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OBJECTIVE: To investigate liver function in vinyl chloride workers and assess its relation with current/past occupational exposure to vinyl chloride monomer (VCM). METHODS: A medical examination including the execution of liver function tests (LFTs) and liver ultrasonography was executed in a group of 757 workers with a long-standing service in the production of VCM/polyvinylchloride (PVC). Cumulative and maximum VCM exposures were calculated. History of viral hepatitis and alcohol intake were carefully investigated. Regression analysis explored the association between abnormal LFTs and a group of possible determinants (VCM cumulative and maximum exposure, BMI, age, history of viral hepatitis, alcohol and triglyceride levels). Also, synergistic effect between VCM and a history of hepatitis was analysed, as well as the possible association between VCM exposure and aspartate aminotransferase/alanine amino transferase (AST/ALT) ratio >1. Distribution of abnormal LFTs was also assessed in relation to the results provided by liver ultrasonography. RESULTS: The most frequently abnormal serum parameters were, in decreasing order: total cholesterol (27.3%), triglycerides (12.2%), total bilirubin (9.1%), gamma glutamil transpeptidase (GGT; 9.0%) and ALT (8.2%). The AST/ALT ratio >1 was present in 28.1% of workers. Abnormal LFTs were not found to be associated with current or past VCM exposure. High ALT resulted positively associated with BMI, AST with alcohol intake, GGT with alcohol intake and triglycerides. No synergistic effect on LFTs of exposure to VCM and a history of hepatitis was observed. The AST/ALT ratio >1 was not found to be associated with VCM exposure. The prevalence of abnormal LFTs was higher in case of liver steatosis (ALT) or periportal fibrosis (GGT), but not in case of pure hepatomegaly, as documented by ultrasonography. CONCLUSIONS: Liver function assessment only including LFTs is not able to detect VCM-induced liver damage, but reveals alterations due to non-occupational factors, such as dietary and/or metabolic disfunctions. The LFTs are however of importance to detect conditions that could recommend avoidance of exposure to VCM and are useful for medical counselling and health promotion purposes.

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This study was carried out to define reference values for urinary ethylenethiourea (ETU) in the Northern Italy population and to identify the sources of exposure. Ninety-five healthy subjects were selected. A spot urine sample was collected in the morning, and analyzed using GC/MS in the EI/SIM mode. Thirty-nine subjects showed urinary ETU concentrations lower than the limit of detection (LOD, 0.4 microg/g creatinine), and the remainders ETU concentrations ranging from 0.5 to 11.6 microg/g creatinine. No correlation was shown between smoke or alcohol intake and urinary ETU concentrations. Based on data on ethylene-bis-dithiocarbamate (EBDC) concentrations in food, we estimated a total EBDCs intake of 31.7-50.1 microg/day. These values are largely below the ADIs, but explain the presence of small amounts of ETU in the urine samples we have analyzed. Finally, it was estimated that the mean ETU in urine in the Italian general population is 0.6-0.8 microg/g creatinine, with a 95th percentile of 4.5-5.0 microg/g creatinine. These values can be used as reference, to compare the results of biological monitoring activities carried out on EBDCs occupationally and environmentally exposed populations.

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In the framework of the EXPOLIS study in Milan, Italy, 48-h carbon monoxide (CO) exposures of 50 office workers were monitored over a 1-year period. In this work, the exposures were assessed for different averaging times and were compared with simultaneous ambient fixed-site concentrations. The effect of gas cooking and smoking and different methods of commuting on the microenvironment and exposure levels of CO were investigated. During the sampling the subjects completed a time-microenvironment-activity diary differentiating 11 microenvironments and three exposure influencing activities: gas cooking, smoking and commuting. After sampling, all exposure and time allocation data were stored in a relational database that is used in data analyses. Ambient 48-h and maximum 8-h distributions were similar compared to the respective personal exposures. The maximum 1-h personal exposures were much higher than the maximum 8-h exposures. The maximum 1-h exposures were as well higher than the corresponding ambient distribution. These findings indicate that high short-term exposures were not reflected in ambient monitoring data nor by long-term exposures. When gas cooking or smoking was present, the indoor levels at "home-" and in "other indoor" microenvironments were higher than without their presence. Compared with ambient data, the latter source was the most affective to increase the indoor levels. Exposure during commuting was higher than in all other microenvironments; the highest daily exposure contribution was found during "car/taxi" driving. Most of the CO exposure is acquired in indoor microenvironments. For the indoor microenvironments, ambient CO was the weakest predictor for "home indoor" concentrations, where the subjects spent most of their time, and the strongest for "other indoor" concentrations, where the smallest fraction of the time was spent. Of the main indoor sources, gas cooking, on average, significantly raised the indoor exposure concentrations for 45 min and tobacco smoking for 30 min. The highest exposure levels were experienced in street commuting. Personal exposures were well predicted, but 1-h maximum personal exposures were poorly predicted, by respective ambient air quality data. By the use of time-activity diaries, ETS exposure at the workplaces were probably misclassified due to differences in awareness to tobacco smoke between smokers and nonsmokers.

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Exposure analysis is a crucial part of effective management of public health risks caused by pollutants and chemicals in our environment. During the last decades, more data required for exposure analysis has become available, but the need for direct population based measurements of exposures is still clear. The current work (i) describes the European EXPOLIS study, designed to produce this kind of exposure data for major air pollutants in Europe, and the database created to make the collected data available for researchers (ii) reviews the exposure analysis conducted and results published so far using these data and (iii) discusses the implications of the results from the point of view of research and environmental policy in Europe. Fine particle (with 37 elements and black smoke), nitrogen dioxide, volatile organic compounds (30 compounds) and carbon monoxide inhalation exposures and exposure-related questionnaire data were measured in seven European cities during 1996-2000. The EXPOLIS database has been used for exposure analysis of these pollutants for 4 years now and results have been published in approximately 30 peer-reviewed journal papers, demonstrating the versatility, usability and scientific value of such a data set. The multipollutant exposure data from the same subjects in the random population samples allows for analyses of the determinants, microenvironments and sources of exposures to multipollutant mixtures and associations between the different air pollutants. This information is necessary and useful for developing effective policies and control strategies for healthier environment.

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Current air pollution levels have been shown to affect human health. Probabilistic modeling can be used to assess exposure distributions in selected target populations. Modeling can and should be used to compare exposures in alternative future scenarios to guide society development. Such models, however, must first be validated using existing data for a past situation. This study applied probabilistic modeling to carbon monoxide (CO) exposures using EXPOLIS-Milan data. In the current work, the model performance was evaluated by comparing modeled exposure distributions to observed ones. Model performance was studied in detail in two dimensions; (i) for different averaging times (1, 8 and 24 h) and (ii) using different detail in defining the microenvironments in the model (two, five and 11 microenvironments). (iii) The number of exposure events leading to exceeding the 8-h guideline was estimated. Population time activity was modeled using a fractions-of-time approach assuming that some time is spent in each microenvironment used in the model. This approach is best suited for averaging times from 24 h upwards. In this study, we tested how this approach affects results when used for shorter averaging times, 1 and 8 h. Models for each averaging time were run with two, five and 11 microenvironments. The two-microenvironment models underestimated the means and standard deviations (SDs) slightly for all averaging times. The five- and 11-microenvironment models matched the means quite well but underestimated SDs in several cases. For 1- and 24-h averaging times the simulated SDs are slightly smaller than the corresponding observed values. The 8-h model matched the observed exposure levels best. The results show that for CO (i) the modeling approach can be applied for averaging times from 8 to 24 h and as a screening model even to an averaging time of 1 h; (ii) the number of microenvironments affects only weakly the results and in the studied cases only exposure levels below the 80th percentile; (iii) this kind of model can be used to estimate the number of high-exposure events related to adverse health effects. By extrapolation beyond the observed data, it was shown that Milanese office workers may experience adverse health effects caused by CO.

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A wide range of studies concerned with analytical methods for biological monitoring of exposure to pesticides is reviewed. All phases of analytical procedures are assessed, including sampling and storage, sample preparation and analysis, and validation of methods. Most of the studies aimed at measuring metabolites or unchanged compounds in urine and/or blood as biological indicators of exposure or dose. Biological indicators of effect, such as cholinesterase, are also evaluated. The principal groups of pesticides are considered: organophosphorus pesticides, carbamate pesticides, organochlorine pesticides, pyrethroid pesticides, herbicides, fungicides and other compounds. Choice of the method for biological monitoring of exposure depends on the study population: a detection limit of 1 microg/l or less is required for the general population; higher values are adequate for occupationally exposed subjects. Interpretation of results is also discussed. Since biological indices of exposure are only available for a few compounds, biological reference values, established for the general population, may be used for comparison with levels of professionally exposed subjects.

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