Enrico Tomao

Occupational exposure to noise and the cardiovascular system: a meta-analysis.

The aim of our meta-analysis is to evaluate the association between the modifications of the cardiovascular system and chronic exposure to noise in occupationally exposed subjects. We considered the articles published from 1950 to May 2008. Only 15 papers were conforming to the inclusion criteria identified for this meta-analysis. A total of 18,658 workers were divided in three groups according to the level of noise exposure as measured in the original studies (High Exposure, HE, Intermediate Exposure, IE, Low Exposure, LE). A preliminary evaluation of the type of data allowed for a classification of the type of performed measurements. Two classes of variables were identified: Class I, composed by continuous variables (systolic blood pressure, SBP, diastolic blood pressure, DBP, and heart rate, HR) and Class II, composed by not continuous variables (prevalence of hypertension and prevalence of ECG abnormalities). For each variable the calculation of heterogeneity was performed. For continuous variables the calculation of ES and its significance were performed while Odds Ratio (OR) and its significance were calculated for not continuous variables. The results show a statistically significant increase of SBP and DBP in HE workers compared to LE and IE workers while HR is statistically higher in HE participants compared to LE participants. The prevalence of both hypertension and ECG abnormalities is statistically higher in HE workers compared to LE and IE workers. Taking into account both the extremely high heterogeneity among studies and the ES/OR values we suggest a particular attention to the measurement and evaluation of SBP, DBP and HR in workers with chronic exposure to noise. Also ECG for workers with chronic exposure to noise is suggested in order to identify and evaluate possible abnormalities noise could be a concurrent cause of.

Hypertension and chronic exposure to noise

Abstract The effects of noise on various cardiovascular parameters are conflicting and uncertain. In the current study, the authors studied 52 workers who were employed in a bedframe factory who were chronically exposed to noise and who had poor hearing. An additional group of 65 workers who had jobs in the light-metal sector and another group of 64 office workers served as two control groups; none of the controls were exposed to noise, and none had hearing defects. Blood pressure was measured for each person in the supine and standing positions, and an electrocardiogram was also performed. Sound-level measurements were taken in the workplaces. Mean systolic and diastolic blood pressures and diastolic blood pressure distributions were significantly higher in the noise-exposed group than in both control groups. Among the three groups, there were significantly different frequencies of hypertension, drops in blood pressure, and electrocardiogram anomalies. Within the group of bedframe workers, those exposed to a personal daily level of exposure (i.e., equivalent continuous noise level for exposure to noise for each individual workers in an 8-hr shift) that exceeded 90 dBA had a higher mean diastolic blood pressure and a higher frequency of diastolic hypertension than workers exposed to a personal daily level of exposure of < 90 dBA. The findings suggested that (a) work performed by the bedframe group had some effects on the cardiovascular system, (b) noise is a cardiovascular risk factor, and (c) cardiovascular effects are relative to intensity and type of exposure. Vascular damage often accompanies auditory damage, but—depending on individual susceptibility—the cardiovascular system can respond in various ways.

Chronic venous disorders and occupation

BACKGROUND Chronic venous disorders in the general population are a significant socio-medical pathology. The importance and role of venous pathologies in the occupational field are underestimated and the data in the literature are incomplete and contradictory. METHODS A study was made of 336 male workers: 112 industry workers, 120 stoneworkers, and 104 office workers. A targeted questionnaire was administered to all workers regarding occupational and extraoccupational risk factors for venous pathologies. The same workers were clinically examined, and a venous check-up and specific tests were done in clinostatic and orthostatic postures. RESULTS The prevalence of chronic venous disorders, including major and minor pathology, was significantly higher among industrial workers (39.28%) than among stoneworkers (24.16%, P=.019) and office workers (22.11%, P=.010). Only for major pathology was the mean age higher in phlebopathic workers than in non-phlebopathic; furthermore, the proportion of workers standing for >/=50% of the work shift was higher in phlebopathic than in non-phlebopathic. These differences were significant in all working groups. The results showed a positive relationship between the prevalence of phlebopathy and increased age and number of hours spent standing. Considering workers of the same age classes, a higher prevalence of phlebopathy was found between those who stood for >/=50% of their shift and those who stood for <50% of the time. CONCLUSIONS The results suggest that professions involving standing, particularly for those standing for >/=50% of the shift, can influence the development of chronic venous disorders and a diagnostic clinical protocol to be used by occupational physicians in screening working populations for the prevention of venous disease is suggested.

Study of some cardiovascular parameters after chronic exposure to noise

Research has focussed lately on noise as a risk factor for cardiovascular diseases. Recent findings, which have not been well confirmed, indicate that it does appear to affect heart rate, blood pressure and the electrocardiogram. This study involved two groups of subjects (with 75 and 225 in each, respectively) classified on the basis of different intensity of exposure to noise. Non-occupational risk factors studied (cholesterol, blood glucose, smoking, body mass index, family history of cardiovascular problems) revealed no significant differences between the two groups. Audiometric deficits and time exposure to noise were also studied. Blood pressure was measured at rest, an electrocardiogram was taken, and a cycloergometric stress test was made. The prevalence of hypertension and electrocardiographic modifications in basal conditions and under the stress test differed to a significant extent in relation to the different exposures to noise.

Plasma concentration of adrenocorticotropic hormone in traffic policemen

Plasma Concentration of Adrenocorticotropic Hormone in Traffic Policemen: Francesco Tomei, et al. University of Rome “La Sapienza”, Department of Occupational Medicine— The aim of this study is to evaluate whether traffic policemen exposed to urban pollutants and possible psycho‐social stressors could be at risk of changes on plasma adrenocorticotropic hormone [ACTH(P)] levels compared to a control group. Traffic policemen were matched by sex, age, length of service and drinking habit (<50 g of wine or beer per day) with a control group after excluding principal confounding factors; 62 traffic policemen with outdoor activity (34 men and 28 women) and 62 control subjects with indoor activity (34 men and 28 women) were included in the study. The levels of ACTH(P) were significantly higher in male and female traffic policemen than in the control subjects (respectively P=0.040, P=0.043). The authors hypothesise that occupational exposure to chemical and physical stressors, that may interact with possible psycho‐social stressors, could cause a change in ACTH(P) levels in traffic policemen.

Liver damage among shoe repairers.

BACKGROUND The risk of hepatotoxicity in the shoe industry has already been suggested, however, there has been no investigation among the craftsmen who repair shoes. METHODS A group of 33 shoe repairers who work in supermarkets, and who use the same glues which contain mixtures of potentially hepatotoxic solvents were identified. A control group of 61 workers not exposed to hepatotoxic substances was also examined. All participants completed a questionnaire designed to identify potential risk factors and the main non-occupational confounding factors for hepatotoxicity. Laboratory tests, commonly used in clinical practice, were done to check whether they were useful markers of hepatotoxicity due to exposure to solvent mixtures, and to investigate which tests should be used in the screening campaigns. RESULTS The exposed workers had a higher prevalence of elevated mean alanine aminotransferase (ALT), aspartate aminotransferase (AST), conjugated bilirubin (P=0.0001), and alkaline phosphatase (AP) (P=0.004) than controls did. The number of workers who had values outside the upper limit of normal for our laboratory was significantly higher (ALT P=0.034, AST P=0. 037, conjugated bilirubin P=0.014). Exposed workers all had a ratio of ALT to AST greater than 1, with a mean of 1.5; it was > 1.6 in more than half the exposed workers. CONCLUSIONS The findings suggest that there is the possibility of liver involvement among even asymptomatic shoe repairers, and that periodic liver screening may be useful; furthermore, use of these tests (especially the ratio of ALT to AST) for craftsmen who repair shoes, and are exposed to solvent mixtures, is advisable even when environmental monitoring indicates levels below the threshold limit values (TLVs).

Vascular effects of noise

The possible vascular effects of noise were studied. A study of the carotid vessels was made with Doppler ultrasonography in two groups of subjects exposed to various intensity of noise. The following data were studied: age, blood pressure, serum cholesterol, blood glucose, smoking habits, excess weight, electrocardiographic anomalies, family history of vascular disease, connection with duration of exposure and the type of noise and with audiometric deficits, and cerebrovascular modifications after postural changes and after a stress test. The control group comprised subjects not exposed to noise. The findings confirm that noise does play a role in causing vascular modifications that can be detected early by use of Doppler ultrasonography. This technique is predictive and could be useful in screening campaigns, following the method suggested here.

Occupational exposure to urban pollutants and plasma growth hormone (GH)

Abstract The aim of present study was to evaluate whether traffic policemen exposed to urban pollutants and possible psycho-social stressors are at risk of alterations on plasma growth hormone (GH) levels compared with a control group. Out of a population of 395 Municipal Police employees, the subjects with principal confounding factors were excluded from the study. The remaining traffic policemen were matched with those not exposed by sex, age, working life, and habitual consumption of alcohol; 71 traffic policemen (40 men and 31 women) with outdoor activity exposed to urban pollutants and 71 not exposed subjects (40 men and 31 women) with indoor activity were included in the study. The plasma levels of GH were significantly lower in the exposed traffic policemen compared with those not exposed (P = 0.000); similarly in male (P = 0.011) and female subjects (P = 0.000). The authors hypothesize the possibility of an effect of the specific working activity in traffic policemen on the plasma GH concentrations.

Occupational exposure to urban pollutants and plasma insulin-like growth factor 1 (IGF-1)

The aim of present study is to evaluate whether traffic policemen exposed to urban pollutants and possible psycho-social stressors could be at risk of alterations on plasma insulin-like growth factor (IGF-1) levels compared to a control group. Out of a population of 395 Municipal Police employees, the subjects with principal confounding factors (cigarette smoking habits, drinking habits, oral contraceptives being taken, use of paints, solvents and pesticides) were excluded from the study. The remaining traffic policemen were matched with those not exposed by sex, age and length of service; 49 traffic policemen (22 men and 27 women) with outdoor activity exposed to urban pollutants and 49 not exposed subjects (22 men and 27 women) with indoor activity were included in the study. The plasma levels of IGF-1 resulted significantly higher in the male and female traffic policemen compared with control subjects (respectively P < 0.001; P < 0.001). The authors hypothesise that occupational exposure to chemical stressors, that may interact with possible psycho-social stressors, could cause an alteration on IGF-1 levels in traffic policemen.

Urban pollution and nickel concentration in serum.

The studys objective has been to evaluate whether urban pollution, here nickel compounds and metallic nickel (Ni) are present, could determine serum concentrations of the above mentioned metal. Out of a population of 394 Municipal Police employees, subjects with main confounding factors were eliminated. The remaining subjects were made comparable for sex, age, and length of employment. Thus, 160 subjects were included in the study: 80 traffic policemen (42 men and 38 women) with outdoor activity exposed to urban pollutants in a direct way, and 80 administrative workers (42 men and 38 women) with indoor unexposed activity. The results obtained in the studied population demonstrate that in traffic policemen the serum levels of Ni are more elevated than those in administrative workers; both in male and female workers. The authors hypothesise that the presence of Ni as fuel additive in lead free fuels and as catalyser in catalytic exhausts, which have been obligatory in Italy in new cars for the last 10 years, could be one of the causes for the increased serum levels of the above mentioned metal in traffic policemen.