Alberto Modenese

The European Status Quo in legal recognition and patient-care services of occupational skin cancer

Skin cancer is the most common malignancy in Caucasian populations worldwide and ultraviolet radiation (UVR) is known for being the number one carcinogen. As, especially in outdoor workers, UVR is an inevitable carcinogen, the prevention and management of UVR‐related skin cancers in these at‐risk populations represent a collective challenge for dermatologists and healthcare policymakers likewise.

Work-Related Eye Injuries: A Relevant Health Problem. Main Epidemiological Data from a Highly-Industrialized Area of Northern Italy

The province of Modena is one of the most industrialized areas of Northern Italy. The medical records of the Ophthalmological Emergency Department (OED) of Modena University Hospital were studied: there were 13,470 OED accesses in 2014 and in 754 cases that an occupational eye injury occurred. The frequency of work-related eye injuries (3‰) was lower compared to other published studies, but the absolute number is still relevant, showing the need for more adequate prevention, especially in metal work, construction work, and agriculture, where the worst prognoses were observed. Intervention programs must be implemented as early as possible in the working life, considering that the frequency in younger workers is about double that of the oldest age class (3.5‰ vs. 1.8‰), and special attention should also be given to foreigners, who have a 50% higher injury risk. Furthermore, the planning of specific interventions for eye-injured workers may be useful, considering that a previous injury does not appear to encourage the adoption of preventive interventions, and a subgroup of eye-injured workers have a potential risk for new injuries. Finally, the data presented here indicates how OED records, integrated with specific occupational information, can be applied for studies on work-related eye injuries.

Outdoor work and solar radiation exposure: Evaluation method for epidemiological studies

BACKGROUND The health risk related to an excessive exposure to solar radiation (SR) is well known. The Sun represents the main exposure source for all the frequency bands of optical radiation, that is the part of the electromagnetic spectrum ranging between 100 nm and 1 mm, including infrared (IR), ultraviolet (UV) and visible radiation. According to recent studies, outdoor workers have a relevant exposure to SR but few studies available in scientific literature have attempted to retrace a detailed history of individual exposure. MATERIAL AND METHODS We propose a new method for the evaluation of SR cumulative exposure both during work and leisure time, integrating subjective and objective data. The former is collected by means of an interviewer administrated questionnaire. The latter is available through the Internet databases for many geographical regions and through individual exposure measurements. The data is integrated into a mathematical algorithm, in order to obtain an esteem of the individual total amount of SR the subjects have been exposed to during their lives. RESULTS The questionnaire has been tested for 58 voluntary subjects. Environmental exposure data through online databases has been collected for 3 different places in Italy in 2012. Individual exposure by electronic UV dosimeter has been measured in 6 fishermen. A mathematical algorithm integrating subjective and objective data has been elaborated. CONCLUSIONS The method proposed may be used in epidemiological studies to evaluate specific correlations with biological effects of SR and to weigh the role of the personal and environmental factors that may increase or reduce SR exposure. Med Pr 2016;67(5):577-587.

Questionnaire‐based evaluation of occupational and non‐occupational solar radiation exposure in a sample of Italian patients treated for actinic keratosis and other non‐melanoma skin cancers

An adequate evaluation of the ultraviolet (UV) cumulative exposure is a major problem in epidemiological studies on chronic skin damage. Questionnaires may be applied as useful tools.

Occupational Exposure to Solar Radiation at Different Latitudes and Pterygium: A Systematic Review of the Last 10 Years of Scientific Literature

Pterygium is a chronic eye disease: among its recognized risk factors there is long-term exposure to ultraviolet (UV) radiation. The Sun is the main source of UV exposure: according to the World Health Organization, the Population Attributable Fraction of pterygium due to solar radiation (SR) is 42–74%. Outdoor work can deeply influence the eye exposure to solar UV rays, but, despite this, pterygium is currently not adequately considered as a possible occupational disease in this working category, at least in Europe. For this reason, we performed a systematic review of the scientific literature published in the last ten years (2008–2017) considering the role of outdoor work as a risk factor for pterygium, in order to give new support for the prevention of this UV related disease in workers. We identified 29 relevant papers. Our results show that pterygium prevalence highly increased with latitude and mean annual UV index, and outdoor work is one of the most relevant risk factors, as well as age and male sex, both in high risk and in moderate risk World areas considering the environmental UV levels. Accordingly, pterygium occurring in outdoor workers should be considered an occupational disease. Moreover, our findings clearly support the need of further research on more effective prevention of the occupational risk related to long-term solar radiation exposure of the eye.

Cataract frequency and subtypes involved in workers assessed for their solar radiation exposure: a systematic review

Cataract is currently the primary cause of blindness worldwide, and one of its main risk factors is solar ultraviolet radiation exposure. According to the localization of lens opacities, three main subtypes of cataract are recognized: nuclear, cortical and posterior subcapsular cataract. One of the main determinants of individual long‐term solar radiation exposure is outdoor work. We systematically reviewed scientific literature from the last 20 years to update the recent development of research on the risk of cataract in outdoor workers and on the specific subtypes involved, also investigating the methods applied to evaluate the occupational risk. A total of 15 studies were included in the review, of which 12 showed a positive association. The studies confirm the relationship of long‐term occupational solar radiation exposure with cortical cataract and give new support for nuclear cataract, although no substantial new data were available to support a relation with the posterior subcapsular subtype. In most of the studies, the exposure assessment was not adequate to support a representative evaluation of the ocular risk; however, outdoor work is clearly a relevant risk factor for cataract. Further research providing a better evaluation of the relation between solar radiation exposure levels and lens damage in workers is needed and aimed to establish adequate occupational exposure limits and better preventive measures, studying also their effectiveness.

Work-related stress and role of personality in a sample of Italian bus drivers

BACKGROUND Several studies have shown that professional drivers are at risk of developing work-related stress. Stress may be responsible for a variety of adverse effects and may also be associated with an increased number of accidents. OBJECTIVE Perform an integrated, objective and subjective evaluation of work-related stress in bus drivers, that also considered the role of personality traits. METHODS Salivary α-amylase and cortisol were measured in 42 bus drivers. Subjective stress evaluation was performed with the Perceived Stress Scale (PSS-10) and Driver Stress Inventory (DSI). To evaluate personality traits, we administered the Eysenck Personality Questionnaire-Revised (EPQ-R) and the Impulsivity Inventory (IVE). RESULTS Salivary biomarkers showed no associations with PSS-10 and personality traits. Cortisol levels were positively correlated with fatigue (r = 0.44) at the middle of the work-shift and with aggression (r = 0.51) at the end of a day off. At the end of the work-shift, cortisol levels were negatively correlated with hazard monitoring (r = -0.37) and salivary α-amylase was positively correlated with thrill-seeking (r = 0.36). Neuroticism (β= 0.44) and impulsiveness (β= 0.38) were predictors of perceived stress by multiple regression. CONCLUSIONS An integrated method, considering both objective and subjective indicators, seems adequate to evaluate work-related stress in professional drivers. Personality traits are relevant in determining perception of stress.

1651d Occupational uv exposure and the eye

Ultraviolet (UV) and blue-light components of optical radiation can affect the eye with a photochemical mechanism; both acute and/or long term effects can be induced. By large, the most diffuse source of optical radiation is Solar Radiation (SR) that includes both components. Among factors influencing SR exposure one of the most important is outdoor work: only in Europe outdoor-workers (OWs) are about 15 million. Another factor specifically relevant to the eye is reflection as, for anatomical reasons, the eye is less protected from reflected rays. As a consequence the presence of highly reflecting surfaces, like fresh snow or water, can increase eye exposure. In OWs various adverse chronic eye effects, involving different structures of the eye, can be found, as pterygium, cataract and macular degeneration. We reviewed scientific studies on eye effects of optical radiation in OWs. The results confirm an increased risk of the abovementioned adverse effects, but knowledge on various aspects is largely insufficient. Among relevant aspects deserving further studies are the evaluation of lifetime ocular exposure to ultraviolet radiation and blue-light considering both occupational and leisure activities, and possibly integrating subjective questionnaires data with objective data, as UV effective irradiance, available through meteo-climatic databases or field measurements. Individual aspects to be adequately investigated must include among other, also the possible presence of reflection, protective habits as the use of hats (type, frequency, etc.) and of sunglasses (frequency, shape, UV/blue light filters, etc). These aspects are extremely important especially for the development of more adequate preventive measures.

1650a Subjective symptoms in magnetic resonance imaging operators: preliminary results of an italian study

Introduction Magnetic Resonance Imaging (MRI) operators are exposed to significant levels of electromagnetic fields (EMF). In these workers an elevated prevalence of variuos subjective symptoms has been reported. Even if most symptoms are non-specific, in some recent studies a group of 5 more specific symptoms, defined ‘core symptoms’, was proposed: vertigo, nausea, head ringing, magnetophosphenes and metallic taste. Our aim was to investigate the prevalence of subiective symptoms, including ‘core symptoms’, in Italian MRI operators, in order to evaluate the association with exposure. Methods A sample of 152 MRI operators working in 6 different hospitals in Italy was collected. No measurments were available, so for each participant exposure was estimated based on scanner type (<1T, 1.5T –<3T and ≥3T respectively) and on the total number of MRI procedures followed. In all operators an ad hoc questionnaire including relevant sociodemographic and occupational data, and the occurrence of subjective symptoms based our previous experience, was collected. The influence of stress was also evaluated. The relation between occupational exposure and symptoms was studied using multivariate analysis. Result The multivariate analysis shows a significant correlation between exposure level and the total number of investigated symptoms. The results were confirmed considering the specific subset of ‘core symptoms’ based on previous literature data. In the multivariate model, the weight of the other covariate factors was not significant. The overall results were substantially confirmed considering the effect of work stress. Discussion and conclusions In the observed group of MRI operators the total number of subjective symptoms was associated with EMF exposure; the subset of ‘core symptoms’ also proved significantly dose-related with exposure. The symptoms prevalence was not significantly influenced by work stress. The results support the association between subjective symptoms and EMF exposure in MRI operators. Another conclusion is that the appearance of the specific group of ‘core symptoms’ may be usefully investigated in health surveillance of MRI operators.

1616b Questionnaire based evaluation of the whole-life history of solar uv radiation exposure in a group of patients in italy

Introduction An adequate evaluation of the ultraviolet (UV) cumulative exposure is a major problem in epidemiological studies on chronic skin damage. Questionnaires may be applied as useful tools. For these reasons, a detailed questionnaire for the evaluation of individual cumulative exposure to Solar Radiation (SR) of outdoor workers (OWs) was developed, to investigate the associations between exposure and the presence of skin damage. Method Based on ICNIRP publications, a detailed questionnaire, considering both working and leisure UV exposure, was developed and applied in group of volunteers and in patients affected by Non Melanoma Skin Cancers (NMSCs), to evaluate whole-life SR exposure and the relevant factors associated, including exposure habits, environmental factors and use of protections. Results In patients with NMSCs, we found that the co-presence of in situ squamous cell carcinoma (SCC) and invasive NMSCs was more frequent in OWs than in indoor workers (IWs), as was also the frequency of multiple skin lesions. The prevalence of lesions in the most exposed body areas, as the face, was significantly higher in OWs, while working in shades was negatively associated with skin lesions. Also working posture was relevant: adopting a bent-over position was associated with lesions on the head. For leisure activities, the questionnaire application confirms the relevant role of tanning beds, in particular for body areas usually not highly exposed to SR, and the relevance of intense exposure in the middle hours of the vacation days (‘sunbaths’), significantly associated with NMSCs presence. Conclusion A detailed questionnaire-based evaluation in subjects with NMSCs can be very useful for estimating the whole-life individual UV exposure and the relevancy of occupation. Furthermore, an integration with personal dosimetric UV measurements can lead to a semi-quantitative evaluation, to set out exposure levels and different exposure modalities (e.g. intermittent vs cumulative) for various occupations and, possibly, for the different SCs.