 workers. Benzene metabolites, t,t-muconic acid (t,t-MA) and S-phenylmercapturic acid (S-PMA) were determined by isotopic dilution liquid chromatography-tandem mass spectrometry on spot urine samples collected at the end of the shift. Urinary benzene (U-B) was determined by solid-phase microextraction gas chromatography-mass spectrometry. Airborne benzene concentration expressed as median [and interquartile range] was 6.07 [0.28-9.53] microg/m(3), as assessed by personal sampling. Urinary concentrations of biomarkers in the whole group were 41.8 [34.1-89.8] microg/g creatinine for t,t-MA, 0.67 [0.23-1.32] microg/g creatinine for S-PMA, and 0.16 [0.13-0.26] microg/l for U-B. Smokers eliminated significantly higher concentrations of unchanged BTEX and benzene metabolites than non-smokers (p < 0.05). When traffic policemen were distinguished into indoor (n=31) and outdoor workers, no significant differences were observed for either airborne benzene or urinary biomarkers. Significantly lower concentrations of S-PMA and U-B were determined in samples collected at Day 1 as compared to Day 2 (p < 0.0001 and p = 0.003, respectively) suggesting that these biomarkers are enough sensitive and specific to detect changes in airborne benzene concentration even at few microg/m(3).

Occupational exposure of coke oven workers, classified by IARC as human carcinogen, is characterized by the presence of PAHs emitted during pyrolysis of coal. We aimed to clarify the mechanism of action of complex mixtures of PAHs and to identify biomarkers of early biological effect, evaluating on lung epithelial cells (A549) genotoxic and oxidative damage of airborne particulate matter collected in a coke plant. Particulate matter was collected in the oven area on glass filter, extract and analysed by GC/MS. Direct/oxidative DNA damage induced by exposure to extract were evaluated by Fpg comet assay. The cells were exposed for 30 min, 2h and 4h to extract of half filter diluted at 0.004%, 0.008% and 0.02%. We evaluated comet percentage and analysed tail moment values of cells treated with Fpg enzyme (TMenz) and untreated (TM) that indicate respectively oxidative and direct DNA damage. Air sample contained 0.328 microg/m3 of pyrene, 0.33 microg/m3 of benzo(a)anthracene, 1.073 microg/m3 of benzo(b)fluoranthene, 0.22 microg/m3 of benzo(k)fluoranthene, 0.35 microg/m3 of benzo(a)pyrene, 0.079 microg/m3 of dibenzo(a,h)anthracene and 0.40 microg/m3 of benzo(g,h,i)perylene. The dose-dependent increase of TM and TMenz in exposed cells was not significant, indicating only a slight direct and oxidative DNA damage in exposed cells. A small dose-time dependent increase of comet percentage was found. The study shows the high sensitivity of comet assay to measure early DNA damage also at low doses suggesting its use on lung epithelial cells to evaluate the effects of complex mixtures of genotoxic substances on target organ.

The main aim of the ISPESL project "Child Labour: to know in order to take action" is to introduce the subject of the problem of child labour in primary schools. This is done through pedagogical tools and communication methods, using the child's curiosity and point of view as a starting point and giving support to the child as he/she expresses his feelings, messages and emotions and at the same time, develops his own reaction to the problem. This project has been developed within the activities of ISPESL as WHO Collaborating Center and addressed to all the reference figures interacting with school such as teachers, educators and headmaster, but also families and local Institutions who promote understanding and awareness on child labour. The project aims at giving a general picture of the phenomenon, by focusing on the multiple and complex causes affecting the physical and psychosocial well-being of children and on fostering the increase of awareness among children on child labour issues. Observation and investigation tools will be developed and used in specific training modules suited to the cultural and geographic framework of each field of teaching, in order to allow the children to acknowledge and express their better awareness on child labour.

Child labour should be analyzed with regard to the main frameworks where it arises: particularly, the small family based enterprises in agricultural, hospitality and restaurateurs' sectors play a leading role. In these contexts the child can underestimate the risks related to the carried out work activity and assimilate the work background to the family background. In spite of the national thorough regulations on child labour, the network of WHO Collaborating Centres is working to develop a common awareness in order to evaluate, communicate and prevent the occupational health and safety risks for children, at national and international level.

The study was aimed at investigating in a sample of general medicine practitioners the level of epidemiologic and law knowledge as well as the degree of sensitivity to the topic of subjects formerly affected by occupational cancer. From the research, carried out on a sample of 745 practitioners from two northern Italy highly industrialized regions, come out the need for training and information on the problems associated with identification and management of subjects formerly exposed to professional cancer.

The aim of the study was to identify the research priorities and strategies in Occupational Safety and Health (OSH) in Italy with a high degree of consensus. Based on the Delphi technique, a two-phase questionnaire was sent to experts at Universities, Local Health Units (ASLs) and Trade Unions. In the first phase, experts were requested to indicate three research topics in the OSH sector. A total of 27 topics for both universities and ASLs and 18 topics for Trade Unions were identified. In the second phase, experts were requested to assign a score from one (low relevance) to five (high relevance) to each topic previously identified. On the basis of a mean score reported for each topic, two ranked lists of priorities, one referred to universities and ASLs the other referred to Trade Unions, were formulated. The highest priority identified by universities and ASLs was occupational carcinogenesis, followed by quality in occupational medicine. Workers' information, education and participation was also identified with a high degree of priority. For Trade Unions, occupational cancers as well as training, information, participation and prevention awareness had the highest priority. Trade Unions also identify small-industries and occupational accidents as topics with high priority for research development. This study allowed a high degree of consensus to be reached regarding the research priorities in the OSH sector in Italy. Differences in the topics identified, or regarding the mean score of topics commonly identified, were related to the origin of the expert recruited to this study (University, ASLs or Trade Unions) and, for universities and ASLs, to the geographical area. In the authors' opinion, the full transfer of existing scientific data to occupational health practice and the harmonization of the priorities identified by this investigation are crucial if the research needs in the OSH sector in Italy are to be met.

Method description and initial results of a study to assess risks to health sector workers and environment due to chemical agents used and waste products generated in diagnostic clinical chemical laboratories, and image diagnostic testing. A survey was conducted of the methods and agents used and their toxicological classification, the number of workers exposed and an analytical profile of the waste produced. The assessment of risk to workers was based on cytogenetic tests (chromosome aberrations and micronuclei); the assessment of environmental risk from waste disposal was based on tests on plant systems.

The presence of Lead, Mercury, Cadmium and Chromium has been estimated in the cow's milk produced in the Rome County. The results show the presence of the metals in cow's milk in different concentrations (5.6-102 micrograms/kg for Pb; 0.9-38 micrograms/kg for Hg: 2.3-53 micrograms/kg for Cr; only one sample positive at 0.77 microgram/kg for Cd). The sanitary evaluation of the data was based on the amounts of metals theorically assumed with milk, and compared with the "tolerable" values as suggested by International Organizations.