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Advances in the treatment and management of cystic fibrosis (CF) have led to a substantial increase in patient life expectancy, thus facilitating healthier lives and labour force participation. This review aimed to address the impact of CF on the occupational functioning of patients. A significant proportion of patients were reported to retain a job on a full- or part-time schedule. Less physically demanding occupations were most frequently performed, perhaps due to CF-related inability to sustain a heavy workload. Disease severity parameters (e.g., lung function measurements, or personal, psycho-social, or economic conditions) have been reported as determinant or co-determinant factors for the development of work-related disability. Although further research is necessary, our results may be useful to inform interdisciplinary CF healthcare management, including the assessment of work function, and to define career counselling plans and workplace risk assessment and management strategies to support the personal, social and professional lives of patients.

Within the EU human biomonitoring initiative (HBM4EU), a targeted, multi-national study on occupational exposure to hexavalent chromium (Cr(VI)) was performed. Cr(VI) is currently regulated in EU under REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) and under occupational safety and health (OSH) legislation. It has recently been subject to regulatory actions to improve its risk management in European workplaces. Analysis of the data obtained within the HBM4EU chromates study provides support both for the implementation of these regulatory actions and for national enforcement programs and may also contribute to the updating of occupational limit values (OELs) and biological limit values for Cr(VI). It also provides useful insights on the contribution of different risk management measures (RMMs) to further reduce the exposure to Cr(VI) and may support the evaluation of applications for authorisation under REACH. Findings on chrome platers’ additional per- and polyfluoroalkyl substances (PFAS) exposure highlight the need to also pay attention to this substance group in the metals sector. A survey performed to evaluate the policy relevance of the HBM4EU chromates study findings supports the usefulness of the study results. According to the responses received from the survey, the HBM4EU chromates study was able to demonstrate the added value of the human biomonitoring (HBM) approach in assessment and management of occupational exposure to Cr(VI). For future occupational studies, we emphasise the need for engagement of policy makers and regulators throughout the whole research process to ensure awareness, relevance and uptake of the results in future policies. Highlights: Potential policy impact of the HBM4EU chromates study is presented and discussed; Surveyed policy makers confirmed policy relevance of biomonitoring results; Study considered to support national enforcement and further lowering of OELs; Added value of HBM in the management of occupational exposure to Cr(VI) was demonstrated; Close co-operation with regulators to support policy uptake is emphasised. Funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No 733032 and received co-funding from the author's organizations and/or Ministries. info:eu-repo/semantics/publishedVersion

Background: Several studies showed important differences in the interpretation of spirometry based on different reference values, in particular by comparing European Respiratory Society (ERS) 1993 and Global Lung Function Initiative (GLI) 2012. The validation of new reference values in local populations is essential before they can be used in an appropriate manner. This study aimed to investigate the fit of GLI reference values in a healthy Italian working population. Methods: Spirometry data were collected in 1355 workers during their health surveillance medical examination conducted for exposure to chemical and biological risk factors. A single portable spirometer that met the ATS/ERS recommendations for occupational testing was used and calibrated daily. Results: Average z-score were −0.13 (with a median of −0.17), −0.25 (with a median of −0.24), and 0.18 (with a median of 0.17) for FEV1, FVC, and FEV1/FVC ratio, respectively. Considering only the normal-weighted workers, the average z-scores were −0.07 (with a median of −0.16), −0.15 (with a median of −0.16), and 0.07 (with a median of 0.02) for FEV1, FVC, and FEV1/FVC ratio, respectively. Conclusions: GLI 2012 reference values fit the Italian data satisfactorily, resulting as more accurate than ERS 1993, especially in women, normal-weighted subjects, aged 30−50 years, and for height < 165 cm.

In the present study, surface contamination where antineoplastic drugs (ADs) are present was investigated, as occupational exposure risk is still an open debate. Despite recommendations and safety standard procedures being in place in health care settings, quantifiable levels of ADs are being reported in the recent literature. Thus, a survey monitoring program was conducted over five years (2016–2021) in nine Italian hospitals. The repeated surveys produced 8288 data points that have been grouped according to the main hospital settings, such as pharmacy areas and patient care units. Based on the most often prepared ADs, the investigated drugs were cyclophosphamide (CP), gemcitabine (GEM), 5-fluorouracil (5–FU), and platinum compounds (Pt). Patient care units had a frequency of positive wipe samples (59%) higher than pharmacies (44%). Conversely, pharmacies had a frequency of positive pad samples higher (24%) than patient care units (10%). Moreover, by statistical analysis, pad samples had a significantly higher risk of contamination in pharmacy areas than in patient care units. In this study, the 75th and the 90th percentiles of the contamination levels were obtained. The 90th percentile was chosen to describe a suitable benchmark that compares results obtained by the present research with those previously reported in the literature. Based upon surface contamination loads, our data showed that 5–FU had the highest concentration values, but the lowest frequency of positive samples. In pharmacy areas, the 90th percentile of 5–FU data distribution was less than 0.346 ng/cm2 and less than 0.443 ng/cm2 in patient care units. AD levels are higher than those reported for health care settings in other European countries yet trends of contamination in Italy have shown to decrease over time.

The widespread application of additive manufacturing (AM) technologies, commonly known as three-dimensional (3D) printing, in industrial and home-business sectors, and the expected increase in the number of workers and consumers that use these devices, have raised concerns regarding the possible health implications of 3D printing emissions. To inform the risk assessment and management processes, this review evaluates available data concerning exposure assessment in AM workplaces and possible effects of 3D printing emissions on humans identified through in vivo and in vitro models in order to inform risk assessment and management processes. Peer-reviewed literature was identified in Pubmed, Scopus, and ISI Web of Science databases. The literature demonstrated that a significant fraction of the particles released during 3D printing could be in the ultrafine size range. Depending upon the additive material composition, increased levels of metals and volatile organic compounds could be detected during AM operations, compared with background levels. AM phases, specific job tasks performed, and preventive measures adopted may all affect exposure levels. Regarding possible health effects, printer emissions were preliminary reported to affect the respiratory system of involved workers. The limited number of workplace studies, together with the great variety of AM techniques and additive materials employed, limit generalizability of exposure features. Therefore, greater scientific efforts should be focused at understanding sources, magnitudes, and possible health effects of exposures to develop suitable processes for occupational risk assessment and management of AM technologies.

Background: The widespread application of engineered nanomaterials (ENMs) and the increasing likelihood of general and occupational exposure raised concerns on their possible human health impact. ENMs, in fact, may induce alterations in different organ systems, and particularly in the respiratory tract. This makes it important to identify possible biomarkers of early lung effect in exposed workers. In this regard, the possibility to use the fractional exhaled levels of nitric oxide (FENO) in biological monitoring has attracted considerable interest. Objective: To comprehensively assess the role of FENO as a possible biomarker of lung effect in ENM exposed workers. Methods: A systematic search was performed on Pubmed, Scopus, and ISI Web of Knowledge databases according to the PRISMA guidelines. Results: Seven studies investigated FENO in workers exposed to different kinds of metal-(i.e. silver and gold), metal oxide- (titanium and silica dioxide), and carbon-based ENMs (carbon nanotubes). In general, no significant alterations were detected between exposed workers and controls. Conclusions: Definite conclusion on the function of FENO in occupational biological monitoring cannot be extrapolated due to the limited number of available studies and the small size of investigated populations. Additionally, the lack of environmental monitoring data and the fragmented knowledge on ENM modes of action prevent to establish dose-response relationships. Future research appears necessary to deeply define the possibility to employ FENO as an early biomarker of lung effects taking in consideration possible occupational exposure issues, i.e. differently characterized ENMs and work tasks, as well as individual influencing factors, i.e. smoking and atopy.

The high toxicity of antineoplastic drugs (ADs) makes them dangerous not only for patients, but also for exposed workers. Therefore, the aim of this review was to provide an updated overview of the biological monitoring of occupational AD exposure in order to extrapolate information useful to improve risk assessment and management strategies in workplaces. Several studies demonstrated that remarkable portions of healthcare workers may have traces of these substances or their metabolites in biological fluids, although with some conflicting results. Nurses, directly engaged in AD handling, were the occupational category at higher risk of contamination, although, in some cases, personnel not involved in AD-related tasks also showed quantifiable internal doses. Overall, further research carried out on greater sample sizes appears necessary to gain deeper insight into the variability retrieved in the reported results. This may be important to understand the impact of the extent of ADs use, different handling, procedures, and cleaning practices, spill occurrence, training of the workforce, as well as the adoption of adequate collective and personal protective equipment in affecting the occupational exposure levels. This may support the achievement of the greatest clinical efficiency of such therapies while assuring the health and safety of involved workers.

Regulatory frameworks to control chemical exposure in general living and occupational environments have changed exposure scenarios towards a widely spread contamination at relatively low doses in developed countries. In such evolving context, some critical aspects should be considered to update risk assessment and management strategies. Risk assessment in low-dose chemical exposure scenarios should take advantage of: toxicological investigations on emerging substances of interest, like those recognised as endocrine disruptors or increasingly employed nanoscale materials; human biological monitoring studies aimed to identify innovative biomarkers for known chemical exposure; "omic" technologies useful to identify hazards of chemicals and their modes of action. For updated risk assessment models, suitable toxicological studies, analyses of dose-responses at low-concentrations, environmental and biological monitoring of exposure, together with exposome studies, and the proper definition of susceptible populations may all provide helpful contributions. These may guide defining preventive measures to control the exposure and develop safe and sustainable chemicals by design. Occupational medicine can offer know-how and instruments to understand and manage such evolution towards a toxic-free environment to protect the safety and health of the workforce and, in turn, that of the general population.

In welding, there is a potential risk due to metal-oxide nanoparticles (MONPs) exposure of workers. To investigate this possibility, the diameter and number particles concentration of MONPs were evaluated in different biological matrices and in personal air samples collected from 18 stainless-steel welders and 15 unexposed administrative employees engaged in two Italian mechanical engineering Companies. Exhaled breath condensate (EBC) and urine were sampled at pre-shift on 1st day and post-shift on 5th day of the workweek, while plasma and inhalable particulate matter (IPM) at post-shift on 5th day and analysed using the Single Particle Mass Spectrometry (SP-ICP-MS) technique to assess possible exposure to Cr2O3, Mn3O4 and NiO nanoparticles (NPs) in welders. The NPs in IPM at both Companies presented a multi-oxide composition consisting of Cr2O3 (median, 871,574 particles/m3; 70 nm), Mn3O4 (median, 713,481 particles/m3; 92 nm) and NiO (median, 369,324 particles/m3; 55 nm). The EBC of welders at both Companies showed Cr2O3 NPs median concentration significantly higher at post-shift (64,645 particles/mL; 55 nm) than at pre-shift (15,836 particles/mL; 58 nm). Significantly lower Cr2O3 NPs median concentration and size (7762 particles/mL; 44 nm) were observed in plasma compared to EBC of welders. At one Company, NiO NPs median concentration in EBC (22,000 particles/mL; 65 nm) and plasma (8248 particles/mL; 37 nm) were detected only at post-shift. No particles of Cr2O3, Mn3O4 and NiO were detected in urine of welders at both Companies. The combined analyses of biological matrices and air samples were a valid approach to investigate both internal and external exposure of welding workers to MONPs. Overall, results may inform suitable risk assessment and management procedures in welding operations.

Improvements in the survival and clinical outcomes of cystic fibrosis (CF) patients raised questions about their workforce participation and capacity to work. One hundred and ninety-six outpatients, attending the Adult CF Center of an Italian University Hospital, were enrolled between May 2020 and March 2021. The patients’ personal and clinical characteristics, employment status, and profession were assessed. The Cystic Fibrosis Questionnaire—Revised and the work ability index (WAI) were employed to assess CF health-related quality of life and the employee’s perception of their ability to work, respectively. Among the enrolled patients, 98 (50%) were employed. The non-working subjects were significantly younger (mean age ± standard deviation: 30 ± 10 vs. 37 ± 10 years) and were diagnosed with CF significantly earlier (9 ± 13 vs. 17 ± 18 years) than the employed subjects. The vast majority of CF workers (82.6%) were employed in tertiary professions. A general good work ability perception was determined in the employed population. Aging and being employed for &gt, 15 years could significantly predict a reduction in work ability, while a better quality of life was a positive predictor for its enhancement. Although further research is necessary, these results may introduce interdisciplinary CF healthcare management that includes a work function assessment, formal career counseling, and job guidance to support the personal, social and professional lives of CF patients.

Background: The aim of the present study was to evaluate the psychological well-being (PWB) during the coronavirus disease (COVID-19) pandemic in workers of a multinational company. Methods: Employees (aged ≥ 18 years) were recruited from Latin American, North American, New Zealand and European sites of a multinational company operative during all the pandemic period. The self-reported Psychological General Well Being Index (PGWBI) was employed to assess the global PWB and the effects on 6 sub-domains: anxiety, depressed mood, positive well-being, self-control, general health and vitality. The influencing role of age, gender, geographical location, COVID-19 epidemiology, and restrictive measures adopted to control the pandemic was explored. Results: A total of 1335 workers completed the survey. The aggregate median PWB global score was in a positive range, with significantly better outcomes detected in the Mexican and Colombian Latin American sites compared to the other worldwide countries (p

Exposure to hexavalent chromium [Cr(VI)] may occur in several occupational activities, e.g., welding, Cr(VI) electroplating and other surface treatment processes. The aim of this study was to provide EU relevant data on occupational Cr(VI) exposure to support the regulatory risk assessment and decision-making. In addition, the capability and validity of different biomarkers for the assessment of Cr(VI) exposure were evaluated. The study involved nine European countries and involved 399 workers in different industry sectors with exposures to Cr(VI) such as welding, bath plating, applying or removing paint and other tasks. We also studied 203 controls to establish a background in workers with no direct exposure to Cr(VI). We applied a cross-sectional study design and used chromium in urine as the primary biomonitoring method for Cr(VI) exposure. Additionally, we studied the use of red blood cells (RBC) and exhaled breath condensate (EBC) for biomonitoring of exposure to Cr(VI). Personal measurements were used to study exposure to inhalable and respirable Cr(VI) by personal air sampling. Dermal exposure was studied by taking hand wipe samples. The highest internal exposures were observed in the use of Cr(VI) in electrolytic bath plating. In stainless steel welding the internal Cr exposure was clearly lower when compared to plating activities. We observed a high correlation between chromium urinary levels and air Cr(VI) or dermal total Cr exposure. Urinary chromium showed its value as a first approach for the assessment of total, internal exposure. Correlations between urinary chromium and Cr(VI) in EBC and Cr in RBC were low, probably due to differences in kinetics and indicating that these biomonitoring approaches may not be interchangeable but rather complementary. This study showed that occupational biomonitoring studies can be conducted successfully by multi-national collaboration and provide relevant information to support policy actions aiming to reduce occupational exposure to chemicals. This work has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 733032 and received co-funding from the author's organizations and/or Ministries. Luxembourg entered the study at a later stage and thus financed the study at its own means. Sí

Background: Noise-induced hearing loss (NIHL) is one of the leading causes of acquired sensorineural hearing loss. However, molecular mechanisms responsible for its pathogenesis remain to be elucidated. Epigenetic changes, i.e. DNA methylation, histone and microRNA expression modifications may function as a link between noise exposure and hearing loss. Therefore, the aim of the present review was to assess whether epigenetic alterations may serve as biomarkers of noise exposure or early effect. Materials and Methods: A systematic review of studies available in Pubmed, Scopus, and ISI Web of Science databases was performed. Results: Noise exposure was able to induce alterations in DNA methylation levels in workers and animal models, resulting in expression changes of genes related to hearing loss and also to extra-auditory effects. Differently expressed microRNAs were determined in NIHL workers compared to noise-exposed subjects with normal hearing, supporting their possible role as biomarkers of effect. Acoustic trauma affected histon acethylation and methylation levels in animals, suggesting their influence in the pathogenesis of acute noise-induced damage and their role as targets for potential therapeutic treatments. Conclusions: Although preliminary data suggest a relationship between noise and epigenetic effects, the limited number of studies, their different methodologies and the lack of adequate characterization of acoustic insults prevent definite conclusions. In this context, further research aimed to define the epigenetic impact of workplace noise exposure and the role of such alterations in predicting hearing loss may be important for the adoption of correct risk assessment and management strategies in occupational settings.

Bisphenol A (BPA) and its substitutes bisphenol S (BPS) and bisphenol F (BPF) are endocrine disrupting chemicals widely used in the production of polycarbonate plastics, epoxy resins and thermal papers. The aim of the review was to identify occupational studies using human biomonitoring (HBM) as a tool for bisphenol exposure assessment and to characterize research gaps on the topic as part of the HBM4EU project. Hence, a systematic literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was conducted for articles published between 2000 and 27th March 2020 across three databases (PubMed, Scopus and Web of Science). Thirty studies on the occupational HBM of BPA met the inclusion criteria. Regarding BPS and BPF, only 4 and 2 publications were retrieved, respectively. Fifty-seven percent (57%) of the studies selected for BPA were conducted in Asia whereas half of BPS and BPF studies were undertaken in Europe. Studies on BPA in plastic and epoxy resin sectors were infrequent in Europe while Asian data showed higher exposure when the substance is employed as raw material. The main data on BPS were among cashiers while BPF data were available from incinerator workers. Several research gaps have been identified: (i) shortage of HBM studies on occupational exposure, especially to BPS and BPF; (ii) different methodological designs making suitable comparisons between studies difficult; and (iii) only few studies conducted on the industrial applications of bisphenols outside Asia. This review highlights the lack of recent occupational HBM studies on bisphenols and the need for a harmonized approach to acquire reliable data. Considering the increasing replacement of BPA by BPS and BPF, it is of relevance to evaluate the exposure to these substances and the impact of the available risk management measures on workers exposure and possible health risk.

In the current coronavirus (COVID-19) pandemic, the definition of risk factors for susceptibility to adverse outcomes seems essential to support public and occupational health policies. Some specific issues need to be addressed to understand vulnerability in occupational settings. Among these, individual factors, e.g., age, sex, and preexisting comorbidities (hypertension, cardiovascular diseases, diabetes, obesity, cancer), that can predispose individuals to more severe outcomes and post-COVID-19 symptoms that may represent conditions of acquired susceptibility, possibly impacting the return to—and fitness for—work. Additionally, the risk of contracting COVID-19 through work should be addressed, considering the probability of being in contact with infected people, physical proximity to others, and social aggregation during work. Occupational health settings may represent appropriate scenarios for the early identification of vulnerable subjects, with the final aim to guide risk assessment and management procedures. These should include the systematic surveillance of work-related risk factors, collective preventive policies, stringent actions for specific groups of workers, decisions on occupational placement of employees, and health promotion activities. Concerted actions of general practitioners, hospital specialists, occupational physicians, and all the stakeholders involved in the occupational health and safety management should be focused on planning suitable preventive measures for susceptible subjects.

Hypertensive disorders in pregnancy (HDP), including gestational hypertension (GH) and preeclampsia (PE), characterize a major cause of maternal and prenatal morbidity and mortality. In this systematic review, we tested the hypothesis that occupational factors would impact the risk for HDP in pregnant workers. MEDLINE, Scopus, and Web of Knowledge databases were searched for studies published between database inception and 1 April 2021. All observational studies enrolling > 10 pregnant workers and published in English were included. Un-experimental, non-occupational human studies were excluded. Evidence was synthesized according to the risk for HDP development in employed women, eventually exposed to chemical, physical, biological and organizational risk factors. The evidence quality was assessed through the Newcastle–Ottawa scale. Out of 745 records identified, 27 were eligible. No definite conclusions could be extrapolated for the majority of the examined risk factors, while more homogenous data supported positive associations between job-strain and HDP risk. Limitations due to the lack of suitable characterizations of workplace exposure (i.e., doses, length, co-exposures) and possible interplay with personal issues should be deeply addressed. This may be helpful to better assess occupational risks for pregnant women and plan adequate measures of control to protect their health and that of their children.

Multicenter Study The EU human biomonitoring initiative, HBM4EU, aims to co-ordinate and advance human biomonitoring (HBM) across Europe. As part of HBM4EU, we presented a protocol for a multicentre study to characterize occupational exposure to hexavalent chromium (Cr(VI)) in nine European countries (HBM4EU chromates study). This study intended to collect data on current occupational exposure and to test new indicators for chromium (Cr) biomonitoring (Cr(VI) in exhaled breath condensate and Cr in red blood cells), in addition to traditional urinary total Cr analyses. Also, data from occupational hygiene samples and biomarkers of early biological effects, including genetic and epigenetic effects, was obtained, complementing the biomonitoring information. Data collection and analysis was completed, with the project findings being made separately available. As HBM4EU prepares to embark on further European wide biomonitoring studies, we considered it important to reflect on the experiences gained through our harmonised approach. Several practical aspects are highlighted for improvement in future studies, e.g., more thorough/earlier training on the implementation of standard operating procedures for field researchers, training on the use of the data entry template, as well as improved company communications. The HBM4EU chromates study team considered that the study had successfully demonstrated the feasibility of conducting a harmonised multicentre investigation able to achieve the research aims and objectives. This was largely attributable to the engaged multidisciplinary network, committed to deliver clearly understood goals. Such networks take time and investment to develop, but are priceless in terms of their ability to deliver and facilitate knowledge sharing and collaboration. Highlights: Feasibility of conducting harmonised Pan-European biomonitoring study on occupational exposure demonstrated; Developing a successful network and implementation of systematic methodology takes significant dedication from all involved; Methodological improvements were identified which will benefit future large-scale occupational biomonitoring campaigns; Developed multicentre network allows and promotes further opportunities for future research, knowledge sharing and collaboration; Data produced supports science to policy interface in the scope of REACH and occupational safety and health regulations. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 733032 and received co-funding from the author’s organizations and/or Ministries. info:eu-repo/semantics/publishedVersion

Various decontamination methods that may be used to extend respirator inventories have been examined for over a decade. In light of the ongoing coronavirus disease 2019 pandemic, many health-care settings are now implementing these techniques amid respirator shortages. We sought to perform a critical review of the available literature regarding decontamination methods to determine which strategies are effective at inactivating the target organism, preserve performance (filter efficiency and fit) of the respirator, leave no residual toxicity from the treatment, and are fast-acting, inexpensive, and readily available. We also identified areas for future research. We found that ultraviolet germicidal irradiation (UVGI) is the most widely studied method, and treatments are effective at inactivating SARS-CoV-2 without diminishing filtration efficiency or fit. These treatments were found to leave no residual toxicity for the wearer, have a relatively short cycle time of less than 1 h, and existing systems can likely be retrofitted to accommodate this method. Further, UVGI (among other treatment methods) has been recommended by the Centers for Disease Control and Prevention (CDC), Occupational Safety and Health Administration (OSHA), and respirator manufacturers. Methods involving microwave-generated steam also show potential in that they are likely effective against SARS-CoV-2, preserve performance, have no residual toxicity, require a short duration treatment cycle (often less than 10 min), and microwave ovens are inexpensive and readily available. Steam methods are currently recommended by the CDC, OSHA, and manufacturers. These respirator decontamination methods are likely also useful against other viruses or pathogens. © The Author(s) 2020.

Background The aetiology of Parkinson’s disease (PD) is still very controversial, with a peculiar lack of established risk factors or protective behavior. Methods We carried out a case–control study of 634 idiopathic PD patients admitted from 2011 to 2015 to two hospitals located in central Italy and 532 controls matched by hospital, gender and age (± 5 years). The study questionnaire included questions on host factors, family history, residence, occupation and lifestyle. Odds ratios (ORs) for PD and 95% confidence intervals (CIs) were estimated with logistic regression, adjusting for actual and potential confounders. Results A lower OR was observed in females (0.74; 95%CI:0.58–0.96), while older age classes showed a constantly increased risk for PD (p Conclusions The results from this study confirmed the higher risk of PD in males and in elderly, and the inverse association with smoking habit. The possible etiological role of familial clustering, dietary habit, and some job tasks is suggested.

Thyroid diseases are characterized by a wide range of physical and mental symptoms that can affect biological function, emotional and social life of patients. However, their impact on work functioning is not yet fully understood. Therefore, this review aims to address the way in which thyroid diseases can affect occupational outcomes, i.e., the employment rate, sick leave, working capacity and work income of patients. A systematic review of Pubmed, Scopus and ISI Web of Knowledge databases has been performed. Although it is not possible to extrapolate precise data for benign pathologies, about a third of the survivors of thyroid cancer could be unemployed. Hyperthyroid and hypothyroid patients presented a greater risk of long-term sick leave than controls, depending on the severity of the disease. Hyperthyroidism impaired working ability in about a third of affected patients, particularly in cases complicated by orbitopathy with diplopia. A possible influence of thyroid diseases on various occupational outcomes emerged from our review, however further research seems necessary to understand the relationship between work problems, specific pathological characteristics over time and risk factors in the workplace. This may support a comprehensive, interdisciplinary management of thyroid disorders, with benefits for patients’ personal, social and professional life.

Purpose To evaluate the possible role of occupational low dose ionizing radiation exposure in increasing the healthcare workers’ risk of thyroid functional alterations. Methods 120 healthcare workers exposed to ionizing radiation (60 belonging to category A with a potential exposure to an annual dose between 6 and 20 mSv and 60 to category B potentially exposed to an annual dose between 1 and 6 mSv) were compared with a control group consisting of 60 unexposed healthcare subjects assessing serum levels of different thyroid function parameters as free triiodothyronine, free thyroxine, thyroid stimulating hormone and thyroid autoantibodies. Age, gender, history of thyroid diseases, job task, dosimetric values were analysed as possible influencing factors using linear and multiple logistic regression analysis. Results Exposed workers showed significantly higher average levels of thyroid stimulating hormone, and lower average levels of free triiodothyronine and free thyroxine than non-exposed workers, although nonsignificant differences were observed between the two different exposure categories. According to the values of the thyroid hormones a condition of hypothyroidism has been considered in 11 exposed workers (9.2 %) and interestingly this clinical condition was significantly associated with ionizing radiation exposure. Conclusions Low dose ionizing radiation exposure would seem to significantly influence levels of free triiodothyronine, free thyroxine, thyroid stimulating hormone, then suggesting a possible increased risk of hypothyroidism in healthcare workers although no relationship could be determined with exposure category. However, further studies are necessary to confirm such association on greater number of workers in order also to define a possible dose-response relationship.

Formaldehyde (FA) is a general living and occupational pollutant, classified as carcinogenic for humans. Although genotoxicity is recognized as a FA mechanism of action, a potential contribution of epigenetic effects cannot be excluded. Therefore, aim of this review is to comprehensively assess possible epigenetic alterations induced by FA exposure in humans, animals, and cellular models. A systematic review of Pubmed, Scopus, and Isi Web of Science databases was performed. DNA global methylation changes were demonstrated in workers exposed to FA, and also in human bronchial cells. Histone alterations, i.e., the reduction in acetylation of histone lysine residues, in human lung cells were induced by FA. Moreover, a dysregulation of microRNA expression in human lung adenocarcinoma cells as well as in the nose, olfactory bulb and white blood cells of rodents and nonhuman primates was reported. Although preliminary, these findings suggest the role of epigenetic modifications as possible FA mechanisms of action that need deeper qualitative and quantitative investigation. This may allow to define the role of such alterations as indicators of early biological effect and the opportunity to include such information in future risk assessment and management strategies for public and occupationally FA-exposed populations.

Introduction: Spirometry is the main pulmonary function test routinely employed in the occupational medicine practice. Its interpretation depends on the choice of the theoretical reference values. Therefore, our objective was to retrospectively evaluate the differences in the spirometric interpretation according to the reference values used. Methods: A total of 2462 spirometries performed during health surveillance programs were analyzed. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC ratio were compared according to three different reference values: the European Coal and Steel Community (ECSC) 1971, the European Respiratory Society (ERS) 1993, and the Global Lung Initiative (GLI) 2012. Results: The GLI 2012 provided significantly higher predicted mean FVC and FEV1 values compared to the ERS 1993 and significantly lower compared to the ECSC 1971. The GLI 2012 were able to detect all the obstructive deficits and mixed patterns diagnosed with ECSC 1971 and ERS 1993, in addition to others not diagnosed by these two latter reference values. The number of restrictive patterns identified through the GLI 2012 was significantly reduced and increased compared to those diagnosed using the ECSC 1971 and the ERS 1993, respectively. Discussion: In comparison to the GLI 2012, the ERS 1993 values significantly underestimated obstructive and restrictive alterations. Conversely, the ECSC 1971 significantly underestimated obstructive changes, while overestimated restrictive patterns, compared to GLI. Although the GLI reference values may provide a correct spirometric interpretation, their validation in an Italian worker population is necessary to confirm their possible use in routine occupational health programs.

Background: Hexachlorocyclohexane (HCH) isomers have been largely employed as pesticides during the 1960's-1970's, and included into the Stockholm Convention persistent organic pollutant list in 2009 with the aim to reach their global elimination. beta-HCH isomer is characterized by a strong lipophilicity, bio-persistence and potential harmful properties for human health. Dispersion of industrial processes and uncontrolled waste storage caused a global environmental beta-HCH contamination. This still represents a public and occupational health concern, not only for past-exposed subjects, but also for the populations that may still be exposed to highly polluted environmental matrices and food. Objective: To provide a critical overview of the existing evidence exploring beta-HCH biomonitoring data and possible health effects in workers involved in the production and use of such compound. Methods: A systematic search and revision of available literature was performed in Pubmed, Scopus, and ISI Web of Science databases. Results: Conclusive evidence concerning the possible dose-response relationship in beta-HCH occupational settings cannot be extrapolated due to the heterogeneity in explored contexts, and the lack of information on environmental conditions and levels of exposure. Nevertheless, biomonitoring data support the need for a deeper understanding of the toxico-kinetic and dynamic profile of the substance, once absorbed into the organism, and possible early alterations in endocrine signaling. Conclusion: The potential toxicity, bioaccumulation and bio-magnification properties of beta-HCH make necessary to plan preventive actions aimed to manage the beta-HCH risk, through the reduction of exposure levels and the definition of health surveillance programs, including biological monitoring investigations, for the general and occupational exposed populations.

"Sterile inflammation" is a type of pathogen-free inflammation which may be induced by various physical, chemical, or metabolic insults, including environmental particles e.g. silica dioxide crystals and asbestos. The possible role of nanomaterials as danger signals able to trigger sterile inflammatory responses is not yet fully understood. Therefore, the aim of this review was to investigate conditions of sterile inflammation induced by nanomaterial exposure with a specific focus on possible modes of action. Metal-, metal-oxide- and carbon-based nanomaterials may trigger a sterile inflammatory cascade by means of different damage-associated molecular patterns, including chromatin associated protein high-mobility group box-1 secretion, ATP, ADP and adenosine purinergic signaling, interleukin-1α alarmin, and NLPR-3 inflammasome activation. However, such preliminary results do not enable us to draw definite conclusions regarding the sterile inflammatory potential of nanomaterials and possible underlying molecular mechanisms. Therefore, further research is required to understand the complex "interplay" between the multitude of nanomaterial intrinsic or acquired physico-chemical properties and the extremely changeable immunological competence of organisms. The identification of possible nanomaterial modes of action in sterile inflammation could provide early indicators of the biological reactivity of nano-sized chemicals and could direct "safe by design" efforts for improving occupational safety and that of the general population. Moreover, the possible pathological consequences of nanomaterial-induced sterile inflammatory reactions need to be clarified in order to define suitable preventive measures to protect the health of chronically exposed subjects.

Objectives Migraine is a chronic neurological disorder characterized by recurrent attacks of headache, mainly affecting the working age population with a great socioeconomic impact. The etiology of migraine is still uncertain, and various individual and/or environmental risk factors have been suggested as triggers of the attacks, including irregularities in the sleep‐wake rhythm. In this perspective, it is possible that shift and night work, affecting circadian rhythms, may play a key function in the disease pathogenesis. Therefore, aim of this review was to provide an overview on the possible association between shift works and migraine development or clinical outcomes. Methods A systematic review of literature studies available in Pubmed, Scopus, and ISI Web of Science databases, addressing the possible shift work‐migraine relationship was performed. Results Conflicting data emerged from the revised studies. Some results supported a positive association between migraine prevalence and shift works, according to peculiar job tasks, seniority in shift works, specific work schedules, and number of night shifts performed in a month. However, other investigations failed to confirm such findings. Conclusions The limited number of available studies, their cross‐sectional nature, the different criteria employed for migraine diagnosis, and the various shift work schedules analyzed, together with exposure to other confounding factors on workplace do not allow to extrapolate definite conclusions on shift work‐migraine relationship. From an occupational health perspective, further studies appear necessary to better understand such exposure‐disease association and possibly define risk assessment and management strategies to protect the health of susceptible and/or migraine affected workers.

Nanotechnology may offer innovative solutions to overcome the physiological and anatomical barriers that make the diagnosis and treatment of ear diseases an extremely challenging issue. However, despite the solutions provided by nano-applications, the still little-known toxicological behavior of nanomaterials raised scientific concerns regarding their biosafety for treated patients and exposed workers. Therefore, this review provides an overview on recent developments and upcoming opportunities in nanoscale otological applications, and critically assesses possible adverse effects of nanosized compounds on ear structures and hearing functionality. Although such preliminary data do not allow to draw definite strategies for the evaluation of nanomaterial ototoxicity, they can still be useful to improve scientific community and workforce awareness regarding possible nanomaterial adverse effects on ear.

The widespread industrial application of nanotechnology has increased the number of workers exposed to engineered nanomaterials (ENMs), but it is not clear to what extent prevention guidance is practiced. Our aim was to explore the extent that companies manufacturing and/or using ENMs apply risk assessment and management measures. Thirty-four companies were surveyed with an international 35-item questionnaire investigating company and workforce features, types of ENM handled, and risk evaluation and preventive measures adopted. Among participating companies, 62% had a maximum of 10 employees. Metal-based nanomaterials were most frequently identified (73%). Environmental monitoring was performed by 41% of the companies, while engineering exposure controls were approximately reported by 50%. Information and training programs were indicated by 85% of the sample, only 9% performed specific health surveillance for ENM workers. Personal protective equipment primarily included gloves (100%) and eye/face protection (94%). This small-scale assessment can contribute to the limited amount of published literature on the topic. Future investigations should include a greater number of companies to better represent ENM workplaces and a direct access to industrial settings to collect information on site. Finally, deeper attention should be paid to define standardized frameworks for ENM risk assessment that may guide nano-specific preventive actions.