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.

BACKGROUND:Healthcare professionals have an important role to play both as advisers-influencing smoking cessation-and as role models. However, many of them continue to smoke. The aims of this study were to examine smoking prevalence, knowledge, attitudes, and behaviours among four cohorts physicians specializing in public health, according to the Global Health Profession Students Survey (GHPSS) approach.MATERIALS AND METHODS:A multicentre cross-sectional study was carried out in 24 Italian schools of public health. The survey was conducted between January and April 2012 and it was carried out a census of students in the selected schools for each years of course (from first to fourth year of attendance), therefore among four cohorts of physicians specializing in Public Health (for a total of n. 459 medical doctors). The GHPSS questionnaires were self-administered via a special website which is created ad hoc for the survey. Logistic regression model was used to identify possible associations with tobacco smoking status. Hosmer-Lemeshow test was performed. The level of significance was P ≤ 0.05.RESULTS:A total of 388 answered the questionnaire on the website (85%), of which 81 (20.9%) declared to be smokers, 309 (79.6%) considered health professionals as behavioural models for patients, and 375 (96.6%) affirmed that health professionals have a role in giving advice or information about smoking cessation. Although 388 (89.7%) heard about smoking related issues during undergraduate courses, only 17% received specific smoking cessation training during specialization.CONCLUSIONS:The present study highlights the importance of focusing attention on smoking cessation training, given the high prevalence of smokers among physicians specializing in public health, their key role both as advisers and behavioural models, and the limited tobacco training offered in public health schools.

Although influenza vaccination is recognized to be safe and effective, recent studies have confirmed that immunization coverage among health care workers remain generally low, especially among medical residents (MRs). Aim of the present multicenter study was to investigate attitudes and determinants associated with acceptance of influenza vaccination among Italian MRs. A survey was performed in 2012 on MRs attending post-graduate schools of 18 Italian Universities. Each participant was interviewed via an anonymous, self-administered, web-based questionnaire including questions on attitudes regarding influenza vaccination. A total of 2506 MRs were recruited in the survey and 299 (11.9%) of these stated they had accepted influenza vaccination in 2011-2012 season. Vaccinated MRs were older (P = 0.006), working in clinical settings (P = 0.048), and vaccinated in the 2 previous seasons (P<0.001 in both seasons). Moreover, MRs who had recommended influenza vaccination to their patients were significantly more compliant with influenza vaccination uptake in 2011-2012 season (P<0.001). "To avoid spreading influenza among patients" was recognized as the main reason for accepting vaccination by less than 15% of vaccinated MRs. Italian MRs seem to have a very low compliance with influenza vaccination and they seem to accept influenza vaccination as a habit that is unrelated to professional and ethical responsibility. Otherwise, residents who refuse vaccination in the previous seasons usually maintain their behaviors. Promoting correct attitudes and good practice in order to improve the influenza immunization rates of MRs could represent a decisive goal for increasing immunization coverage among health care workers of the future.

To evaluate neuroendocrine and cardiovascular parameters of stress related to car racing, 24 healthy amateur drivers were studied both before and during a car race. For this purpose, we measured catecholamines and cortisol in urine and monitored the dynamic electrocardiogram (ECG). Urinary epinephrine (E) and norepinephrine (NE) increased significantly during the race, whereas dopamine (DA) remained unchanged and cortisol rose, but not significantly. Urinary excretion of E during the race increased in all drivers, and the increase was, on average, about fourfold that observed for NE and cortisol. A significantly lower NE/E ratio and significantly higher 10 E/DA and 10 NE/DA ratios were observed during racing. The percentage change in E excretion levels (from before to during the race) was positively related to anxiety scores. Continuous ECG Holter recordings in 6 out of the 24 volunteers showed heart rates of 76 to 152 beats/min over the 15 min before the start of the car race. During the race, heart rate reached a mean of 163.5 ±7.4 beats/min with a range of 146 to 180 beats/min. Except for sporadic ectopic beats, no significant arrhythmias, and S–T segment changes were observed in the electrocardiograms.

Objective: The aim of the present study is to evaluate the psychomotor performance of professional drivers in a field setting and in relation to certain variables, including age, behavioral factors, urinary levels of 6-sulfatoxymelatonin (aMT6s) normalized to urinary creatinine excretion, and the characteristics of the work shifts.Methods: The study was carried out on 16 professional male truck drivers aged 34-53 years. The drivers were submitted to the Vienna Reaction Test (RT) and Vienna Determination Test (DT) and provided urine specimens before and after 39 work shifts. They were also asked to record the road and traffic conditions (motorways, suburban and urban roads, traffic jams, visibility), duration, and mileage for each driving shift.Results: Using the 50th percentile as a cut point to arbitrarily categorize the performance measurements (Vienna RT reaction time and motor time, Vienna DT reaction time and number of correct reactions) into low and high performance levels, a direct relation emerged between the risk of low performance levels, as assessed by RT reaction time and motor time, and morning urinary levels of aMT6s categorized by tertiles. Before the driving shifts, the odds ratios of low performance levels (adjusted for start time and age) were 8.39 (95% confidence interval [CI]: 1.23-57.10) in the highest tertile compared to the lower tertile of aMT6s for RT reaction time and 4.15 (95% CI: 1.26-13.65) for RT motor time, respectively. After driving shifts, negative age-related effects on motor performance were detected. Multiple linear regression analyses, performed using early morning urinary aMT6s levels, age, and driving shift characteristics (start time, duration of driving shift) as predictors of performance measurements, showed aMT6s levels to be the primary independent predictor of RT reaction time before driving shifts and age as the primary predictor of RT motor time after driving shifts. No correlation was found between the risk of low performance levels as assessed by Vienna DT (reaction time and number of correct reactions) and aMT6s levels.Conclusions: Thewide interindividual variability of urinary aMT6s excretion observed before driving shifts and the direct association between aMT6s levels in the early morning and performance measurements suggest that the circadian typology of drivers should be taken into account when scheduling the work shifts of professional drivers.

La guida di un autoveicolo, specie in condizioni di intenso traffico o di cattive condizioni meteoclimatiche, e considerata uno dei principali fattori stressanti della vita odierna. Durante la guida si possono infatti osservare significative risposte simpatoadrenergiche e cardiovascolari con la comparsa anche di episodi coronarici. Tali risposte presentano un’ampia variabilita interindividuale in quanto sono influenzate da vari fattori (stile di vita, personalita etc.). In questa rassegna, vengono presentati i principali risultati degli studi da noi condotti sulle risposte psicofisiologiche indotte dalla guida di diversi tipi di autoveicoli. In conducenti di autobus urbani e stato registrato un sensibile aumento del tasso urinario di adrenalina durante il turno lavorativo rispetto alla stessa fascia oraria di un giorno di riposo. Tale risposta adrenergica era esaltata dall’abitudine tabagica e dall’assunzione di caffe e bevande alcoliche. In soggetti che alla guida di camion coprono lunghe distanze, i piu elevati tassi urinari di catecolamine e i piu alti livelli di frequenza cardiaca sono stati registrati quando la guida era particolarmente stressante per la presenza di nebbia o di intenso traffico. In soggetti che partecipano, a livello amatoriale, a manifestazioni agonistiche di velocita su pista, abbiamo osservato che durante la gara, rispetto al periodo pre-gara, l’escrezione urinaria di catecolamine aumenta in misura molto rilevante. Analogamente a quanto osservato in autisti di camion, l’attivazione del sistema adrenergico e risultata direttamente associata ai livelli di ansieta. Dall’elettrocardiogramma dinamico e emerso che durante la gara la frequenza cardiaca raggiunge un valore medio di 163.5±7.4 battiti/min. (range: 146,180 battiti/min.). Un significativo peggioramento della percezione visiva stereoscopica, con potenziale ricaduta negativa sulla performance dei guidatori, e stato osservato in studenti universitari esposti per 5 ore al complesso dei fattori stressanti propri dell’ambiente della discoteca. In un recente studio condotto su autisti di autocarri abbiamo altresi osservato, al termine del turno di guida, un rilevante incremento del trombossano urinario che potrebbe rappresentare un marcatore di rischio cardiovascolare.

A microbiological environmental investigation was carried out in ten dental clinics in Italy. Microbial contamination of water, air and surfaces was assessed in each clinic during the five working days, for one week per month, for a three-month period. Water and surfaces were sampled before and after clinical activity; air was sampled before, after, and during clinical activity. A wide variation was found in microbial environmental contamination, both within the participating clinics and for the different sampling times. Before clinical activity, microbial water contamination in tap water reached 51,200cfu/mL (colony forming units per milliliter), and that in Dental Unit Water Systems (DUWSs) reached 872,000cfu/mL. After clinical activity, there was a significant decrease in the Total Viable Count (TVC) in tap water and in DUWSs. Pseudomonas aeruginosa was found in 2.38% (7/294) of tap water samples and in 20.06% (59/294) of DUWS samples; Legionella spp. was found in 29.96% (89/297) of tap water samples and 15.82% (47/297) of DUWS samples, with no significant difference between pre- and post-clinical activity. Microbial air contamination was highest during dental treatments, and decreased significantly at the end of the working activity (p<0.05). The microbial buildup on surfaces increased significantly during the working hours. This study provides data for the establishment of standardized sampling methods, and threshold values for contamination monitoring in dentistry. Some very critical situations have been observed which require urgent intervention. Furthermore, the study emphasizes the need for research aimed at defining effective managing strategies for dental clinics.

PP-31-188 Background/Aims: Soft-tissue sarcoma is a rare neoplasia of the connective tissue with unknown etiology. Heavy metals and dioxins, which are also emitted by municipal solid waste incinerators, are among the environmental factors suspected to play a role in its etiology. We assessed the possible relation between long-term exposure to emissions of a municipal solid waste incinerator and risk of soft-tissue sarcoma in the Italian municipality of Reggio Emilia, through a population-based case-control study. Methods: We identified 50 cases of newly diagnosed sarcomas from 2001 to 2008, and we randomly selected 4 population controls for each case, matched for sex and age, of whom we geocoded residential history. We also identified 2 areas of the municipal territory with intermediate and high exposures to emissions of the solid waste incinerator. All this information was added to a Geographical Information System database, to assess exposure status of study subjects, and to calculate the associated relative risk (RR) of soft-tissue sarcoma in a conditional logistic regression model. Results: Three cases of soft-tissue sarcoma occurred among previously exposed subjects. Residence in 1 of the 2 exposed areas was associated with a RR of 0.52 (95% confidence interval [CI]: 0.12–2.37) at disease diagnosis and with a RR of 1.10 (95% CI: 0.28–4.35) 20 years before, after adjusting for educational attainment. When we limited the analysis to highly exposed subjects, we found a RR relative risk of 1.93 (95% CI: 0.32–11.71) at diagnosis and of 3.70 (95% CI: 0.72–18.97) 20 years before. No dose-response relation between exposure status and disease risk was detected. Conclusion: Overall, the risk of soft-tissue sarcoma was increased among subjects with high exposure to incinerator emissions, but risk estimates were statistically very unstable and no evidence of dose-response relation emerged. Larger studies are required to confirm a relation between emissions from waste incineration and incidence of soft-tissue sarcoma.

Within a research project on the role played by human factors on road accidents, the aim of the present study is to evaluate, in young adults, the relationships between driver behaviour and personality factors as well as to assess the neuroendocrine correlates of psychological and behavioural factors investigated. Another aim is to estimate in what measure the performance levels are affected by demographic, psychological and chronobiological variables. It has been found a positive relation between highway code violations, extroversion trait of personality and Sensation Seeking scores, so confirming that this component of personality can affect risky behaviour. Furthermore the subjects more oriented to morningness chronotype were found to be prone to adopt safe driving behaviour. Regarding the relations of the neuroendocrine parameters and driving behaviour a positive correlation was observed between dopamine levels and frequency of driving violations while a negative relationship was found between adrenaline levels and frequency of driving errors. In conclusion the identification of psycho-physiological variables related to driving risky behaviour might be a useful instrument to design traffic safety programs tailored to high risk subjects.

Excess exposure to the metalloid selenium (Se), a trace element with both toxicological and nutritional properties, has been implicated in the etiology of a human motor neuron disease of unknown origin and extremely severe prognosis, sporadic amyotrophic lateral sclerosis (ALS). This relation has been suggested on the basis of two epidemiologic investigations which found an increased risk of ALS associated with residence in a seleniferous area or with consumption of drinking water with unusually high levels of inorganic hexavalent Se, in South Dakota and in northern Italy respectively. Biological plausibility to a Se-ALS relation is provided by veterinary medicine observations and toxicological studies, showing that Se, particularly the inorganic forms, has a selective toxicity to motor neurons in swine and in cattle. Neurotoxic effects of Se species have also been demonstrated in laboratory studies and, for the inorganic forms, even at very low concentrations. Selenium has also been shown to affect muscle function in experimental animal models. Overall, these findings from the epidemiologic and the toxicological literature indicate that environmental Se, particularly in its inorganic forms and at unexpectedly low levels of exposure, might be a risk factor for ALS, suggesting the opportunity to further investigate this issue.

The latest developments of epidemiologic and biochemical research suggest that current upper limits of intake for dietary selenium and for overall selenium exposure may be inadequate to protect human health. In particular, recent experimental and observational prospective studies indicate a diabetogenic effect of selenium at unexpectedly low levels of intake. Experimental evidence from laboratory studies and veterinary medicine appears to confirm previous epidemiologic observations that selenium overexposure is associated with an increased risk of amyotrophic lateral sclerosis, and a recent large trial indicated no beneficial effect in preventing prostate cancer. Moreover, the pro-oxidant properties of selenium species and the observation that the selenium-containing enzymes glutathione peroxidases are induced by oxidative stress imply that the increase in enzymatic activity induced by this metalloid may represent at least in part a compensatory response. Taken together, the data indicate that the upper safe limit of organic and inorganic selenium intake in humans may be lower than has been thought and that low-dose chronic overexposure to selenium may be considerably more widespread than supposed.

Some contaminants emitted by municipal waste incinerators are believed to adversely affect reproductive health in the exposed populations; yet only limited and conflicting epidemiologic evidence on this issue has been provided so far. In this study we analyzed rates of spontaneous abortion and prevalence at birth of congenital anomalies in women residing or working near the municipal solid waste incinerator of Modena, northern Italy, during the 2003–2006 period and who experienced higher levels of exposure to polychlorinated dibenzo-p-dioxins and dibenzofurans, compared to the remaining municipal population. In women residing in two areas close to the incinerator plant with increasing exposure to dioxins, we did not detect an excess risk of miscarriage (relative risk [RR] 1.00, 95% confidence interval [CI] 0.65–1.48) and of birth defects (RR 0.64, 95% CI 0.20–1.55), nor did any indication of dose–response relation emerge. Among female workers employed in the factories located in the exposed areas, we did not observe a higher risk of spontaneous abortion (RR 1.04, 95% CI 0.38–2.30); however, an increase in prevalence of birth defects was noted (RR 2.26), although this risk estimate was statistically very unstable (95% CI 0.57–6.14). Overall, the study results provide little evidence of an excess risk of adverse pregnancy outcomes in women exposed to emissions from a modern municipal solid waste incinerator.

AIMS AND BACKGROUND:Hospital-referred subjects are widely used as controls in studies on the relation between diet and cancer risk. However, concern has been raised about the potential for bias of such type of referents, and few studies seem to have examined their reliability in estimating dietary habits of the underlying general population.METHODS:In a northern Italian setting, the differences in dietary patterns between 41 individuals referred for non-neoplastic lesions to hospital surgical outpatient units and age- and sex-matched subjects drawn from the general population were examined. The effects of such differences when carrying out a case-control study on a neoplastic disease, cutaneous melanoma, were also analyzed. Dietary intake was assessed using the EPIC food frequency questionnaire.RESULTS:Population controls showed higher intakes of energy, animal proteins and animal fats compared with sex- and age-matched hospital controls, whereas intake of carbohydrates and fiber was comparable. An excess melanoma risk associated with intake of animal proteins and fats emerged when hospital controls were used as the referent group, whereas no such relation was detected when cases were compared to population controls.CONCLUSIONS:The results suggest that hospital-referred subjects may not reflect dietary habits of the underlying general population and may be unsuitable for case-control studies concerning the relation between diet and cancer risk.

Background The present study assessed microbial contamination in Italian dental surgeries. Methods An evaluation of water, air and surface microbial contamination in 102 dental units was carried out in eight Italian cities. Results The findings showed water microbial contamination in all the dental surgeries; the proportion of water samples with microbial levels above those recommended decreased during working. With regard to Legionella spp., the proportion of positive samples was 33.3%. During work activity, the index of microbial air contamination (IMA) increased. The level of microbial accumulation on examined surfaces did not change over time. Conclusion These findings confirm that some Italian dental surgeries show high biocontamination, as in other European Countries, which highlights the risk of occupational exposure and the need to apply effective measures to reduce microbial loads.

We investigated the association of melanoma risk with food consumption in a northern Italian population in which disease risk was shown to correlate with linoleic acid and soluble carbohydrates intake. We collected information regarding the habitual consumption of 188 food items in 59 patients with newly diagnosed cutaneous melanoma and 59 sex- and age-matched population controls. In the unadjusted analyses, the intake of several foodstuffs directly or inversely correlated with melanoma risk. In multivariate analysis adjusting for several potential confounders, risk correlated directly with vegetable oil intake and inversely with consumption of crispbreads and rusks. Overall, most of the food items rich in linoleic acid and soluble carbohydrates were unrelated to disease risk. Despite the limited statistical precision of the point estimates, these findings seem to indicate that consumption of specific foods may influence melanoma risk.