Background In dental laboratories, exposure to crystalline silica can occur during procedures that generate suspended mineral dusts, e.g. dispersion of mixing powders, removal of castings from molds grinding, polishing of castings and porcelain, and use of silica sand for blasting. There is also a large list of toxic agents (acrylic resins, polymeric materials, etc.) used to produce removable and fixed prostheses, but also impression materials and more. Using personal protective equipment and other aids reduces the exposure to these potentially harmful agents. Case presentation We report the case of a 42-year-old male dental technician who began to suffer from a dry cough and exertional dyspnea after approximately 15 years of work. The operations he conducted for his job resulted in the generation of crystalline silica, aluminum, chromium and titanium dust. The worker did not regularly wear personal protective equipment and some of the above operations were not carried out in closed circuit systems. The Chest X-ray showed diffused micronodules in the pulmonary interstitium of the upper-middle lobes, bilaterally, and a modest left basal pleural effusion. Simple spirometry showed small airway obstruction in its initial stage. High Resolution Computerized Tomography of the chest showed bilateral micronodulation of a miliariform type, with greater profusion to the upper lobes, also present in the visceral pleura, bilaterally. Histological examination showed aggregates of pigment-laden macrophages forming perivascular macules or arranged in a radial pattern around a core of sclerohyalinosis. Scanning Electron Microscopy and Energy Dispersive Spectrometry revealed several mineral particles, typically characterized by the presence of crystalline silica and metal aggregates. The environmental concentrations of total dust and its respirable fraction were all lower than the relative TLV-TWA—ACGIH, yet not negligible. Conclusions The above findings and a multidisciplinary assessment led to the diagnosis of mixed dust pneumoconiosis s/q with 2/2 profusion of occupational origin. This diagnosis in a dental technician was supported for the first time in literature by environmental exposure analysis.

SUMMARY The study aimed to evaluate, through the use of the EA-RfitTM Validation System, the real reduction (PAR) for the right ear (AuD), for the left ear (AuS) and biaural reduction related to each of the seven earplugs currently produced by 3M. In addition, we wanted to verify any difference between the aforementioned PARs in consideration of the tendency to predominantly use the right hand (right-handed) or the left hand (left-handed) and in relation to gender. Finally, for each insert and for each subject, an audiometric examination was conducted with the insert worn, to compare the average PAR value obtained by the EA-RfitTM system for each of the seven inserts and for all selected subjects, with the determined abatement curve through the audiometric measurement of the hearing threshold with the insert worn. The use of the E-ARfitTM system for the choice of the ear insert leads to important advantages in the protection of all workers. Moldable acoustic PPE generally proved to be more efficient than non-moldable, so much so that the higher SNRs (provided by the manufacturer), especially when referring to non-moldable inserts, were found to be misleading as to the real personal abatement capacity of the inserts. The average audiometric curves, obtained with the different inserts worn, confirmed that all of them guarantee a higher reduction for high frequencies than for social ones.

Illustre e caro Direttore, nella mattina dell’ultima giornata del 79° Congresso SIMLII di Roma, si e tenuta una sessione sulla Sorveglianza Sanitaria davvero di grande interesse e con relazioni qualificate e stimolanti. Per ragioni di tempo non ho potuto esprimere una mia riflessione che di seguito riporto. Penso che noi dovremmo chiederci perche la nostra disciplina sia l’unica di quelle mediche per la quale la qualita non paghi. Se una persona - mi lasci passare una evidente provocazione - ha necessita di andare da un ...callista, si informa su quale sia il migliore. Nel nostro caso, quando il datore di lavoro deve assumere il Medico Competente, si informa, nella stragrande maggioranza dei casi, su chi costa meno. Questo, a mio avviso e il problema di cui bisogna capire le motivazioni e a cui cercare di dare una risposta per invertire la tendenza.

BACKGROUND Laboratory levels of perceived noise attenuation as heard using earplugs are always higher than the real levels that can be achieved at the workplace. The employer is bound by law to supply individual hearing protection devices (HPDs), to assess their efficiency and efficacy, and also to inform and train workers on the correct use of HPDs. OBJECTIVES This study assessed the real "personal attenuation rating" (PAR) of HPDs  used by workers at the workplace, before (PAR A) and after (PAR B) specific and individual training. These values were also compared with the theoretical  "single number rating" (SNR) provided by the manufacturer. METHODS The study covered all the 65 male employees of an awnings factory, using the E-A-RfitTM computerized method, which can measure PARs, based on the difference between sound pressures recorded by an "outside" microphone and an "inside" microphone placed in the auditory canal, with earplugs inserted, before (PAR A) and after (PAR B), i.e., the specific and individual training described above. RESULTS/CONCLUSIONS PARs B were always definitely higher than PARs A, both for all tested frequencies and the corresponding average values, which were automatically detected by E-A-RfitTM. Furthermore the same PARs B were  decidedly lower than the respective SNRs supplied by the manufacturer on the basis of laboratory assessments. These data prove that specific and individual training for workers improves the performance of earplugs, contributing to a more appropriate secondary prevention of the effects of noise on hearing; they also prove that the real attenuation recorded in workers are always lower than those supplied by the manufacturer of the devices. It is recommended that the E-A-RfitTM system, which allowed these results to be achieved objectively, should be normally used to assess exposure to noise in workers, when HPDs are worn.

BACKGROUND The assessment of efficiency of hearing protection devices (HPDs), conducted above statutory limits, must be made using a standardized method while devices are worn; however, standardized and suitable laboratory conditions are difficult to encounter at the workplace. To overcome this problem, there are methods of measurement at the workplace such as "field-microphone-in-real-ear" (F-MIRE). OBJECTIVES The study was concerned with the measurement of real noise attenuation using earplugs and a new evaluation system: we checked the difference between "real" attenuation (at workplace) and "theorical" attenuation (reproduced in the laboratory) as stated by the manufacturer. METHODS We used the E-A-Rfit computerized method, which measures the loss of attenuation of earplugs in the ear, calculating the difference of sound pressure between an "outside" microphone and an "inside" one, in relation to the same earplug. The measurements at the workplace were carried out on eight subjects with good hearing levels (aged between 20 and 25 years), who were trained to wear the devices correctly. After the tests carried out with the E-A-Rfit system, which does not require a subjective answer, we obtained graphs and tables showing real noise attenuation. RESULTS/CONCLUSIONS We propose a comparison between hearing threshold for frequency, personal attenuation rating (PAR) and single number rating (SNR, provided by manufacturer): a difference of 10 dB (PAR 27 db vs. SNR 37 dB) was clearly evident although dissimilar methods were used to obtain such values. The instrument is rapid, simple and objective to use and also allows personalized information and training for every worker.

Our study has examined the valuation of exposure to dust, noise and hand-arm vibrations (HAVs) during "extra-professional" activities of do-it-yourself, like wood smoothing, considering a group of 8 heterogeneous volunteer subjects (not expert of the sector), to find any kind of variability among the subjects. The results have shown a moderate risk for dust exposure and a realer one for HAVs, also higher noise exposure levels when an aspiration system is added to the sander. It's important that the exposure time considered in this study is not comparable to professional time exposure, cause of the "domestic" feature of this activities. Moreover, data could be influenced by different use conditions, grip and material grounds. It's also significant that there are not controls, formation and information of the subjects about the health risks, as well as ipersusceptibility.

"Temporary hearing threshold shift in policemen after firearm training". Background: The paper involves exposure to noise of the State Police officers connected with the use of firearms. The noise generated by these weapons is of short duration and high intensity. Methods: The research was carried out during the sessions of firearm training of State Police officers to assess exposure to noise. Results: The values of the various investigations, both audiometric and phonometric, carried out made it possible to demonstrate a significant exposure and a temporary increase in the threshold, above the frequency of 6000 Hz. Conclusion: Even taking account of the abatement from use of headphones, an exposure was demonstrated that was above the statutory limits, as was confirmed by the temporary hearing threshold shift.

This work pertains to the study of exposure to air pollution and noise, of any citizen, in any time of day, within the perimeter of the Polyclinic of Bari. We utilized "dynamic" samplings, in a period of 24 hours, along a walking trail that lasted about 70 minutes, divided on the roads inside the general hospital, performed by voluntary people carrying, by shoulder, a bag containing necessary tools, with their sample heads placed externally in the respiratory area. The values of the environmental survey revealed, particularly, the presence of atmospheric concentrations of PM10 of 63,4 microg/m3 as average value of the whole day and 93 microg/m3 as maximum average value in one hour, far above the limits expected by law for the protection of human health (maximum average value of 50 pg/m3 in 24 hours), almost the whole day and in all areas interested in this study. Also data related to noise showed steady and marked exceeding the limits (average of 68,2 dBA in the morning and 68,0 dBA in the afternoon, versus the limit of 50 dBA by day for hospital areas; average of 65,9 dBA in the night, versus the limit of 40 dBA by night for hospital areas). Instead, a normal situation has been ascertained for the remaining pollutants of the study: the concentrations of carbon monoxide (CO), carbon dioxide (CO2) and ozone (O3) were consistently maintained below the limits for health protection during the whole survey, as well as monitoring for sulfur dioxide (SO2) and volatile organic compounds (VOCs). Air concentration of PM10 and Leq values for noise were, in different times, above the reference limits and surely prejudicial to human health, not only for casual users, employees and students, but especially for the most sensitive patients accessing the hospital; the highest average values were found in periods corresponding to hours of greater intensity of traffic, or rather in the morning and late afternoon, decreasing, however, during the night. It supports the hypothesis that the main anthropogenic source for pollution should be found in the excessive road traffic and transport, as well as data of other urban areas confirm.

The employment contracts for Italian working abroad are legally different. So many national laws, European Union (EU) directives and regulations should be applied concerning health and safety at work. This paper is aimed to clarify these features, focusing on their impact on workers' health surveillance. For originally transnational contracts the law applicable is chosen by the parties but in compliance with minimum standards of workers' health protection. An authorization by Italian Labour Minister is also needed for employment in non-EU countries requiring minimum protection conditions. Italian legislation is applied to temporary work abroad. Long-lasting or permanent abroad transfer is regulated as originally transnational work. Workers posted in a EU country should receive the same protection ensured by laws, regulations, collective agreements or arbitrations to resident workers. Health surveillance of workers hired or transferred to work abroad is performed by a occupational physician (OP) operating in the foreign country. Temporary abroad workers undergo health surveillance by the Italian OP. The workplace inspection could be conducted by the OP through audiovisual electronic systems, reserving the on-site visit to particular situations. The host employer is responsible for health surveillance of posted workers entrusted to a local OP.

BACKGROUNDAir pollution leads to increased levels of morbidity and mortality for cardiovascular and respiratory diseases in populations living in urban environments.OBJECTIVESOur study tested the possibility of using sampling techniques that are typical of industrial hygiene to measure exposure to atmospheric pollutants and using personal samplers for concentrations of certain pollutants to which an ordinary resident of Bari is exposed on a daily basis.METHODSWe monitored dusts (PM10, PM2.5), CO, CO2, humidity, ventilation and noise, by dynamical sampling along a route on foot, bicycle, motorbike and automobile and then compared the results with data provided by fixed stations distributed in the municipality of Bari.RESULTSBy comparing our data with those values provided for by the law, we found out that the concentrations of all pollutants resulted to be higher than 50 microg/m3, with the exception of the measurements carried out along the route by car. The measurements of PM2.5 were, on average, similar to the values of PM10 for the route on foot, but they were totally different for the measurements made along the route by car, bicycle and motorbike. Moreover, comparing our data with those obtained from the municipal network of fixed stations, we found that results provided by our measurements were higher for PM10.CONCLUSIONSConsidering that compliance with the limits set by law refers to average values over 24 hours, we can conclude that those hours in which pollutant concentration reaches a risk level shall be considered especially regarding groups of people with respiratory disorders.

Background: The authors studied exposure to the noise generated by digital music listening devices (MP3) as used by young people. Objectives: to study the level of sound emission Of some of these devices at 100%, 75% and 50% volume. Methods: Using a mannequin, the LeqA LmaxA, LeqC and the peak in C of nine of the most commonly used devices was measured at levels of sound emission of 100016, 75% and 50%. Results: It was found that all the devices exceeded 100 dBA of Leq at 100% of the listening volume. We therefore estimated the Lex8, as recommended in Italian Law 195106, to which these young people are exposed using the devices for 15, 30, and 60 minutes/day. Conclusions: Young people undergoing daily exposures for only 15 minutes at maximal listening volume exceed the limit value of daily occupational exposure for workers, which Law 195/06 fixes at 87 dBA.

Lead (Pb) may affect humoral and cellular immunity, acting on lymphocytes as well as on granulocytes and monocytes. Cytokines and nitric oxide (NO) play a central role in the immune balance. In this study, plasma levels of nitrites and nitrates (NOx), IL2, IL4, IL6, IL10, TNF-alpha and INF-gamma, were measured in healthy workers with very low (Pb-B=3.2-18.0 microg/dL) and low (Pb-B=9.1-46.0 microg/dL) Pb-exposure compared to non-exposed workers. Low Pb-exposed workers (Pb-B=9.1 -46.0 microg/ dL) were found to have significantly higher plasma IL-10 levels, and tendentially higher plasma TNF-alpha levels compared to non-exposed workers. This is the first report of a significant increase of plasma IL-10 levels in Pb-exposed workers. Plasma IL-10 increase was influenced by blood Pb levels even after correction for main confounding factors. No difference was found in plasma NOx levels between Pb-exposed and non-exposed workers, which is in agreement with previous findings exclusively regarding groups in the general population. Low Pb-exposure can induce an increase of pro-inflammatory cytokines, such as TNF-alpha, with a consequent increase of other cytokines, such as IL-10, considered a T cell cross-regulatory factor, suggesting possible interference of Pb in the system of immunophlogosis.