**4. Workplace interventions**

The particulate matters IR pathophysiologic mechanisms are rather similar to the ones involved in heavy metal exposure: obesity risk increase [183], enhancement of inflammation, with higher plasma levels IL8, ICAM‐1 or eosinophilic cationic protein [184], endoplasmic reticulum stress and insulin signalling interference in a dose‐response manner [172]. Reduction in antioxidant defence is supported by both experimental on cell lines and from the increased effect on per‐ sons with GSTM1 null alleles [184]. Disruption of metabolic genes has also been reported [185]. Several studies proposed a link between genetic variants of ABO locus; particulate exposure and IR risk [186]. When occupational exposure to particles (particularly to asbestos, weld‐ ing fumes, respiratory irritants) was added to the epidemiological model, the risk of group O subjects was enhanced [187]. There is no conclusive explanation about this association, but ABO antigens are expressed also on the von Willebrand factor, presumably increasing the pro‐ thrombotic and chronic inflammation risk [188] and the ABO locus is related to the E‐selectin,

*Cardio‐vascular and ECG modifications*: Controlled particulate exposure showed high sys‐ tolic [189] (or high systolic and diastolic increase [172] according to the type of particle), decreased of blood plasminogen and thrombomodulin, and an increase in the inflamma‐ tory markers: CRP and serum amyloid [190]. Diesel exhaust double‐blind experiment mean peak effect on systolic blood pressure increases between 30 and 60 min. after exposure and remained high 24 h after, independent of metabolic syndrome previously existing compo‐ nents. Interestingly, in this experiment, the increase in blood pressure was not related to perception of exposure [189]. Persons with metabolic syndrome exposed to ultrafine par‐ ticles and GSTM1 null allele are particularly at risk of altered repolarization and increased

*Clinical approach*: Indoor air pollution measurement is part of the occupational safety pro‐ cedures and whenever data are available there should be transmitted to the occupational physician. The detailed occupational anamnesis, symptoms, clinical examination and existing

For heavy metals exposure, biological monitoring is recommended in workplaces or occu‐ pations at risk. The biological monitoring is included in the national recommendations for occupational medicine practice in many countries. The limit values of the exposure indicators are defined for chronic poisoning. On what concerns the metabolic risk, there is no threshold limit established yet and general population data suggest that lower limits than those for chronic poisoning would be a reasonable approach. We cannot conclude this topic, until well‐ designed studies to address this specific objective are conducted. On the other hand, until these studies are available and taken into consideration the increasing incidence of insulin resistance worldwide, efforts to reduce this non‐classical risk factor should not be postponed. A special concern is related to the maternal and foetal risk and to the gestational diabetes. Ideally, pregnant women should not be exposed to chemicals; if environmental contamina‐ tion is not easy to avoid, at least the occupational one should be limited. Besides the negative effects of chemicals on the foetus development, the increased risk of gestational diabetes adds

ICAM‐1 and TNF‐α blood level [186].

exposure indicators orient the medical conduct.

unfavourable short‐ and long‐term consequences.

QT duration [191].

122 Occupational Health

As insulin resistance implication is better understood, and its prevalence increases worldwide, the number of interventions that have been published in last decade has also increased. Most of them, even if they directly target insulin resistance are better known as workplace wellness programmes. In countries were private insurance is paid by the employer, they could be a mean to reduce the insurance plans; in others, where work‐promotion activities are more and more valued by the companies, they are conducted either as a channel to encourage individu‐ als to take preventive measures through education and screening or as employment‐based activity to promote health behaviours and disease management, such as stress management, adjustable work station to reduce continuous sitting, team support groups and cafeteria/can‐ teen provision of healthy food initiatives. Although very diverse, there are however some general characteristics of these interventions:


a proactive participation of the line and human resource management. Of course, there are some universally interventions for mental health [167], but they should be aligned with other managerial and organizational initiatives [168].

