[The stress index: proposed method for risk assessment of stress and burnout in health care settings]. / Lo "stress index": proposta di un metodo per la valutazione del rischio da stress e burnout in ambient sanitari.

To assess the risk from exposure to stress and burnout in health care workers, a pilot study was planned to compare and integrate the information based on the risk evaluation obtained through different parameters that can be quantified and elaborated to produce a numerical index, called the "Stress Index", and the subjective symptoms from the individual workers. For these purposes, three internationally validated questionnaires were administered: the Job Content Questionnaire, the State-Trait Anxiety Inventory and the Maslach Burnout Inventory. The study considered six different Units from three divisions of Internal Medicine of a large public hospital in Northern Italy, and a total group of 228 health care workers employed in the six units. The results showed an association between the Stress Index scores and the scores from the questionnaires. In particular, in the two units with the highest levels of the index, a significantly higher unbalance between job demand and decision latitude was observed, together with the highest levels of state and trait anxiety and of depersonalization, indicating higher burnout levels.

[Neurotoxic effect of exposure to low doses of mercury]. / Effetti neurotossici da esposizione a basse dosi di mercurio.

OBJECTIVES: To assess early effects on the Central Nervous System due to occupational exposure to low levels of inorganic mercury (Hg) in a multicenter nationwide cross-sectional study, including workers from chloro-alkali plants, chemical industry, thermometer and fluorescent lamp manufacturing. The contribution of non-occupational exposure to inorganic Hg from dental amalgams and to organic Hg from fish consumption was also considered. METHODS: Neuropsychological and neuroendocrine functions were examined in a population of 122 workers occupationally exposed to Hg, and 196 control subjects, not occupationally exposed to Hg. Neuropsychological functions were assessed with neurobehavioral testing including vigilance, motor and cognitive function, tremor measurements, and with symptoms concerning neuropsychological and mood assessment. Neuroendocrine functions were examined with the measurement of prolactin secretion. The target population was also characterized by the surface of dental amalgams and sea fish consumption. RESULTS: In the exposed workers the mean urinary Hg (HgU) was 10.4 +/- 6.9 (median 8.3, geometric mean 8.3, range 0.2-35.2) micrograms/g creatinine, whereas in the control group the mean HgU was 1.9 +/- 2.8 (median 1.2, geometric mean 1.2, range 0.1-33.2) micrograms/g creatinine. The results indicated homogeneous distribution of most neurobehavioral parameters among exposed and controls. On the contrary, finger tapping (p < 0.01) and the BAMT (Branches Alternate Movement Task) coordination test (p = 0.05) were associated with occupational exposure, indicating an impairment in the exposed subjects. Prolactin levels resulted significantly decreased among the exposed workers, and inversely related to HgU on an individual basis (p < 0.05). An inverse association was also observed between most neuropsychological symptoms and sea fish consumption, indicating a "beneficial effect" from eating sea fish. On the contrary, no effects were observed as a function of dental amalgams. CONCLUSIONS: In conclusion, this study supports the finding of early alterations of motor function and neuroendocrine secretion at very low exposure levels of inorganic Hg, below the current ACGIH BEI and below the most recent exposure levels reported in the literature.

[A pilot study on training and information of workers exposed to biomechanical overload of the upper limb]. / Studio pilota sulla formazione ed informazione di lavoratori esposti a sovraccarico biomeccanico dell'arto superiore.

Health education (HE) is very important in the prevention of occupational diseases, particularly when exposure to risk factors can be reduced through working procedures and hygienic behaviours. This pilot study refers to a HE program for prevention of work related muscle-skeletal disorders of upper limbs, carried out in two groups of 15 and 12 workers, respectively employed in trimming and assembling of plastic and metal parts. The first phase of the program consisted of worksite inspections and video recording of working procedures, characteristics of tools and machinery. This was followed by an informative meeting with the workers, which began with the administration of a multiple choice questionnaire, designed to evaluate the baseline knowledge about risk factors, work related muscle-skeletal disorders of upper limbs, working specific procedures and preventive actions. Questionnaires and video recording were repeated after two months in the second phase of the program, as subjective and objective methods of evaluation of HE effectiveness. In both groups, the questionnaire score was significantly increased after the program and a clear improvement was shown in the correct working procedures. This HE program contributed to increase the level of knowledge of the workers and fostered the adoption of working behaviours suitable to reduce the strain for the upper limbs.

Health conditions of bus drivers in a 6 year follow up study.

The bus drivers of a public bus company, working in a fast rotating 4 shift system from 05.00 to 24.30, were examined in 1993 (230 persons) and 1999 (266 persons). The comparison between the two years showed no significant differences for all the parameters evaluated by the Standard Shiftwork Index and medical examination. In both surveys work organisation was considered "efficient-fairly good" by most workers, who were mostly satisfied with their job. Work load was rated significantly higher for "afternoon" and "morning" shifts, during which most accidents at work and "in itinere" occurred. Night sleep was reduced by 3 hours on "early" shift and about 2 hours on "morning" shifts. The most prevalent health troubles dealt with low back pain, gastritis, headache and haemorrhoids. Neuroticism was the trait more correlated with poorer health conditions, whereas shiftwork exposure appeared as a significant predictor of risk of critical Effort/Reward Imbalance and minor psychological disorders. Both extrinsic and intrinsic efforts significantly increased with age, but not reward. The comparison of the same cohort of 108 persons examined both in 1993 and in 1999 showed a significant increase of low back pain, gastrointestinal troubles, haemorrhoids and lipids disorders.