Abstract: The influenza illness is a concern for health care workers (HCW) due to the potential nosocomial transmission and sickness absenteeism. Immunization and Isolation Precautions might be effective preventive measures.
Abstract: Nosocomial transmission of varicella-zoster virus, certain paramixovirus and rubivirus might pose a risk of morbidity for varicella (V), rubella (R), mumps (Mu) and measles (Me) in health care workers (HCW), patients and coworkers. International literature and European legislation recommend preventive interventions to minimize the risk.
Abstract: Transmission of infections from healthcare workers to patients during clinical activities has been an issue for at least twenty years. Studies and general considerations on this topic have brought to consensus documents, guidelines and public health policies, that were sometimes different depending on which social and cultural backgrounds they referred to. Though crucial, this issue remains nowadays not completely resolved, especially if we consider that no agreement has been found on how to face the problem. In this complex framework a question arises about the potential role of the occupational physician. We are talking in fact about a risk that, though present in the working environment, does not directly involve the workers themselves, but rather the people the healthcare workers get in contact with. We may say it is not only a problem of occupational medicine, but rather an issue involving medicine in working environment. This is a real challenge for those who deal with job healthcare and security, even if it is fundamental to fully understand how to face it. After a synthesis of the problem in its conceptual and quantitative dimensions, we now offer some new food for thought and outline some operating clues for the occupational physician too, as a contribution for a common and effective solution.
Abstract: Tuberculosis (TB) is still a threat for healthcare workers (HCW), due to the non decreasing incidence, the spread of drug-resistance, the introduction of new tests for the screening, the relevant costs of surveillance of exposed subjects. These issues implicate a revision of activities to prevent TB in health-care settings.
Abstract: The biological risk from exposure to bloodborne pathogens in health care environments represents a frequent and widespread risk, involving a large number of exposed workers. On the basis of the available scientific innovations, the recent legislation regarding health and safety of workers and the experiences of SIMLII guidelines on health surveillance (HS) workers exposed to biological risk, a multicenter study was carried out, involving nine relevant hospitals and about 32 000 healthcare workers (HCW). A review of the literature was performed, with particular reference to the last 10 years. For each hospital, protocols of HS have been examined according to tasks and biological risk from bloodborne viruses (HBV, HDV, HCV, HIV) as well as management of HCW infected with this pathogens. Differences of risk management in the hospitals, in relationship also with recommendations of the literature have been evaluated. The literature supplies important indications for HS management of HCW exposed to bloodborne pathogens, with relevant information also for patient safety. Preventive examinations are in line with the recommendations of literature and similar across the hospitals for HCV and HIV, while they are different for HBV. Periodic surveillance was different for the frequency, among the hospitals and also as compared to national SIMLII guidelines. As for management, no differentiation among the hospitals was detected as referred to different risk of exposure, while differences were observed around definitions of restrictions. Finally, good medical practices to support occupational physicians in the prevention and management of HCWs' exposed to biological risks are suggested.
Abstract: The purpose of this study is to assess the risk of medical malpractice litigation for Italian radiologists, compared with the corresponding data in the literature.
Abstract: The hospital risk assessment (VdR) is certainly a relevant issue concerning the activities of prevention for the health of healthcare workers in relation to biological risk. The aim of this paper is to provide an up-date of the issue, based on the suggestions of recent literature about the rules ratified by the new legislative decree and data supplied by the Group of 10 Hospitals participated in this multicenter study. From the analysis of data on healthcare settings (HCS) participating in the project the following considerations can be formulated: i) All HCS considered VdR from biological agents. The method recommended in the Guidelines SIMLII 2005 is the most followed ii) To grading the risk, the use of invasive procedures for carrying out the analysis results is a necessary element iii) the operators classified as exposed to biological risk, and therefore subject to health surveillance, represent almost all of workforce in 7 out of 10 HCS. The subgroup believes that VdR must be conducted in close collaboration with the occupational physician and should represent a worthwhile investment with spin-off character on prevention, decision making, empowering. The presence of environmental requirements and organizational procedures should be considered, so that HCS is enabled for an effective risk management, without which risk assessments cannot be performed. The method of VdR mentioned in the guidelines MLIS 2005, besides being the most widely used by the company participating in the study, still has practical reasons and opportunities to justify its use. The HCS group felt the need to propose an implementation of the definition of invasive procedures and EPP, together with individual assessment. Flexibility was suggested in identifying different levels of risk with the involvement of occupational physicians, especially in the presence of EPP, also in order to plan content and frequency of health surveillance.
Abstract: Organizational justice is a construct defining the quality of social interaction at work. Organizational justice can be divided into three categories: procedural justice (fairness of the decision-making procedures), distributive justice (fairness of outcomes) and relational justice (equity and fairness in the interpersonal treatment of employees by their supervisors). Organizational justice is related to employees' health and well-being. Low perceived justice has been shown to be associated with experienced stress reactions and related physiological and behavioral reactions, such as inflammation, sleeping problems, cardiovascular regulation and cognitive impairments, and with a high rate of work absenteeism. This paper is a review of the literature on organizational justice and its impact on workers' health.
Abstract: The concept of the "impaired physician" is an oxymoron. Physicians are by definition bearers of health, which can lead to overlooking the possibility of them contracting an illness that reduces their diagnostic and therapeutic abilities, with a consequent danger to their patients' health. The clinical reasons for which a radiologist may constitute a danger to patients can be divided into two categories: infectious blood-borne diseases, which can be transmitted to the patient during interventional radiology procedures; and neurodegenerative and psychiatric disorders, including alcohol and drug abuse, which temporarily or permanently impair the faculty of judgement. All radiologists have a duty to periodically verify their own state of health and seek help as soon as possible when they fear it may be a danger. This individual responsibility towards one's own patients is flanked by the health and safety requirements provided by European regulations for radiologists who are employers, directors or department heads. The occupational health physician plays a key role in identifying and managing the impaired radiologist.
Abstract: In radiological practice, as in any medical activity, errors are inevitable despite being foreseeable and preventable. The approach to managing medical error and relations with patients prompt the need for resolving the ethical dilemma arising from conflicting legitimate interests. The solution to this dilemma is particularly complex in an environment in which the tendency to sue physicians for civil liability or incriminate them for criminal liability appears to be particularly high. The disclosure of error is undeniably useful in raising patient awareness, reducing their suffering, improving the quality of care and limiting the consequences of the damage. There does not appear to be any evidence to suggest disclosure modifies the probability of litigation against the physician.
Abstract: This study sought to evaluate professional satisfaction among Italian radiologists and identify what personal characteristics of radiologists and features of their work and work setting affect job satisfaction.
Abstract: Assaults against health care workers and musculoskeletal disorders are two significant issues for occupational health physicians. Training (the most common form of proposed intervention) by itself is not effective in reducing adverse effects.
Abstract: The evaluation of diagnostic accuracy of new in vitro diagnostic assays for tuberculosis infection has been hampered by the lack of a standard reference test. The aim of this study was to compare sensitivity and specificity of interferon gamma assays for latent tuberculosis infection by assessing the association of test results with tuberculosis occupational exposure and by using latent class analysis. We analysed data from 115 healthcare workers on whom tuberculin skin test (TST) and the following in vitro tests were performed: in-house ELISPOT for RD1 proteins, T.SPOT-TB and Quantiferon-TB Gold. Results of all tests were associated with increased occupational risk of exposure to Mycobacterium tuberculosis, but only TST was associated with Bacillus Calmette-Guerin (BCG) vaccination. Sensitivity/specificity (95% confidence intervals) estimated by a latent class model were: 99.9%/64.2% (53.0-74.1) for TST, 95.3% (61.8-99.6)/87.5% (78.0-93.2) for in-house ELISPOT, 96.7% (69.3-99.7)/85.6%(75.3-92.0) for T.SPOT-TB, and 76.3% (55.9-89.1)/93.6% (85.4-97.3) for Quantiferon. The estimated specificity of in vitro assays was higher than that of TST also among individuals who were not BCG-vaccinated. In conclusion, when used in healthcare workers, in vitro assays may provide a significant increase of specificity for tuberculosis infection compared to TST, even among non vaccinated individuals, at the cost of some sensitivity.
Abstract: One of the causes of the increasing request for radiological examinations occurring in all economically developed countries is the active role played by the patient-consumer. Consumerism places the radiologist in an ethical dilemma, between the principle of autonomy on the one hand and the ethical principles of beneficence, nonmaleficence and justice on the other. The choice made by radiologists in moral dilemmas is inspired by an adherence to moral principles, which in Italy and elsewhere refer to the Judaeo-Christian tradition or to neo-Darwinian relativism. Whatever the choice, the radiologist is bound to adhere to that choice and to provide the patient with all the relevant information regarding his or her state of health.
Abstract: This study explored the relationship between individual characteristics, physical and psychosocial work-related risk factors and the musculoskeletal pain among non-specialized personnel working in different kinds of social care.
Abstract: The aim of this study was to analyse malpractice claims in mammography, estimate the specific risk of future claims and assess their impact on radiologists and society.
Abstract: Italian Law 81/08 (so-called "Unified Text of Laws on Health and Safety at Work"), came into force on 15 May 2008 and incorporates provisions related to medical surveillance of drug and alcohol dependency at the workplace.
Abstract: The aim of this review is to describe the state of the art of the assessment of psychosocial risk at work in Italy. Questionnaires for such assessment can be divided into four broad categories: a) those aimed at identifying work-related stress factors and assessing work organization; b) those that investigate the individual's perception of stress; c) those assessing mediating factors; and d) those that measure the effects of stress. For a complete picture of psychosocial risk at work, all these factors should be taken into account. However, lack of time and resources available for the practice of occupational medicine imposes the choice of simple questionnaires that are quick and easy to administer. A vast range of options is available in the literature. This gives rise to the need for multicenter trials to be set up and for research methods to be standardized. It is strongly recommended to use questionnaires published in the international literature which have a validated Italian version with adequate psychometric validity index and standardized methods of administration.
Abstract: Health care workers are exposed to a wide range of musculo-skeletal hazards: manual loading (nurses, ancillary personnel, blue-collars), body posture (technicians, physicians, nurses, blue-collars), repetitive motions (clerks, blue-collars, technicians). An integrated management approach to tackle musculoskeletal disorders (MSDs) was proposed in three health care organizations. An action programme, including participatory modification of tasks and jobs, and early identification and treatment of MSDs cases has been implemented, following a proper assessment of the hazards and risks. Participatory ergonomics programs proved to be effective in reducing absence rate and prevalence of workers with reduced work capacity, and in increasing workers' job satisfaction.
Abstract: A descriptive exploratory survey was used to investigate the occurrence of physical workplace violence among health care workers as well as the complaints and responses to such violence. The questionnaire was used for collecting data from a sample of 355 workers. Results showed that 25.6% of hospital workers reported physical aggression at any time of the working life, 8.5% in the last year. Injured workers showed significantly higher environmental complaint score than other workers. The results of the study indicated the importance of adopting hospital policies for dealing with incidents of violence.
Abstract: Job satisfaction is an important determinant of wellbeing and a moderator of stress at work. The Warr's Job Satisfaction Scale (JSS) is probably the most used questionnaire to assess job satisfaction. The aim of this paper is to evaluate the Italian version of the JSS. The questionnaire has been distributed to 632 health care workers. Results show that the Italian version of JSS has good reliability (Cronbach's alpha = 0.94). Principal component analysis revealed that a significant percentage of the variance (52%) was explained by a single factor which included all the 16 items. Varimax orthogonal rotation yielded the same two factors observed in the original questionnaire: intrinsic and extrinsic job satisfaction. The JSS may be an useful tool in the assessment of psychosocial risk at work.
Abstract: The Work Organisation Assessment questionnaire (WOAq) has been translated into Italian, back-translated, and modified. Data were collected from 160 health care workers and 50 white-collar bank employees. Employee wellbeing was assessed by the General Health Questionnaire (GHQ12), while work stress was assessed by the Karasek's Job Content Questionnaire (JCQ). Reliability, as measured by Cronbach's alpha, was very good (0.95). Principal component analysis revealed that a significant percentage of the variance (41.8%) was explained by a single summative factor which included 25 of the 28 items. Varimax orthogonal rotation yielded the same five factors observed in the original questionnaire (reward and recognition, quality of relationship with management, quality of physical environment, quality of relationship with colleagues, workload). The WOAQ sum score was positively related to social support, as measured by the Karasek's JCQ (Spearman's rho = 0.523; p < 0.001). It was negatively related both to job strain (Spearman's rho = -0.516; p < 0.001) and psychological distress GHQ (Spearman's rho = -0.365; p < 0.001). In conclusion, the Italian version of WOA maintains the original characteristics. The questionnaire has strong association with job stress and employee wellbeing, and it may be useful in risk assessment procedures.
Abstract: The potential risk factors for sick building syndrome (SBS) are not yet well elucidated. A questionnaire was administered concerning environmental conditions at the work place and complaints before and after the take-over of one company from another corporation. Workers had to move into new company, but were still working in old office building. Before the change, environmental objective and subjective conditions and workers' wellbeing were within normal range. The change did not involved air quality, however results of the questionnaire demonstrated an increased irritation of the mucous membranes and a reduction of well-being. The level and severity of symptoms appeared to be related to perceived indoor environment quality, and depression score. High stress related to work changes was found to be significantly associated with SBS symptoms. The psychosocial work environment can be an important predictor of SBS symptoms.
Abstract: Workplace assessment is a critical issue in small firms, and even in bigger ones if workers are scattered in large working areas. The traditional "top-down" approach, based on centralized risk assessment and hardly understandable documents, may have limited impact on workers' safety behaviour. The Local Sanitary Unit RMF tried to improve workers' participation to risk assessment, through auditing techniques. Waste workers signalled occupational condition of biological and chemical risk, which had not been taken into account in the Corporate Risk Assessment Document. The participatory approach to workplace risk assessment proved to be an easy and not expensive method to increase workers' awareness of risk and compliance to hygienic measures.
Abstract: The occupational health physician charged of medical surveillance of hospital workers is often mandated to manage impaired physicians. Some "red flags" may be observed during medical surveillance of workers, and this should elicit the suspect that the colleague is impaired by chemical, psychiatric, or neurological disease. Three emblematic cases are discussed. While English-speaking countries have faced the problem since the 70's, Italy currently lacks policy to deal with impaired physicians.
Abstract: Radiology is among the specialties with an increasing risk of litigation. Regardless of the outcome of legal proceedings, physicians who are sued usually perceive the claim as an assault on their integrity and may suffer psychological or physical effects known as "malpractice stress syndrome".
Abstract: Participatory techniques have been adopted in vigilance of Civitavecchia's port activities, in order to control and remove injury causes. Injuries were studied by small participatory groups of port workers. As an example, seafastening operations were analyzed. The project team encouraged the workers to design ergonomic measures, or to modify work organization. Workers made suggestions and presented their points of view, that were reported to management for implementation.
Abstract: Nurses and physiotherapists who work in a Rehabilitation Centre are exposed to biologic hazards due to the close physical contact they have with their patients, who are often affected by contagious infectious diseases. The perceived risk amongst these workers is a significant element in establishing an effective prevention plan and in evaluating educational needs and was therefore investigated in this survey. An anonymous self-administered questionnaire, structured in four subsections for a total of twenty four multiple-choice questions was used. The evaluated variables included knowledge of pathogen transmission pathways, modes of exposure to such pathogens, knowledge of universal precautions and of ways in which to deal with known exposure. Physiotherapists, more so than nurses, have a partial and insufficient knowledge of biologic hazards. The main reason for this gap can be found in the school curriculum for such professionals, in which, in comparison to other graduate degree courses (medicine, nursing) a much smaller amount of course time is allotted to the topic of biologic hazards and risk prevention. In order to practice effective risk management it is therefore necessary for the employer to commit to providing specific on-site education and training to its workers. For this purpose, our centre has developed specific educational activities and internal procedures which can be shared on the topic of biologic hazards and risk management.
Abstract: Complaints and symptoms related to the indoor environment experienced by 3380 workers were collected from 26 workplaces by using the Italian modified version of the Swedish questionnaire MM-040 and the Finnish IAQ-Indoor Air Quality questionnaire. Complaints related to environmental factors, and air related symptoms, were common in indoor workers. Women reported work related symptoms more often than men, the difference being significant. The Indoor Air Quality questionnaire is a suitable tool for the occupational health physician in investigating indoor air problems. In the Italian version six general symptoms were added to the symptom scale, in order to make the questionnaire feasible for analysis of general health, during medical surveillance at work.
Abstract: The etiology of systemic sclerosis, probably multifactorial, is not yet well defined. Among the many endogenous and exogenous factors probably involved, occupational elements may play an essential role. Here we report a cluster of local scleroderma and systemic sclerosis, which occurred in a small group of typography workers exposed to polyvinyl-acetate glues, containing up to 1% of vinyl-acetate. Vinyl acetate exposure has been associated with acidification of the intracellular environment, which is thought to produce cytotoxic and/or mitogenic responses that are the sentinel pharmacodynamic steps toward cancer. Autoantibody production in systemic sclerosis depends upon intracellular acidification. More studies are needed to clarify the relationship between vinyl acetate exposure and scleroderma.
Abstract: Stalking is a form of interpersonal victimization that can have irrevocable effects on the lives of victims but is frequently misunderstood and minimized. This article presents a case study of a woman who was stalked in the workplace by a 39-year-old male colleague, and offers recommendations for occupational health clinicians charged of medical surveillance of workers (so-called "Competent Physicians") who have to cope with stalking at the workplace. The prevalence of stalking provides many opportunities for Competent Physicians to intervene, but first they must recognize and understand the problem. The study underlines the inadequacy of the current legal and medical responses to the needs of these victims.
Abstract: A 39 year male pharmaceutical worker employed in a clean-room developed in 2003 acute dysphonia after environmental disinfection with glutaric aldehyde and isopropyl alcohol. Laryngoscopic examination showed glottis edema; the syndrome healed after a cycle of cortisone. In subsequent years, withdrawal from exposure to irritating chemicals was observed. The worker, however, complained for recurrent episodes of dysphonia, in the absence of abnormalities of the larynx, and gradually developed intolerance for perfume, solvents, and other smelling substances. He came to our observation in 2007, showing strong conviction that occupational exposure had a causative effect in his complaints. He was working in an office open to public, and fragrance exposure appeared to be the main cause of dysphonic episodes. We rejected the hypothesis of association between complaint and job exposure, and advised him to work in a well defined working situation, such as in a clean room, where chemical contamination may be effectively controlled over time.
Abstract: Occupational stress is currently studied by the Job Demand/Control model of Karasek, and the Effort/Reward Imbalance model of Siegrist. In this study we have translated into Italian and validated the short form of the Job Content Questionnaire (JCQ) and of the Effort Reward Imbalance Questionnaire (ERI). The questionnaires were applied to 531 health care workers during periodical medical examinations. Estimations of internal consistency, based on the correlation among the variables comprising the set (Cronbach's alpha), in each case were satisfactory (alpha ranging from 0.76 to 0.89), with the exception of the control" scale of JCQ (alpha = 0.57). Exploratory factor analysis showed that "control" scale of JCQ, and "reward" scale of ERI could be divided into two and, respectively, three sub-scales. The Karasek's and Siegrist's models made distinct contributions to explaining perceived work stress. Both JCQ and ERI questionnaire may be useful in occupational health.
Abstract: Hazardous workers (HWs) are they who, depending upon their pathologic conditions, ageing or addictive behaviour, may pose at risk the safety and health of their colleagues, customers, and other people. Physicians charged of the medical surveillance of workers (Competent Physicians, CPs) are called to assess fitting for work of HWs. The aim of this paper was to analyze the frequency of debate about HWs in the online forums of the Italian CPs' website. Results show that there is growing attention on the HWs issue. Different stakeholders are involved, and some ethic dilemma are posed. A systematic approach to the problem, and the formulation of guidelines for CPs, is highly desirable.
Abstract: Stressors at work are classified, according to Kalimo (1980) and Cooper (1976) in six broad categories: role within organisation, intrinsic stressors, interpersonal problems, work climate, career, social context. The 40-item Factors of Stress Questionnaire has been proposed as a screening instrument for causes of stress at work. The factor structure of the questionnaire was evaluated in 371 health care workers. Internal reliability analysis was also conducted. The Factor Analysis, according to the Kaiser rule to drop all components with eigenvalues under 1.0, gave nine principal components, with a 58% cumulative variance explained. However, most of these components had poor comprehensibility. The first component was significantly related to most of the items. The questionnaire showed good reliability (Cronbach's alpha = 0.93).
Abstract: The Italian version of a short anxiety and depression questionnaire developed by Goldberg et al. (1988) was applied to 1918 health care workers during periodical medical surveillance at work. Internal consistency reliability coefficient (Cronbach's alpha) value was 0.82 for anxiety scale (A), and 0.78 for depression scale (D); both scales can be retained "good". The factor structure of the two scales was examined through use of the factor analysis technique. The anxiety scale showed an homogenous pattern: a significant percentage of the variance (41.5%) was explained by a single summative factor which included all the items. Varimax orthogonal rotation of the D-scale variables yielded two factors, both typical of depression: reduced activity (6 items, 28% of variance), and poor self-image (3 items, 22% of variance). The scales would be used by occupational health physicians in medical surveillance as indicators of stress levels.
Abstract: A worker is considered to be hazardous to others when, in the course of performing a specific work task, his/her health problems (e.g., substance dependence, emotional disorders, physical disability, transmissible diseases) pose a risk for other workers' or the public's health and safety, or begins to interfere with ability to function in profession life. The presence of certain illnesses or the fact that a health care worker is impaired because of them do not necessarily imply that he, or she, is hazardous for others. Working in health care increases the probability that an impaired worker being hazardous for others. Management of hazardous workers requires new techniques and procedures, and specific policies.
Abstract: A significant percentage of physicians may be impaired at some point in their career by substance dependence, psychiatric and neurological disease.
Abstract: Malpractice claims filed against radiologists have become a relevant phenomenon in Italy and are a real risk in the radiologists' professional activity.
Abstract: Workers with handicap or psychological impairment are frequently submitted to mobbing. If causative factors of psychological disorders are not recognized, the physician charged of medical surveillance of workers may himself become a prosecutor and enhance the mobbing actions to the extent that the mobbed worker is discharged. In order to avoid this undue effect, the physician should strictly adhere to the body of legislation and to good occupational medicine practices. Health surveillance for occupationally exposed groups of workers is required under specific health and safety legislation. Workers unexposed to hazard in the workplace cannot be included in health surveillance programme, and declaring these workers unfit for their job is a patent violation of Workers' Statute Law. Psychological disorders should be carefully evaluated in order to clarify their relationship with work. The case of a worker affected with schizophrenia, already reported in the literature, is here re-analysed in order to emphasize these concepts.
Abstract: Health care workers (HCWs) suffering from psychiatric or neurological disorders, alcohol or drug addiction, may pose a risk for the health and safety of patients. The occupational health specialist charged of medical surveillance of hospital workers (the so-called "Competent Physician") often needs to recognize functional impairment in HCWs.
Abstract: The Impact Factor (IF) was thought up 50 years ago, and it is currently the best available bibliometric index. Despite its shortcomings, the IF is widely used and offers, at present, the best simple tool to help libraries decide which journals to purchase.
Abstract: Violence and aggression in health care settings is an ill-defined and under-reported problem. Early risk assessment, adequate training and information of health care workers, and specific monitoring tools (such as the Violent Incident Form, VIF) are necessary for risk management.
Abstract: A case is described of aesthesioneuroblastoma in a woodworker who had been exposed to wood dust for 25 years, without any individual or environmental protection. The case described supports the contention that occupational exposure to wood dust may have caused the neoplasm.
Abstract: We report the case of a policeman who suffered a severe head injury to the right temporoparietal lobe while driving a police car. Four years later, the patient developed a neoplasm at the precise site of the meningocerebral scar. Histological examination confirmed a glioblastoma multiforme adjacent to the dural scar. Radiological documentation of the absence of tumor at the time of injury, exact localization of the neoplasm in the injured cerebral area, and latency of the cancer supported the hypothesis of a causal relationship with brain trauma. Physicians faced with brain neoplasms in adults should carefully investigate the patient's personal history of head trauma. When a relationship with occupational head injury is probable, reporting of suspect occupational illness is compelling.
Abstract: Medical surveillance of wood-dust exposed workers has been compulsory in Italy since 1956. The Law 66 of 25/2/2000, as a consequence of the EU Directive regarding occupational carcinogenic and mutagenic agents, has recently enforced preventive measures for wood dust exposure.
Abstract: Risk management of occupational exposure in hospital personnel involved in the preparation and administration of antineoplastic drugs was performed using the A.S.I.A. model. The first step was auditing of compliance. Training of workers specifically addressed the areas of deviation from guidelines. Medical surveillance, and risk assessment, were oriented toward observed deviations.
Abstract: The ASIA model (assessment, surveillance, information audit) has been applied in wood work. The physicians charged of medical surveillance of workers were enrolled in a specialistic audit, concerning the main aspects of their preventive activity. Doctors significantly improved the quality of their surveillance programs, so identifying two cases of work-related illnesses (nasal cancer and poliposis). Even quality of risk assessment, and information of workers, were significantly improved after the audit. The ASIA model proved to be feasible and useful in wood risk prevention.
Abstract: Non-ionizing radiation, which is produced in large amounts by welding arcs, may induce photophthalmia, keratoconjunctivitis and cataracts. Retinal injuries resulting from exposure to electric welding arcs have been reported, but such injuries are not commonly seen and may be misdiagnosed. A case is described of bilateral maculopathy in a millwright exposed to metal arc inert gas-shielded welding and oxygen lance light. Insurance adjudicators denied his claim, as they did not acknowledge the cause-and-effect relationship between welding and retinopathy. Welding emits a wide spectrum of radiation, ranging from IR to UV and beyond. UV and far-IR radiation are adsorbed by the cornea and the lens, whereas visible light and near-IR radiation penetrate to the retina. According to the intensity and time of exposure, they may cause thermal or photochemical retinal damage, which may be permanent and sight-threatening. Workers covered by compulsory collective insurance should be eligible for compensation in every case of welding light-induced retinal damage.
Abstract: The analysis of the liability claims filed by Italian radiologists over the past 8 years allows us to evaluate past trends and predict the future evolution of litigation in radiology.
Abstract: To describe the radiographic features and progression of cervical spine destructive spondyloarthropathy (DSA) in hemodialyzed patients, and to evaluate the relationship between this disease and patient characteristics, biochemical values, and hemodialysis duration.
Abstract: Self-reported cacosmia (i.e. feeling ill from the odour of xenobiotic substances) was studied in 151 young, healthy workers, unexposed to unpleasant odours and working in food stores without air-conditioning. Almost half (46%) of the sample reported feeling ill from the smell of chemical materials. Chemical odour intolerance induced headache, itching eyes, irritated or congested nose, dry and/or sore throat, cough, dizziness, and itching or rash. Cacosmic subjects showed a slight prevalence of the female sex, and had significantly higher symptom scores, anxiety, and depression than non-cacosmic subjects. Cacosmia may be related to multiple chemical sensitivity, sick-building syndrome and psychopathology. Individual variability in odour tolerance may substantially bias epidemiological studies on indoor air quality and health.
Abstract: Self-reported cacosmia (i.e. feeling ill from the odour of xenobiotic substances) was studied in 151 young, healthy workers, unexposed to unpleasant odours and working in food stores without air-conditioning. Almost half (46%) of the sample reported feeling ill from the smell of chemical materials. Chemical odour intolerance induced headache, itching eyes, irritated or congested nose, dry and/or sore throat, cough, dizziness, and itching or rash. Cacosmic subjects showed a slight prevalence of the female sex, and had significantly higher symptom scores, anxiety, and depression than non-cacosmic subjects. Cacosmia may be related to multiple chemical sensitivity, sick-building syndrome and psychopathology. Individual variability in odour tolerance may substantially bias epidemiological studies on indoor air quality and health.
Abstract: Legal claims against radiologists are a relevant phenomenon also in our country and represent an increasing risk for a radiologist's professional activity.
Abstract: Two previously unpublished outbreaks of Mass Psychogenic Illness (MPI) in Italy are reported. The first outbreak involved 427 female workers at an electro-mechanical plant. Workers complained of work-related stressors, and high levels of conflict between their job and home duties. We conclude that the episode resulted from the interaction of environmental and work-related factors, the persons and the social organization of the workplace. The second case is one in which risk of MPI developing seems to have been successfully prevented. An effective stress coping strategy, coupled with workplace improvement, may have succeeded in eliminating cases of illness and preventing an outbreak of MPI.
Abstract: Academic stress is a good model of psychological stress in humans for studying psychoneuroimmune correlations. We looked for correlations between psychological scores, immune tests and plasma levels of cortisol and neuropeptide Y (NPY). A group of medical students were evaluated at the beginning of the academic year (Baseline) and the day before an examination (Stress). They underwent evaluation by The Profile of Mood States (POMS), The Malaise Inventory, The Self Efficacy Scale and A Global Assessment of Recent Stress (GARS). The lymphocyte subsets, the lymphocyte proliferative response and the cytokine production were also evaluated. We detected modifications of some psychological test scores between the Baseline and Stress evaluation, a significant reduction of lymphocyte proliferation, IL-2 production and percentage of the lymphocyte CD19, and an increase in plasma cortisol levels during stress. The lymphocyte proliferation negatively correlated with the POMS score as well as the percentage of CD16+ cells with NPY plasma levels. NPY levels were not different from Baseline. The emotional and mood states seem to influence immunity. Copyrightz1999S.KargerAG,Basel
Abstract: We report the results of a pilot survey in diagnostic medical sonographers. Aim of the study was to evaluate the frequency of musculoskeletal disorders in sonologists and the relationship of these symptoms to ergonomic factors.
Abstract: The prevalence of musculoskeletal complaints of the hand and wrist, and the neck and back, in physicians who operate sonography equipment was evaluated, and associations between these complaints and various work-related and personal variables were studied. A questionnaire survey was distributed among physician sonographers (sonologists) in Italy. The relationship between work habits and musculoskeletal complaints was analyzed by logistic regression models adjusted for gender, age, and duration of work with ultrasound. A total of 2041 physician sonographers completed the questionnaire. It was found that a large proportion of the subjects regularly had work-related complaints, such as neck and back pain (NBP) (18.5%) or hand and wrist cumulative trauma disorder (HWD) (5.3%). Roughly 80% of the sonographers were currently affected, or had been affected in the past, by one or more work-related symptoms. Various work-related factors appeared to be related to musculoskeletal syndromes. The average time spent for each examination was related both to NBP and HWD. Discomfort for transducer design was the best predictor of HWD, whereas a comfortable chair and correct position of the body protected from the onset of NBP. These results support the role of ergonomic factors in the pathogenesis of both NBP and HWD in sonographers.
Abstract: The insurance claims against Italian radiologists over a five-year period (1993-97) were anonymously evaluated, based on pertinent data provided by the Insurance Company of the Italian Society of Medical Radiology.
Abstract: This study examines the possible relationship between Type A behaviour pattern (TABP) and traffic accident risk in a cohort of traffic policemen. Data were gathered from 86 police drivers from a small Italian town, using the Bortner questionnaire. Results reveal that police drivers with Type A behaviour had higher traffic accident risk than those with lower scores at the Bortner scale. Adjusted odds ratio was 4.2 (95 per cent CI: 1.17-15.17) after correction for confounding variables in multiple logistic regression.
Abstract: The insurance claims against Italian radiologists over a three-year period (1993-1995) were anonymously reviewed, based on pertinent data provided by the Insurance Company of the Italian Society of Medical Radiology. The incidence risk-rate of claims was 11.4 per thousand persons/year. The overall claims rate increased in 1995. Alleged malpractice accounted for more than 85% of the claims. Misdiagnosis represented the first and most important claim category (43.4% of the total). The most common misdiagnosis was the failure to diagnose fracture or dislocation. The second most common plaintiff's misdiagnosis argument was the failure to diagnose breast cancer. The second most frequent claim category (35.8%) were complications, frequently occurring during interventional radiology and contrast media injection. A minority of claims (11.3%) originated from patient injury occurring in the radiology department during exam execution. Finally, radiologists were frequently sued together with medical (or surgical) doctors in case of patient death, according to an Italian law (Art. 589 P.C.). Claims were more frequent in public health services and they were mostly related to emergency examinations and interventional procedures.
Abstract: The purpose of this study is to provide information to Italian radiologists regarding claims and patient injuries in medical malpractice claims. The assurance claims of Italian radiologists over a two-year period (1994-95) were anonymously analyzed, based on pertinent data provided by the Insurance Company of the Italian Society of Medical Radiology. The incidence risk-rate of claims was 9.1 per thousand person/year. Alleged malpractice accounted for more than 85% of the claims. In nearly one-half of the cases (44.4%), the plaintiff's argument was based on a <<failure to diagnose>>. The most common misdiagnosis was failure to diagnose fracture or dislocation. The second most common claim category (40.7%) were complications, most commonly occurring during interventional radiology and contrast media injection. The third claim category (14.8%) was patient's accidents occurring during the diagnostic procedure. The most frequent types of injuries experienced by patients were death (6 cases), loss of chance for survival and permanent disability. Claims were more frequent in public health services, and mostly related to emergency examinations and interventional procedures. Misdiagnoses almost exclusively involved public health radiologists. Private health care, on the other hand, had a higher rate of fatal injuries, mostly related to technical complications.
Abstract: It was observed that "medical diagnosis utilizing Magnetic Resonance (MR) scanners may be one of the first modalities in which there is more risk for the operator of the equipment than for the patient" (Young, 1984). Despite this statement, only a few studies have been devoted to the assessment of occupational hazard in MR imaging personnel. The principal features associated with MR systems are: static magnetic fields, time-varying magnetic fields, and radiofrequency irradiation. Potential medical effects related to these hazards are reviewed. Static magnetic fields are known to induce in vitro changes in enzyme kinetics, orientation changes of macromolecules and subcellular components, distortion of ion currents and magnetohydrodynamic effects. Possible mechanisms for static magnetic field bioeffects include the exertion of magnetic forces, the induction of voltages, and other mechanisms (proton tunneling, ion cyclotron resonance) that are yet scarcely known. Human epidemiological studies on static magnetic fields are mainly based on subjective observations, and lack adequate control for confounding factors. Time-varying magnetic fields in the extremely-low frequency range have been associated with both occupational and non-occupational adverse health effects. Exposure to electromagnetic fields in office workers has been related to an increased rate of abortion; the vast majority of studies in this field, however, did not reach any significant result. Many literature reports support the evidence of an elevation of cancer risk in subjects exposed to residential and occupational ELF fields. Although such observations are not yet proved, the alleged occupational risk in magnetic fields exposure should induce to optimize exposure in MR imaging workers.
Abstract: Ultrasound (US) is extensively used in the medical field for its therapeutic and diagnostic applications. US units are commonly found in hospitals and clinics of all sizes, and a growing number of medical staff such as doctors and nurses are exposed to hand-transmitted ultrasound waves in their work-place. This review discusses the available information on the occupational risk of the operators using diagnostic and therapeutic ultrasound devices. The new occupational groups of medical workers who use ultrasound (diagnostic, surgical, sterilization, and physiotherapeutic) equipment are exposed to contact ultrasound waves. Contact ultrasound -- i.e., no airspace between the energy source and the biological tissue -- is much more hazardous than exposure to airborne ultrasound because air transmits less than one percent of this kind of energy. In spite of being a non-ionizing radiation with an excellent safety record, US is likely to induce some changes in the exposed organ. Recent Russian studies indicate that the hospital workers who have been long exposed to ultrasound at work may develop neurovascular dose-dependent disorders of the peripheral nervous system in the form of the angiodystonic syndrome of vegetative polyneuritis of the hands. In some Scandinavian studies, female physiotherapists (exposed to ultrasound and short waves) exhibit increased rate of spontaneous abortions and congenital malformations, but no definite conclusion can be drawn on the basis of these results alone. Trends in exposure for diagnostic ultrasound equipment over the last two decades show a continuous increase. While there is no reason for alarm, there is a growing need for avoiding unnecessary exposure to medical workers.
Abstract: Candida albicans, an ubiquity yeast, has several properties which allow it colonize and invade host tissues, often resisting eradication. Acid proteinase is the virulence factor. Bacterial proteinases are widely used in the detergent industry and the role of occupational exposure to enzymes in the development of mucocutaneous candidosis warrants investigation. A case of candidosis is reported in a worker employed in a detergent factory in whom there was no evidence of any kind of immunosuppression. The relationship between occupational exposure and illness is analyzed.
Abstract: The statistical methods used in occupational health studies were evaluated by analyzing the papers published from 1986 to 1990 in the proceedings of the annual meetings of the Italian Society of Occupational Medicine and Industrial Hygiene, in order to calculate the degree of understanding of the readers provided with only one-sided knowledge of statistical subjects and to improve the educational objectives in postgraduate schools of occupational health. Almost 70% of the 1151 articles reviewed contained some kind of statistical analysis: methods more complicated than descriptive statistics were used in about 35%. Student's t test (15%) and chi square (12%) were the most common methods. Other methods were less frequently used, so that it was possible to estimate that the learning of any new method would improve the understanding of about 1-2% of the articles. A wider use of statistical methods in data analysis is recommended; the attainment of a higher level of statistical knowledge should be a priority target in occupational health training.
Abstract: A follow-up study of chronic conjunctivitis in arc welders in a foundry in Italy was conducted from 1979 up to 1989. Airborne dust concentration in the foundry often exceeded the TLV-TWA limit. The frequency of chronic conjunctivitis was markedly higher amongst the welders than in the unexposed controls (RR = 4.25). The incidence rate of conjunctivitis was 49.8% in the exposed group; manual welders showed a higher incidence rate (56.9%) than non manual welders (risk ratio = 1.76). Ocular symptoms (eye burning, tearing, photophobia) often occurred largely before the development of chronic conjunctivitis (predictive value = 61.5%). In current occupational health practice, the disclosure of a high prevalence of ocular symptoms should lead to careful examination of the working environment.
Abstract: Although etiological diagnosis represent a major issue in occupational health, it is frequently difficult to achieve because of the concurrent effect of a multitude of both work-related and non-work-related pathogenic factors. A construction worker, exposed for over 20 years to silica and silicate dust, asbestos dust and vibrations transmitted through the hand-arm axis, complained of dyspnoea a cough and peripheral paraesthesia. Two years later he developed scleroderma-like skin lesions in the appendages, and a small-cell bronchogenic carcinoma was subsequently revealed by radiological and bronchoscopic examination. The analysis of a single case failed to provide any substantial support for the hypothesis that scleroderma and lung cancer have an occupational origin; however, we believe it is significant that occupational exposure to chemical and physical agents inhibiting the immune response is often observed in association with some kinds of immune abnormalities, such as those of scleroderma and oat-cell cancer.
Abstract: The authors studied the prevalence of disorders of the spine in a group of dockers working on lifting gear. They stress the great sensitivity of clinical examination performed according to a standardized protocol for the evaluation of spine pathology.
Abstract: Vinyl chloride (VC), a volatile substance mostly used for polyvinyl chloride (PVC) synthesis, is a systemic toxicant particularly noxious to endothelium. Angiosarcoma of the liver, Raynaud's phenomenon, scleroderma-like lesions, acroosteolysis and neuritis are known to be typical vinyl chloride-associated manifestations (VC disease). A so far unknown feature of the disease is purpura. This was first observed by the authors in a worker of a PVC-producing plant. The skin eruption was characterized by small purpuric maculae with tiny, palpable spots and papulae, mostly concentrated on the lower part of the legs, changing into bullae, pustules and crusts and tending to spontaneous regression after withdrawal from VC exposure. A skin biopsy revealed marked inflammatory reaction with a mostly lymphocytic and histiocytic infiltration around and in the walls of dermal arterioles. The finding of increased circulating immune complexes and anti-smooth muscle autoantibodies strengthens the hypothesis that immunologic changes play a role in the appearance of "vinylic purpura."
Abstract: Five patients exposed to vinyl chloride were studied by hand angiography and other non-invasive methods, including photoplethysmography, rheography, and thermography. Raynaud's phenomenon was present in all five subjects, while acro-osteolysis affected only one. Organic vascular lesions, such as narrowing, segmentary occlusions of digital arteries and bridge collaterals, were found in angiographic studies. Only one patient did not show clear segmentary occlusions, but his vessels were crooked and diffusely narrowed. Angiographic results appear to correlate well with the changes shown by non-invasive techniques.
Abstract: 58 miners affected by VWF were studied by some immunological tests: electrophoresis, quantitantive immunoglobulin determination, latex test. C3c, C3PA and C4, cryoglobulin, ANA and ati-DNA antibody, L.E. cell. Slight hyperimmunoglobulinaemia G was observed in 31% of cases; this abnormality was significantly more frequent in patients also suffering for pulmonary silicosis. Authors indicate pneumoconiosis as an important confounding variable, which importance for epidemiological studies has not yet satisfactorily assessed.
Abstract: The authors examined 52 miners affected by Raynaud's phenomenon caused by vibrating instruments, mainly checking the involvement of the osteoarticular system. They found, in the articulation of the upper limbs, in addition to generic signs of arthrosis, zones of bone reabsorption (vacuoles), especially as regard the wrist and hands, and irregularities of the tufts. The authors consider these lesions as important feature of the technopathy.
