Background: We investigated a possible association between pharyngeal/tonsillar carcinoma and mixed carcinogen exposures in an asphalt roll company in Italy that used asbestos until 1979, when a new factory was built using a different production process. Methods: We evaluated all workers involved in the entire production history of the company, divided into two subcohorts based on exposure status (workers in the original factory, 1964–1979, and those who worked only in the new factory, 1980–1997). We ascertained the vital status of the study population in February 2001. Results: Among the subset of workers in the earlier subcohort, there were five deaths from pharyngeal/tonsillar carcinoma for a standardized mortality ratio of 21 (95% confidence interval = 8.8–51). No cases were recorded among workers hired after 1979. Conclusion: The increased standardized mortality ratio for this relatively rare cancer among workers exposed before 1979 may have been due to carcinogenic exposures at the plant.

Objective: To assess risks associated with work-related biomechanical overloads in onset/course of carpal tunnel syndrome. Methods: Workgroups with job tasks spanning different biomechanical exposures were evaluated at baseline in terms of American Conference of Governmental Industrial Hygienists hand-activity/peak force action limit and threshold limit values (TLV). Exposures of interest were "unacceptable" (hand-activity above TLV) and "borderline" (between action limit and TLV) overloads. Clinical/individual data were collected at baseline and 12 months. Results: One-year incidence of "classic/possible" carpal tunnel syndrome symptoms as defined by consensus criteria was 7.3% (153 of 2092). "Unacceptable" overload was associated with a 3-fold increased risk of onset with respect to "acceptable" load. At ordered logistic regression analysis of symptom-status variations, increased risks were recorded for "unacceptable" and "borderline" overloads. Conclusions: Effectiveness of encouraging workplace adherence to the American Conference of Governmental Industrial Hygienists recommendations deserves investigation as a possible key to wide-scale prevention.

OBJECTIVE:To estimate the occupational exposure of hospital personnel handling antineoplastics drugs using a highly sensitive and specific analitycal method in biological and environmental samples.DESIGN:To develop analitycal methods for the biological and environmental monitoring of more than one substance.SETTING:Five departments of the Policlinico Sant'Orsola-Malpighi (Bologna, Italy) involved in the preparation and administration of antineoplastic drugs.PARTICIPANTS:50 nurses handling antineoplastics drugs.MAIN OUTCOME MEASURES:Evaluation of the occupational exposure of hospital personnel handling and administering anticancer drug cocktails.RESULTS:19 of 50 subjects were positive to biological monitoring. Three were positive for MTX only, 11 for CP only and 5 subjects were positive for both. Urinary MTX levels ranged from 0.3 to 2.0 ppb, CP ranged fom 0.06 to 10.0 ppb. Wipe tests showed a higher contamination on the hoods working tray (where drugs are prepared), suggesting that the organization layout can affect the surface contamination level. Samples from each department resulted positive for at least one of three drugs.CONCLUSIONS:The analytical methods developed allow sensitive and specific determination of indicators of internal and external dose. Biological monitoring is of primary importance for assessing the real espoxure of hospital personnel during the preparation and administration of the drugs. Environmental monitoring stresses the importance to observe the Guidelines for standard operating procedures and the importance of protective disposables to reduce exposure and the associated health risk.

OBJECTIVE:To develop a multiple-endpoint monitoring system in order to assess and minimize long term risks in hospital nurses exposed to antiblastic drugs.DESIGN:Molecular epidemiology study.SETTING:S. Orsola-Malpighi Hospital in Bologna, Italy: nurses exposed to antiblastic drugs.PARTICIPANTS:50 exposed subjects (8 males and 42 females) and 50 unexposed individuals (8 males and 42 females) matched for age and smoking habits.MAIN OUTCOME MEASURES:Urinary markers of exposure, Heat Shock Proteins (HSPs) 27, 70, 90, 110, immunologic biomarkers in peripheral blood lymphocytes: apoptosis, cell-cycle analysis G1-S-G, typization of Natural Killer cells (NK) and receptors micronuclei; frequency in peripheral blood lymphocytes and in exfoliated buccal mucosa cells; activation ofspecific oncogenes (bax, bcl2).RESULTS:19/50 subjects showed urinary antiblastic drug levels (3 subjects MTX, 11 subjects CP, 5 subjects MTX and CP). No statistically significant differences were observed in all the considered biomarkers between the exposed and control groups.CONCLUSION:This biomonitoring study doesn't evidence any early significant effect associated to the exposure to antiblastic drugs.

Relatively little is known about occupational and other risk factors for renal-cell carcinoma (RCC). Associations between RCC and occupations, exposures and other factors were investigated in a hospital-based case-control study in Bologna (central-northern Italy). Between 1986 and 1994, 324 histologically confirmed RCC cases were diagnosed at Policlinico S. Orsola-Malpighi in patients from the Province of Bologna. Corresponding control subjects admitted to the same hospital with any diagnosis except RCC were matched for sex, age, and residency. We studied the 249 cases and 238 controls for whom detailed information on occupational history, diet, smoking habits, alcohol and drug intake was obtained. At conditional logistic regression, among males (167 matched pairs), significant matched odds ratios (OR) were found, after adjusting for cigarette smoking and alcohol intake, for high body-mass index BMI (third quartile: OR, 4.91; confidence interval [95% CI], 1.56-15.5; last quartile: OR, 4.42; 95% CI, 1.48-13.18), railway workers (OR, 10.14; 95% CI, 1.46-70.17) and asbestos exposure (OR, 7.11; 95% CI, 1.46-34.51); nearly significant OR were found for managers (OR, 3.59; 95% CI, 0.82-15.59) and metal workers (OR, 2.21; 95% CI, 0.99-5.37). Among females (52 pairs), significant OR were found for BMI > 25.4 (OR, 8.46; 95% CI, 1.02-68.0). Railway workers (on or near to trains) may have increased risk of developing RCC, possibly due to asbestos exposure. Studies are required on possible risks encountered by railway (and metal) workers and by managers.