Rossana Borchini

Prevalence of occupational hazards in patients with different types of epithelial sinonasal cancers.

BACKGROUND Occupational exposure to carcinogens contributes greatly to the etiology of sinonasal cancer (SNC), but the role of different risk factors in determining different histological subtypes is disputed. METHODOLOGY All consecutive surgical epithelial SNC cases (case-series study) underwent a systematic occupational medicine examination to determine previous exposure to a wide range of work-related chemical hazards. RESULTS We investigated 65 SNC cases including intestinal-type adenocarcinoma [ITAC] squamous-cell carcinoma [SCC], and others. Occupational exposure was recognized for 39 cases. Occupational exposures were sensibly more frequent among ITAC than among SCC or other histotypes. Occupational exposure in ITAC cases was to leather or wood dust only, while among non-ITAC cases, we recognised exposure to formaldehyde, solvents and metal fumes. A high proportion of SNC with occupational exposure originated in the ethmoidal epithelium. CONCLUSION In our case-series of SNC, a very high frequency of previous occupational exposure to carcinogens was detected, suggesting that occupational hazards may be associated to the aetiopathogenesis, primarily for ITAC, but also for other histotypes. Besides leather or wood, other chemical agents must be recognized as occupational risk factors.

Prolonged job strain reduces time-domain heart rate variability on both working and resting days among cardiovascular-susceptible nurses.

ObjectivesModifications of hearth rate variability (HRV) constitute a marker of the autonomic nervous system (ANS) deregulation, a promising pathway linking job strain (JS) and cardiovascular diseases (CVD). The study objective is to assess whether exposures to recent and prolonged JS reduce time-domain HRV parameters on working days (WD) among CVD-susceptible nurses and whether the association also persists on resting days (RD).Material and Methods313 healthy nurses were investigated twice with one year interval to assess JS based on the demand-control and the effort-reward models. 36, 9 and 16 CVD-susceptible nurses were classified as low JS in both surveys (stable low strain — SLS), recent high JS (high JS at the second screening only-RHS) and prolonged high JS (high strain in both surveys-PHS), respectively. In 9, 7 and 10 of them, free from comorbidities/treatments interfering with HRV, two 24-h ECG recordings were performed on WD and RD. Differences in the time domain HRV metrics among JS categories were assessed using ANCOVA, adjusted for age and smoking.ResultsIn the entire sample (mean age: 39 years, 83% females) the prevalence of high job strain was 38.7% in the second survey. SDNN (standard deviation of all normal RR intervals) on WD significantly declined among JS categories (p = 0.02), with geometric mean values of 169.1, 145.3 and 128.9 ms in SLS, RHS, PHS, respectively. In the PHS group, SDNN remained lower on RD as compared to the low strain subjects (142.4 vs. 171.1 ms, p = 0.02). Similar findings were found for the SDNN_Index, while SDANN (standard deviation of average RR intervals in all 5 min segments of registration) mean values reduced in the PHS group during WD only.ConclusionsOur findings suggest that persistent JS lowers HRV time-domain parameters, supporting the hypothesis that the ANS disorders may play an intermediate role in the relationship between work stress and CVD.

Heart Rate Variability Frequency Domain Alterations among Healthy Nurses Exposed to Prolonged Work Stress

The deregulation of the autonomic nervous system assessed through the heart rate variability (HRV) analysis is a promising pathway linking work stress and cardiovascular diseases. We aim to investigate the associations between HRV High Frequency (HF) and Low Frequency (LF) powers and work stress in a sample of 36 healthy nurses. Perceived work stress was assessed twice one year apart, using the Job Content and Effort Reward Imbalance questionnaires. This allows to classify nurses in three exposure groups: “prolonged high stress” (PHS), “recent high stress” (RHS) and “stable low stress” (SLS). A 24-h ECG monitoring was later performed during a working day (WD) and a subsequent resting day (RD). Statistically significantly lower (p < 0.02) HF and LF means were found in PHS and RHS nurses during the working periods. In the subsequent resting periods, HF means showed increases over time in the RHS (beta = +0.41, p < 0.05), but not in PHS nurses. LF means did not show any substantial increases in the resting periods, in the PHS group with geometric means lower when compared to SLS, in the non-working and resting periods. Our study evidences that both prolonged and recent perceived high work stress were associated with a reduction of HF and LF powers during work. In addition, prolonged stress was associated with a lack of recovery during not-working and resting periods.

Differing associations for sport versus occupational physical activity and cardiovascular risk

Objectives We investigate the independent and interacting long-term associations of occupational physical activity (OPA) and sport physical activity (SpPA) with the incidence of coronary heart disease (CHD) and cardiovascular diseases (CVD; CHD plus ischaemic stroke) in North Italian male workers. Methods 3574 employed men aged 25–64 years, free of CVD at baseline, recruited in three population-based and one factory-based cohorts, were included in the analysis. The Baecke Questionnaire was used to assess OPA and SpPA in ‘minutes per week’ of moderate or vigorous PA. We estimated the associations between different domains of PA and the endpoints, adjusting for major CVD risk factors, using Cox models. Results During a median follow-up of 14 years, 135 and 174 first CHD and CVD events, fatal and non-fatal, occurred. Compared with the intermediate OPA tertile, the HRs for CHD among low and high OPA workers were 1.66 (95% CI 1.06 to 2.59) and 1.18 (0.72 to 1.94), respectively (P value=0.07). Decreasing trends in CHD and CVD rates across increasing levels of SpPA were also found, with an HR for CVD of 0.68 (0.46 to 0.98) for intermediate/recommended SpPA compared with poor SpPA. We also found a statistically significant SpPA-OPA interaction, and the protective effect of SpPA was only found among sedentary workers, for both endpoints. Conversely, high OPA workers with intermediate/recommended SpPA levels had increased CHD and CVD rates compared with the poor SpPA category. Conclusions Our results provide further evidence on the health paradox of OPA, with higher CVD rates among workers with intense PA at work. Moreover, the protective effect on CVDs of SpPA is prominent in sedentary workers, but it attenuates and even reverses in moderate and strenuous OPA workers.

Prevalence of Abdominal Aortic Aneurysms in the General Population and in Subgroups at High Cardiovascular Risk in Italy. Results of the RoCAV Population Based Study

OBJECTIVES Prevalence data on abdominal aortic aneurysm (AAA) in women, subjects younger than 65 years and in subgroups carrying specific risk factors are scarce. AAA prevalence was evaluated in an Italian population including women and younger subjects, stratifying for the presence of cardiovascular disease (CVD) risk factors and CVD risk score. MATERIALS AND METHODS A population based cross-sectional study was conducted between 2013 and 2016. Men aged 50-75 and women aged 60-75 years, resident in the city of Varese (northern Italy), were randomly selected from the civil registry. A vascular surgeon performed an abdominal aortic ultrasound scan at four sites using the leading edge to leading edge method. CVD risk score was computed using the ESC-SCORE algorithm. The age and gender specific prevalence was estimated, stratifying by the presence of CVD and cardiovascular risk factors. RESULTS Among the 3755 subjects with a valid ultrasound measurement, 63 subjects with an AAA were identified (5 referred for surgical intervention), among whom 34 were not previously known (30 men 1.3%, 95% CI 0.9-1.8; 4 women 0.3%, 95% CI 0.1-0.8). Considering age classes in men only, the highest prevalence of screen detected AAA was found in subjects aged 65-70 (1.2%; 95% CI 0.4-2.5) and 70-75 (2.5%; 95% CI 1.4-4.0) years. Among 65-75 year old men, the highest AAA prevalence was found in subjects with a previous myocardial infarction (MI 4.9%, 95% CI 2.0-9.9) and in ever-smokers reporting more than 15 pack years of smoking (4.1%, 95% CI 2.5-6.3). Among the younger subjects, those having an ESC-SCORE higher than 5% or a previous CVD (MI or stroke) showed a prevalence of 1.4% (95% CI 0.3-4.2; prevalence including subaneurysms 6.7%, 95% CI 3.7-11.0%). CONCLUSIONS In the study population, both a general screening program in 65-75 year old men and an approach targeted to subgroups at higher risk merit evaluation in a cost-effectiveness study. In 50-64 year old men, strategies for population selection should consider CVD risk stratification tools.

1661b Exploring the combined effect of job strain and occupational physical activity on cardiovascular disease incidence

Introduction The aim of the study is to investigate the interplay between job strain (JS) and occupational physical activity (OPA) in determining the risk of major cardiovascular diseases (CVD), in a working male population. Methods n=1515 participants to three population-based (WHO-MONICA Brianza II and III survey and PAMELA) North Italian cohorts, 25–64 years old, employed and CVD-free at baseline, were available for the analyses. JS was investigated using the Job Content Questionnaire (MONICA-MOPSY short version), and dichotomized as high vs no-high strain. A habitual OPA score was derived from the Baecke Questionnaire (8 items) and categorised in tertiles. Age-adjusted hazard ratios (HRs) and 95% confidence intervals for incidence of CVD (first coronary heart disease or ischaemic stroke, fatal or non-fatal) events were estimated from Cox-proportional hazard models. A sensitivity analysis was carried out stratifying by sport PA levels. Result In a median 17 years of follow-up, n=102 first CVD events occurred. As compared to the intermediate OPA tertile, workers with low and high OPA showed higher HRs of 1.67 (95% CI: 0.96 to 2.92) and 2.01 (1.17–3.46), respectively. Stratifying by sport PA, the above reported HRs for low and high OPA workers increased to 2.32 (1.15; 4.69) and to 2.54 (1.09; 5.95) when sport PA was below and above the median, respectively. High vs non-high JS workers evidenced an HR of 1.27 (0.76–2.11). When adjusting for age, BMI, alcohol intake, smoking and sport PA, a joint effect was detected between OPA and JS, with the highest HR for workers in the low OPA and high JS category [2.70 (1.17; 6.26)] as compared to workers in the intermediate OPA and non-high JS. Discussion We observed a joint additive effect between sedentary work and high JS on the incidence of cardiovascular events.

Atrial fibrillation: An additional cardiovascular detrimental effect of stress at work?

More and more evidence accumulates on the association between job strain – work stress – and cardiovascular diseases (CVDs). The cumulative meta-analysis of cohort studies published up to 2014 indicates a risk excess of 33% for coronary heart disease (CHD) and of 24% for ischaemic stroke among high strain versus non-high strain workers. The hazard ratio of high strain versus non-high strain increases up to 1.81 (95% confidence interval (CI): 1.21–2.69) when the analysis is restricted to salaried manual and non-manual workers. Moreover, when the psychosocial work environment is investigated using both the demand– control and the imbalance between effort and reward models, the first referring to the content of the work tasks and the second to its recognition, the CHD excess risk increases to 41% when both stressors are present together on the same subject. Finally, the two major stress-related work organization conditions, that is, long working hours and shift work, are also independently associated with CHD and ischaemic stroke risk. In this issue of the European Journal of Preventive Cardiology, Eleonore Fransson and colleagues, using a large Swedish longitudinal cohort, the SLOSH study, find ‘an almost 50% increased risk of atrial fibrillation’ again when high versus non-high job strain subjects are compared. The excess risk reduces somewhat when adjusting for multiple CVD risk factors, but, as we know, this may represent an over-adjustment as job strain is related to some of them, in particular type II diabetes mellitus and hypertension. The paper, combining the results of other two Swedish studies, using a fixed-effect meta-analysis, estimates a pooled hazard ratio of 1.37 (95% CI: 1.13–1.67) for atrial fibrillation when comparing high versus non-high job strain. The adaptation of humans to psychological stress involves the reactions of the hypothalamic–pituitary– adrenal axis, with increased release of cortisol, and of the autonomous nervous system (ANS), with increased sympathetic activity in healthy patients and in patients with cardiovascular diseases. The mechanisms linking psychological stress to increased atrial fibrillation risk have not been thoroughly investigated so far. It has been hypothesized that the alterations of the ANS can induce the atrial arrhythmogenesis either through a lack of cardiac control, due to an increased sympathetic tone and decreased vagal tone that can trigger atrial fibrillation, or through focal ectopic firing and vulnerable substrates that can maintain the re-entry. In this context, prolonged job strain has been found to produce persisting modifications of timeand frequencydomains of heart rate variability: alterations of the highand low-frequency powers inducing a reduction in the vagal control of the heart rate that may play an intermediate role in the relation between work stress and the cardiovascular system. Further pathways linking stress to atrial fibrillation can be represented by the inflammatory state, commonly detected among workers exposed to prolonged stress, which may lead to structural remodelling of the atria and hence to atrial fibrillation progression and persistence. Finally, hypertension, a possible outcome of prolonged stress conditions, can promote the onset and the maintenance of atrial fibrillation through structural and electrical atrial remodelling. Conversely, it has been shown that hypertensive control reduces the onset of atrial fibrillation. Finally, it is worth mentioning that when using the non-high strain category as reference to estimate the risk excess of high strain subjects, the results are likely biased to the null. In fact, the non-high strain group combines workers with low job strain (low demand and high control at work), but also people

Etiological role of occupational exposure in different subtypes of sino-nasal cancer: results from a large hospital-based cohort in Italy

Objectives Sino-nasal cancer (SNC) is a rare and potentially fatal disease with a high occupational attributable fraction, being wood, leather dust, metals and PAHs well recognised carcinogenic agents. The importance of occupational exposure is often underestimated with some authors that disputed its role in the pathogenesis of histological subtypes different from adenocarcinoma(AC), mainly squamous-cell-carcinoma (SCC). We quantified the etiological role of occupational exposure in a large hospital based cohort of SNC. Methods We systematically evaluate all cases after surgical treatment in Otorhinolaryngology department (period: Feb-2010/Feb-2011) through a standardised and validated questionnaire developed with the National Registry for SNC cases. Results We evaluated 48 cases (69% AC, 21% SCC, 10% other), 13 of them were women. Mean age at diagnosis was 63. A previous occupational exposure was recognised for 31 cases (65% of the total). The proportion of occupational cases was higher for AC (84%) than for SCC and for other histotypes (20%). For AC the more common risk factors were leather (47% of all cases) and wood dusts (32%). Conversely, SCC resulted exposed to a wider range of carcinogen factors (comprising formaldehyde, PAH, metals). Mean latency was 51y (range 30–65), mean duration of exposure was 26y (range 2–52). Conclusions Occupational exposure plays a key role in the aetiopathogenesis of SNC, not only for AC (with wood and leather dust that confirmed their impact in term of public health) but also for other histotypes with formaldehyde and PAHs as important and often misrecognised occupational factors.