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Biomedical subjects

F Toffoletto

Publications and source records attributed to F Toffoletto.

At least 37 records · Page 2Linked to original sources
PubMed1985

Reliability of urinary creatinine as a parameter used to adjust values of urinary biological indicators.

The values of biological indicators used in biological monitoring are usually determined on spot samples of urine. In order to reduce the variations due to dilution, it is common practice to correct the values according to reference parameters, such as urinary creatinine concentration and specific gravity. The aim of the present study was to verify whether creatinine possesses the necessary characteristics for adjustment. The levels of creatinine were not influenced by diuresis, but, contrary to what was expected, the values of the metabolite showed marked intra- and interindividual variations. These data raise serious doubts as to the validity of creatinine as a parameter that can be used for adjustment purposes, and suggest that it would be advisable to ascertain for each biological indicator whether in fact adjustment is of any use. Lastly, since there was only a slight correlation between creatinine levels and specific gravity values, it is concluded that these two parameters cannot be used indifferently for adjustment.

Adult↗
PubMed1985

Behaviour of biological indicators of cadmium in relation to occupational exposure.

Cadmium in blood (CdB), cadmium in urine (CdU) and beta 2-microglobulins (beta 2MU) were determined in 83 male workers exposed to cadmium fumes. CdU was measured both on 24-h urine samples and on spot samples. The behaviour of the biological indicators of cadmium was assessed in relation to degree of current exposure, length of exposure and cumulative exposure (computed as concentration of cadmium at the workplace multiplied by duration of exposure). CdB values were significantly higher in the subgroups of subjects with higher current cadmium exposure and in the subgroups of subjects with greater cumulative exposure, but the test levels were not influenced by duration of exposure. CdU levels were significantly higher in the subgroup of subjects with greater cumulative exposure, but were less influenced by current exposure or duration of exposure. Considering the entire population, a rather close correlation (r = 0.69) was observed between CdB and CdU. When the population was divided according to level of current exposure, a close relationship was observed between the two indicators in all subgroups; nevertheless, for identical CdU values, the CdB values were higher in the subjects with heavier current exposure. Even if in all Cd workers the beta 2MU levels were in the range of reference values, the highest beta 2MU levels were found in the subjects with CdU greater than 10 micrograms/l. The data confirm that CdU is prevalently influenced by the body burden of metal, but they also suggest that the CdB levels are not influenced solely by the intensity of current exposure but also depend to a considerable degree on the body burden.

Adult↗
PubMed1982

[Changes of hemoglobinemia during chelating therapy in lead poisoning].

The modifications of the Hb level of 32 subjects in which a lead poisoning occurred were studied during chelation therapy. 27 subjects showed a subclinical lead poisoning picture; 5 subjects suffered for a mild anemia. At the end of therapy, the mean Hb value of the whole group increased from 14.5 g/100 ml to 15.8 g/100 ml; the 5 subjects with anemia showed a remission and their mean Hb level increased from 12.3 to 15.1 g/100 ml. A group of 12 subjects with Hb values at the lower normal limits and 10 subjects with "apparently normal" values of Hb showed a significant increase in the Hb level following the treatment. The results obtained confirm the inhibitory activity exerted by lead on the heme synthesis also during preclinic lead poisoning and suggesting the opportunity of a constant evaluation of the Hb levels in order to decide the doses and the lengths of the chelation therapy and to lead the decision about the readmission to the working activity.

Adult↗
PubMedDate not supplied

[Ethical problems in health surveillance].

Surveillance of workers' health in the field of occupational medicine poses substantial ethical problems in view of occupational medicine's complex responsibilities towards workers and employers, preventive and protection services, workers' representatives, public healthcare and preventive medicine facilities, controlling agencies and judicial authorities. Potentially conflicting rights and duties often come into play in this sector. In the last few years various international and national bodies have drawn up codes of ethics or guidelines for the conduct of physicians in occupational medicine, three of which are of particular importance: 1) The International Ethical Code of the International Commission on Occupational Health (ICOH, 1992); 2) The Code of Conduct of the National Association of Company Doctors (ANMA, 1997); 3) The Technical and Ethical Guidelines for workers' health (ILO, 1998). The chief purpose of all these documents is to safeguard the health of workers and to guarantee the safety of the workplace by defining programmes of health supervision to match specific risks. The methods should be non-invasive and should allow for a check or efficiency. The physician is expected to have a high degree of professionalism and up-to-date skills; to be independent and impartial; to be reserved and capable of inter-disciplinary co-operation. On the basis of the above documents, a number of problematic aspects may be appraised concerning the relationship between the occupational health physician responsible for the surveillance activities of the local health authority and the relative company physician. The documents stress the importance of keeping up to date and of quality, fields in which the dominant role played by Scientific Societies is underlined. Finally it is recommended that health supervision be arranged in such a manner as to foster the professionalism and responsibility of the physician in charge rather than the formal implementation of health-care procedures that are inadequate and not in line with up-to-date scientific knowledge.

Ethics↗
PubMedDate not supplied

[Health surveillance: from risk presumption to risk assessment].

A working group of the Occupational Medicine and Industrial Hygiene Association of Lombardy, the National Association of Occupational Health Physicians the National Society of Prevention Operators made a paper in order to rationalize the sanitary surveillance, observing the laws in force and following the European Directives. The authors, thinking that everyday experience not very useful health examinations are carried out and that the sanitary surveillance should be planned according to the real working risks, give methodological directives about the way to make the mandatory clinical examinations less frequent, to the firms, to the occupational health physician and to the public occupational health operators of the local health units that must supervise the sanitary surveillance.

Humans↗
PubMedDate not supplied

[Proposal of environmental and biological monitoring and health surveillance of the exposed to inhalation anesthetics. Consensus. A Study Group on Occupational Exposure to Inhalation Anesthetics].

The Study Group on Occupational Exposure to Inhalation Anaesthetics of the Lombardy Association of Occupational Health and Industrial Hygiene prepared a document that was discussed during the Congress "Occupational Risks due to Inhalation Anaesthetics", held in Brescia, Italy, on May 12, 1992. The same document was then approved by the Directory Council of the Lombardy Association of Occupational Health and Industrial Hygiene. Data on environmental concentrations of Nitrous Oxide collected from 1989 to 1991 in 269 operating rooms of 47 hospitals in Lombardy are reported. The measured levels are considerably lower than those collected from the same Study Group from 1985 to 1987 in 111 operating rooms. The methodologies for exposure control are discussed, regarding both environmental and biological monitoring. These two techniques are complementary and can be used with standardized methods. The review of the literature on the early effects showed, even with some uncertainty at the current exposure levels, effects on liver and Central Nervous System. Still controversial are the data regarding the reproductive toxicity. Health surveillance programs have been organized in the last 5 years in 18 Lombardy hospitals and they indicate no cases of pathologies due to inhalation anesthetics on 1498 subjects. Operative proposals are suggested on the methodology and the frequency of environmental/biological monitoring and health surveillance. The "technical limit values" reported in the document from the Italian Ministry of Health are also discussed. Finally, research topics are suggested in order to assess the early effects of exposure.

Anesthesia, Inhalation↗
PubMedDate not supplied

[Occupational exposure to volatile anesthetics and reproductive effects: a bibliographic review of epidemiological studies].

Up to the early eighties, a variety of epidemiological studies suggest that chronic exposure to low doses of anesthetic gases, as occurs in operating rooms, is an occupational risk factor for spontaneous abortion and congenital defects. Numerous and more recent epidemiologic studies are reviewed; currently it is suggested that there is inadequate evidence to conclude that occupational exposure to anesthetic gases causes increased rates of spontaneous abortion or congenital anomalies. The improvement of environmental conditions, that has reduced airborne levels of anesthetic gases in operating rooms, has been critical in reducing the risk of abortion and congenital defects. In agreement with recent epidemiological reports, we believe that the health surveillance of exposed workers must include the study of pregnancy outcome.

Abnormalities, Drug-Induced↗
PubMedDate not supplied

[Health surveillance of workers].

The main purposes of the health surveillance of workers exposed to anaesthetic gases are: a) the finding of disorders either reliable to the exposure or incompatible with the activity in the operating theatre; b) the epidemiological evaluation of the late effects. Simple and rigorous methods to estimate the previous and the current risk are suggested. The main data to be collected during the medical examination are indicated. The registration of the data of the reproductive function by a protocol of recording is proposed. For the health surveillance of workers in Health Care Institution it's advisable to establish an interdisciplinary group, referring to a specialist on occupational medicine.

Anesthesia, Inhalation↗
PubMedDate not supplied

[Health surveillance of the exposed to anesthetics in the environment: a complete program of preventive medicine for health personnel].

Hospital workers often can be simultaneously exposed to several potentially hazardous (biological, chemical, and physical) agents. Consequently the environmental controls and the periodic health assessments must be overall and systematic, but not too frequent. The authors suggest the establishment of an interdisciplinary group, including: Hospital Management, Technical Staff, Occupational Physician, Occupational Health Nurses, Environmental Hygienists.

Adult↗
PubMedDate not supplied

[Proposal of a health education program].

Since 1987 at the Spedali Civili of Brescia the problem of anaesthetic gases pollution in operating surgery rooms was managed by means of periodical environmental monitoring and maintenance of the anaesthesiological equipments. The mean nitrous oxide concentrations were generally reduced to values below the limits indicated by the Italian Ministry of Health. On the contrary, a low participation of the operating room personnel was observed in the health surveillance program and this phenomenon is clearly evidenced by the progressive decrease of the number of medical examinations. In order to clarify the usefulness of health surveillance programs and to promote the adoption of "less pollutant" behaviour, a Health Education Program was planned by the Medical Administration, in collaboration with the Occupational Health Service and the Department of Anesthesiology and Intensive Care. This program will be performed at different times, including the administration of a questionnaire, the participation at information meetings, the distribution of brochures and the evaluation of environmental and biological exposure data before and after the education program.

Anesthesia, Inhalation↗
PubMedDate not supplied

[Determination of interleukin-8 in induced sputum of workers exposed to low concentrations of asbestos].

The concentration of interleukin-8 (IL-8) in the induced sputum of 17 workers exposed to low airborne asbestos levels and of 10 controls was determined. IL-8 levels were statistically significantly increased in the asbestos exposed group compared to controls. This finding underlines the usefulness of the study of proinflammatory mediators as possible predictors of alveolar damage.

Asbestos↗
PubMedDate not supplied

[Characterisation of an HBsAg mutant of hepatitis B virus (HBV) isolated from a dialysed patient involved in an occupational accident].

BACKGROUND: Mutants of the hepatitis B virus (HBV) following vaccination (escape mutants) have been isolated over the course of the last decade. They consist most commonly of an aminoacid change from glycine to arginine at position 145 of the highly antigenic a determinant of the surface antigen (HBsAg). OBJECTIVE: Description of an escape mutant of HBV identified in the course of the post-exposure follow-up of a percutaneous exposure. METHODS: The viral DNA was extracted from serum samples of a dialysed patient vaccinated against hepatitis B, who developed an acute infection. A direct sequencing was performed on the amplified DNA followed by a sequence analysis. RESULTS AND CONCLUSIONS: A threonine to lysine substitution at position 118 of HBsAg (Thrll8Lys) was observed in the analysed viral aminoacid sequence. Such mutation could have significantly changed the antigenic profile of the HBsAg compared to that of the wild type.

Accidents, Occupational↗