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Introduction: This study collected the opinions of sample of workers, sent to the Department of Occupational Medicine of Brescia Civil Hospital, on the contents and the methods used for carrying out information programs on the occupational risks in their workplaces., Methods: A questionnaire including three sections has been prepared: in the first section demographic data and information on the job were collected, in the second section the contents of programs on the prevention of occupational risks were evaluated, the third section investigated how these programs have been performed., Results: 250 workers have been examined; 16 self-employed workers have been excluded. Mean length of employment was sixteen years. 29% of workers reported to have received information about the role of the main actors of the prevention in the workplaces according to the Italian legislation; overall 41.8% of workers have been informed both on occupational risks in their factory and specific job-related risks, potential occupational diseases and working procedures to prevent these risks. 7.2% of workers did not receive any information on occupational risks. 24% of subjects referred the involvement of the occupational physician in the information meetings. 55% of these meetings lasted more than 60 minutes and included frontal lectures and the delivery of information leaflets; learning assessment was referred by 50% of the workers and 77.9% considered the information (contents and quality) at least sufficient., Discussion: This study, even if preliminary and based on anamnestic data, pointed out that, at this moment, careful information on occupational risks in the workplaces seems a target not yet achieved. It is desirable to verify in the future the improvement of the quality of information given to workers, following the entry into force of the recent Italian legislation concerning this topic.

The purpose of this review is to suggest job fitness criteria for health care workers exposed to sensitizing or chemical agents. These recommendations are derived from a comparison between previous documents on prevention and management of allergic and chemical risks in health care settings and updated evidence; the job fitness criteria and the main documents on these topics are summarized in tables. Glove allergy, in particular latex allergy, is still a significant problem but we should remember that a wide choice of alternative materials is now easily available; many different alternative health products are also currently available when an allergy to disinfectants or detergents is diagnosed. Hence the prevention of allergic diseases is mostly based on an appropriate choice and use of the gloves and health products according to the specific tasks and possible individual susceptibility; this meets the requirements of the "good health care organization", which translates into lower costs, if possible, as well as the best protection of worker's health. Concerning chemical risk, it should be remembered that during the last 20 years the improvements made in work environments have profoundly changed the mode and the levels of exposure to chemical substances and the current recommendations concerning the management of workers exposed to anesthetic gases, antineoplastic agents and sterilizers/disinfectants significantly differ from those of early 1990s. However, the past prudential guidelines are still valid for formaldehyde.

The movement computerized analysis of upper limb is a valid support in the definition of residual functional capability and of specific work suitability in complex cases. This methodology of evaluation is able to correctly and objectively define the tridimensional ranges of motion of every patient's upper limb. This fact can be particularly useful for workers coming back to work after a work-related or a not work-related accident of for handicapped workers at the beginning of a new work activity. We report a research carried out using computerized analysis of motion of upper limbs in 20 engineering workers.

This consensus document was prepared by an Italian working group including occupational health professionals involved for many years in the management of glove- and latex-related problems in health care settings. The aim of this document was to address the most significant technical, epidemiological, clinical, environmental and prevention problems related to the use of gloves and latex. The group's recommendations are based on scientific evidence and practical experience but they cannot be considered as final. These topics need to be periodically revised. The following points should be taken into account: glove quality seems to have improved considerably but the information on glove features provided by the manufacturers is often still inaccurate or incomplete; the regulations in force provide that the manufacturers perform tests to supply evidence for the quality of the products but they do not indicate which analytical method should be used and they do not require that the results be reported in the technical data sheets. Thus the manufacturers have only to declare that their products are "in accordance with the rules"; therefore, purchasers should require the manufacturing companies to supply detailed information and verify their reliability. Moreover, the rules should be adapted to higher quality standards; occupational physicians must be involved for the correct choice and purchase of protective gloves; the use of gloves (in particular latex gloves) and latex devices in health care settings should be based on specific criteria: procedures must be available stating which kind of gloves are suitable for specific tasks. When exposure to latex cannot be avoided it is necessary to choose products that have good biocompatibility (e.g., powder free-gloves with low allergen content); once and for all latex powdered gloves should no longer be commercially available! labels for latex devices (including gloves) should report the extractable latex allergen content. Limit values for extractable latex allergens should be established; the use of synthetic rubber gloves should be encouraged since some materials (e.g., neoprene and nitrile rubber) appear to have physical properties and protective efficacy similar to latex, plus good biocompatibility; more studies should be promoted to verify the protective efficacy of new synthetic materials; health care workers should be informed about the advisability and usefulness of using materials other than latex; health care services should not cause additional risks but rather highlight the advantages for workers and patients if the use of latex gloves and devices is minimized.

Background: During the eighties a large increase in latex gloves production was observed because of the high demand of gloves in health care settings. In this period a low compliance to minimal quality standard was detected and the poor glove quality was associated with an increase of both irritant and allergic glove-related diseases. Since the second half of nineties health care workers and manufacturers paid more attention to these problems and a trend to a gradual, even if slow, quality improvement was observed. Most frequently powder-free gloves and synthetic gloves were offered on the market., Objectives: The aim of this study was to highlight what has improved about materials and types of sanitary gloves during the last ten years., Methods: The information are based on a review of the scientific literature and practical experiences., Results and Conclusions: Today a large selection of gloves made of different materials are available and they should be addressed to specific tasks. The review of the scientific literature and the analysis of many technical sheets provided by the manufacturers pointed out a trend to a better latex gloves quality (less chemical additives and generally a lower total protein content); sometimes data about a lower extractable latex allergens content are also available. Unfortunately detailed information on glove composition are not usually provided by the manufacturers; purchasers should require the manufacturing company to give comprehensive information and verify their reliability. Moreover the regulation in force should be adapted to higher quality standards. Powder-free and synthetic gloves consumption has improved but the use of synthetic rubber gloves should be further enhanced since some materials (e.g. neoprene and nitrile rubber) have a good biocompatibility and seem to have physical properties and protective efficacy similar to latex. Moreover allergic reactions to synthetic gloves (some chemical additives) are only occasional.

Background: Skin and respiratory diseases and upper limb cumulative trauma disorders are common in practising hairdressers but unfortunately also in hairdressing trainees. Recent data showed that prevention by education in this working area is of fundamental importance., Objectives: The purpose of this study was to assess the knowledge that hairdressing trainees have of the risks present in their workplaces and to apply and verify, the efficacy of a specific educational programm, Methods: The programme was aimed at hairdressing trainees, aged from 15 to 21 years, attending 3 technical schools. The school training was part-time (1 day per week) and was completed in 3 years. Educational meetings were organized during the first year (154 students participated) and two years later at the end of the school training (only 83 students completed the training). The programme included a booklet and 3 self-administered questionnaires: one for the assessment of risks knowledge, work-related symptoms and preventive measures adopted, one for the assessment of long-term learning and one, after two years,for the assessment of changes in daily hairdressing practice, symptoms and preventive measures., Results: At the beginning of the school training all the trainees were working as apprentices, only 76% reported using gloves (powdered latex gloves in 90% of cases) none used respiratory protective devices, 22.7% were atopic. 39% reported work-related skin lesions, 19.5% work-related rhinitis, 5.8% work-related conjunctivitis, 0.6% asthma, 9.1% work-related low back pain and 2.6% shoulder and/or elbow pain. At the end of school training most of the trainees were performing advanced procedures such as hair-drying and cutting instead of shampooing, dyeing and perming; almost all reported using gloves during technical activities and the use of non-latex gloves and skin care products increased; the percentage of work-related skin symptoms was significantly lower but the percentage of work-related musculoskeletal disorders was significantly higher., Conclusions: At the end of school training hairdressing trainees have a better knowledge of work-related risks and the importance of their prevention. Some changes in hairdressing practice (e.g use of gloves, barrier creams, skin care products) and procedures were evident and were associated with a decrease in work-related dermatitis; in this field the efficacy of specific educational programmes is significant. Nevertheless the increase in musculoskeletal disorders, probably related to the increase in performing advanced procedures (e.g. hair drying or cutting) often characterized by unsafe postures and few rest breaks, could be reduced only if employers too are involved and informed on practical aspects of prevention since, for these risk factors, changes in workplace and work organization are required.

Background: The daily practice of Occupational Physicians in the mot industrialized countries suggests that the frequency of traditional occupational diseases is progressively lowering, their gravity is decreasing, and the etiological factors are changing. This trend should be quantitatively and qualitatively verified with ad hoc studies. The information is particularly relevant for Academic Institutions where medical students and residents in occupational medicine are trained., Objectives: To analyse the trends of clinical diagnoses and health surveillance activities conducted in the last 15 years by an Italian Institute of Occupational Health, and to gain information on the most relevant topics to be taught in academic program and to be addressed with future research., Methods: Data sources were represented by the computerised registration of a) diagnostic activities and b) health surveillance programs, conducted by the Institute of Occupational Medicine of the University of Brescia, a highly industrialized area in Northern Italy. The observation period was from 1990 to 2005. The health surveillance programs regarded workers pulled from an iron foundry, a veterinary institute, a health departments for the assistance of elderly subjects, a nursery schools and a municipal department for road maintenance., Results: Diagnostic activities were conducted on 9080 subjects, who had been referred for suspected occupational disease. The diagnosis of occupational disease was confirmed for 3759 cases. Multiple diseases were diagnosed in 1554 subjects, yielding the total number of 5721 occupational diseases. The most frequent diagnoses accounted for allergic skin disease (23.4%), followed by pneumoconiosis (20.4%), chronic obstructive pulmonary disease (15.9%), noise hearing loss (7.1%), musculoskeletal disorders (6.9%), respiratory allergies (6.9%), cancer (5.9%), miscellaneous (6.4%). When limited to the last quinquennium, the analysis showed a definite increase of muskuloskeltal disorders, cancer, and, although at a lesser extent, diseases due to psychosocial factors. The analysis of the health surveillance programs regarded 1207 workers, and showed that various non occupational diseases caused limitation to individual work fitness. The most frequent conditions were musculoskeletal disorders (65%) and skin diseases (14%)., Conclusions: The results from these two investigations are important not only for the didactic program run by the Institute, but also because they indicate the most relevant topics to be addressed with future research, at least at a local level.

Background: Occupational cardiovascular diseases do not possess any specific clinical and physiopathogenetic features., Objectives: The paper summarizes the results of the most recent studies on chemical and physical cardiovascular risks, and assesses the current degree of risk for occupational cardiovascular disease., Methods: Scientific literature and medline databases on this topic were carefully considered., Results and Conclusion: The scientific literature often provides interesting information on the cardiotoxicity of chemical and physical agents in workplaces; however, a large amount of data refers to high-dose exposures. On the contrary, nowadays exposure conditions have progressively improved and toxic concentrations in air in most cases are below the environmental threshold limit values. In workplaces multiple exposures to different cardiovascular risks, both occupational and non-occupational, are often present simultaneously and these cardiovascular diseases have not been adequately studied in comparison to other occupational organic and systemic diseases. Moreover, possible interferences between occupational cardiotoxic substances and cardiological therapy are still poorly investigated, even though such situations frequently occur.

Background: The severity of occupational asthma (OA) at the time of diagnosis is not known. In this study we aimed to evaluate some features of the disease at the time of diagnosis, particularly looking at severity and treatment before diagnosis., Methods: Medical records of subjects (n = 197) who had received a diagnosis of OA in six specialized centres of Northern and Central Italy in the period 1992-97 were reviewed. The severity of the disease at the time of diagnosis was determined on the basis of symptoms, peak expiratory flow (PEF, percentage predicted), forced expiratory volume in one second (FEV1, percentage predicted), and PEF variability, following the criteria of the National Institutes of Health and World Health Organizaton (NIH/WHO) guidelines on asthma. Medications used in the month before diagnosis were recorded., Results: The most common etiological agents were isocyanates (41.6%), flours (19.8%), woods (9.7%) and natural rubber latex (7.6%). The level of asthma severity (AS) was mild intermittent in 23.9% patients, mild persistent in 28.9%, moderate in 41.6%, and severe in 5.6%. Asthma severity was positively associated with current or previous smoking (P < 0.05), and was not related to atopy and current exposure. A relationship with bronchial reactivity to methacholine was shown in subjects at work. Treatment before diagnosis was consistent with the NIH/WHO guidelines in only 13.2% patients, whereas 75.6% were undertreated and 11.2% were overtreated., Conclusions: In this study we found that the majority of patients had mild asthma at the time of diagnosis and that cigarette smoking was associated with a greater severity. Moreover, the majority of patients were undertreated before etiological diagnosis.

There is a need for several research centers to carry out coordinated large-scale evaluation of the spread of occupational irritant and allergic dermatitis. The Occupational Health Departments of Bergamo, Brescia, Lecco and Cremona therefore decided to join their experiences and bring together all the cases of occupational irritant and allergic dermatitis diagnosed by these Departments between 1993 and 1998. In this period, 1169 cases of occupational dermatitis were diagnosed, subdivided into 768 cases of allergic contact dermatitis (ACD), 337 of irritant contact dermatitis (ICD), 54 of urticaria and 10 of airborne contact dermatitis, and there has not been a trend towards increase of occupational dermatitis over the years. Our population included 724 males and 445 females and average latency after the beginning of exposure to occupational allergens was 8.01 years for ACD, 6.4 for ICD, 3.22 for urticaria and 5.57 for airborne contact dermatitis. The frequency of atopy was 33.9%, in females and 19.5% in males. The frequency of atopy was particularly high (89%) in subjects with urticaria. Among subjects with allergic dermatitis, 362 had had only one sensitization while 406 had had two or more sensitizations. The working areas where we found the highest number of ACD were metal working industry, building, health care workers and hairdressers and the frequency of ICD was high in metal workers and health care workers. Most of the cases of urticaria were diagnosed in health care workers (68.5%) and the main causing agent was latex. These are only preliminary data but occupations at risk and the substances expected to be the most frequent etiological agents do not differ significantly from those reported in the literature. It is hoped that as a result of this project there will be in the future: standardization of diagnostic procedures, uniform assessment of allergological risk in working environments not yet fully investigated, standardization of preventative measures and proper evaluation of their effectiveness.

There are few data on the frequency of occupational allergic dermatitis in the context of occupational diseases and there is a need for coordinated large-scale studies to compare the experiences of different Occupational Health Departments involved in the surveillance of allergic occupational diseases. Therefore 6 Occupational Health Departments of Northern Italy (Bergamo, Brescia, Cremona, Desio, Lecco and Milano-CEMOC) decided to bring together all the cases of occupational allergic dermatitis diagnosed between 1993 and 1998. In this report the main characteristics of these 961 allergic dermatitis (888 allergic contact dermatitis, 63 urticaria and 10 airborne contact dermatitis), the possible correlations with gender, age, length of employment, atopy and the occupations at high risk of acquiring allergic dermatitis have been described.

Turpentine appears to be associated with a high frequency of concomitant allergies. Researcher R. Treudler and colleagues have reported a contact allergy to MCI/MI in 9.5 percent of turpentine-positive patients compared to 23 percent in turpentine-negative patients. MCI/MI is used as a preservative and biocide in cosmetic and industrial products such as latex emulsions. This article reports on a case of allergic contact dermatitis of the hands in an oil painter. The A 43-year-old man reacted to turpentine as well as to epoxy resin in varnish. He had no personal history of atopy, who had been working in a cheese factory for 12 years, complained of about 4 months of itchy erythema on the hands and forearms and then on the thighs and abdomen.

Describes cases of allergy to pectinase among factory workers. Clinical manifestations; Diagnostic results; Treatment regimen.