[Sleep disorders and work: guidelines for health surveillance, risk management and prevention]. / I disturbi del sonno in ambito lavorativo: indirizzi di sorveglianza sanitaria, prevenzione e gestione del rischio.

Sleep disorders and related diseases are becoming increasingly relevant for the health and wellbeing of the general and working populations. Sleep disorders affect all aspects of health, showing a bi-directionality with health conditions and comorbidity with several diseases. Consequently, sleep disorders may have severe negative consequences both for the individual and the enterprise, as well as for society on the whole, in terms of health, productivity and social costs. When considering the disturbances of the sleep/wake cycle, it is important to distinguish between those connected with endogenous biological factors from those related to socio-environmental conditions, including work, and those associated with mental and physical diseases, that are often associated and interact with each other. Many sleep disorders are still underestimated and under-valued in clinical practice and, to a much greater extent, in workers' health surveillance. The present paper is aimed at drawing the attention of the occupational health physician to some key issues, particularly regarding excessive daytime sleepiness, obstructive sleep apnea syndrome and shift and night work, as well as their implications in terms of health and occupational consequences. Information on the main aspects of clinical diagnosis and health surveillance, as well as risk management and prevention at the workplace, are provided.

[Medical surveillance for shift and night work]. / La sorveglianza sanitaria nel lavoro a turni e notturno.

Shift and night work are recognized as risk factors for health and safety; they are related to a wide range of public health problems ranging from cardiovascular disease and cancer to mental disorders and accidents. Occupational health physicians should evaluate workers' fitness for shift and night work before their assignment, at regular intervals, and if health problems connected with shift work occur. The evaluation should be accompanied by a careful job analysis to ensure that shift schedules are arranged according to ergonomic criteria. This arrangement can reduce health problems and make coping with irregular working hours possible, even for people suffering from contraindicative illnesses. Both health disorders representing absolute or relative contraindication and actual work conditions should be taken into account. Health checks should be aimed at detecting early signs of intolerance, such as sleeping and digestive trouble, drug consumption, accidents, and female reproductive function problems.

[Sleep disorders, risk of accidents and traffic accidents in a group of drivers of public transport]. / Disturbi del sonno, rischio infortunistico e incidenti stradali in un gruppo di autisti di mezzi pubblici.

In order to evaluate the prevalence of sleep disorders and visuomotor performance, a survey was conducted on 253 drivers of public transport company, aged between 25 and 64 years. Biometric data (BMI, neck circumference and waist, PA) were collected and three questionnaires were administered to investigate sleep disorders. Simple and multiple choice reaction times were administered using a computerized test battery. Records on road accidents in the period 2005-2011 and all accidents in the period 2002-2010 were analyzed. On the basis of clinical and anamnestic questionnaire, workers were divided into two groups: 194 drivers (group 1) without suspicion of sleep disorders and 59 drivers (group 2) with suspected sleep disorders, and 41 with suspected obstructive sleep apnea syndrome (OSAS). The drivers with suspicion of sleep disorders, in particular those with suspected diagnosis of OSAS, showed reaction times significantly prolonged as compared to the drivers of the group 1. In group 2, a higher incidence of (all) accidents was found, whereas the incidence of road accidents was significantly increased only in drivers with suspected OSAS. In addition to the sleep disorders, the use of drugs altering vigilance (antihistamines and benzodiazepines) were significant determinants. In-depth clinical examinations are in progress to confirm the suspected diagnosis of sleep disorders.

[Quality improvement in workers health surveillance: the spirometry training courses experience]. / Miglioramento della qualità della sorveglianza sanitaria: l'esperienza dei corsi di spirometria.

The spirometry execution during workers health surveillance requires accurate and reproducible spirometric measurements, which should comply with the ATS/ERS guidelines. Low acceptability of spirometric manoeuvres has been reported in health surveillance. This may hamper the validity of the results and affect clinical decision making. Training and refresher courses may produce and maintain good-quality testing, promote the use of spirometric results in clinical practice and enhance the quality of interpretation. We evaluated (with PLATINO score) 239 spirometries from 23 occupational physicians recorded before and after a spirometry refresher course (16 hours) and we verified that only 4 physicians showed a very good improvement and others 4 a good improvement of score, while 9 showed a very slight improvement and 6 instead no improvement. It is worthy of note that in 2012 some spirometers not suitable to UNI EN 26782/2009 were still in use.

[Quality control of spirometry in workers' medical surveillance]. / Il controllo di qualità della spirometria nella sorveglianza sanitaria dei lavoratori.

Spirometry plays an important role in occupational respiratory health surveillance programs. However, when not performed correctly, the values obtained can be misleading, resulting in misclassification of the workers' health status. Studies carried out in Italy have shown that spirometries recorded by occupational physicians often do not comply with quality criteria for recording FEV1 and FVC, according to joint statements on lung function testing for the American Thoracic Society and the European Respiratory Society, issued in 2005. For this reason, they are useless for the purposes of their execution. Compliance with ATS/ERS statements is essential to assure that spirometry results are beneficial for the monitoring of workers' health.

[Smoking in the workplace: role of occupational physicians]. / Abitudine al fume di tabacco nei luoghi di lavoro: ruolo del Medico del Lavoro Competente.

In many industrialized countries smokers have been observed in high prevalence among workers with poor educational status, who are usually exposed to major occupational risks. The smoking habit and passive smoking may by themselves, or through interactions with other occupational risk factors, cause the onset of serious diseases. Therefore health reasons and the legal obligation to observe the smoking ban in the workplace make it essential to prevent and combat smoking in the workplace and to promote smoking cessation in workers who smoke. This initiative should benefit not only workers' health and well-being but also company finances. The Occupational Physician should engage in diverse activities ranging from encouraging young people not to start smoking to providing programmes to encourage workers who smoke to abandon the habit. For example, he or she should i) inform managers, supervisors and workers about the high risks linked to smoking, passive smoking and obligations established by law ii) collect information about the smoking habit among workers and supply workers with the so-called minimal clinical intervention during routine health surveillance appointments and iii) collaborate with specific health promotion programmes in the workplace.

[Sleep disorders questionnaire for medical surveillance of workers]. / Un questionario sui disturbi del sonno per la sorveglianza sanitaria dei lavoratori.

According to Italian law, occupational physicians should assess the fitness of employees for night work before their assignment, at regular intervals, and in cases of health issues related to night work. Moreover, sleep disorders among occupational drivers and shift workers need to be systematically investigated. Sleepiness at the wheel is now identified as one of the main reasons behind fatal crashes and highway accidents caused by occupational drivers. A significant percentage of workers suffer from sleep-disordered breathing, narcolepsy, sleep deprivation, poor sleep hygiene and circadian rhythm diseases. However, all these problems are underestimated. A questionnaire aimed at carefully assessing sleep disorders during medical surveillance of workers was carried out by the Italian Association of Sleep Medicine. It includes twenty-three questions and helps highlight any substantial sleep problem which could require further investigation by sleep medicine specialists.

[Good practice for medical surveillance by occupational physicians]. / La buona pratica nella sorveglianza sanitaria del medico competente.

Society--employers, workers, trade unions, public--demands the highest standards of professional competence and ethical conduct from occupational physicians. However, defining what exactly constitutes good medical practice and acceptable standards of professional competence and conduct is not so easily done. Good practice in occupational medicine should be aimed not only at improving the effectiveness of preventive action in the strict sense, but also at constantly adopting rigorous methodologies based on evidence and procedures breaking loose from rigid formats, which must be as uniform as possible throughout the country. It's essential, therefore, to develop consensus documents on workers' health surveillance, meeting with approval of occupational health physicians both operating in a free market context or within the framework of public sector health service.

[Research and formal demonstration of evidence of efficiency in occupational medicine]. / Ricerca e dimostrazione formale delle prove di efficacia in medicina del lavoro.

There is an increasing pressure on occupational health professionals to ensure that their practice is based on a quality standard and an evidence of appropriateness. The efficacy-effectiveness of their activity strictly depends on their intellectual and professional integrity, their technical and legal competence, but also on the quality of the relations with the company organisation they are able to establish. We asked to some occupational physician when they considered their interventions in the workplace to be efficacious. Then, accordingto our epexrience, we propose some effectiveness indicators, particular concerning health surveillance and health educttaon, that should be evaluated to verify the health professional agccvity agreement to quality standards.

[Experience of the Parmesan Association of Occupational Physicians]. / L'esperienza dell'Associazione Parmense dei Medici del Lavoro.

The paper presents the experience of the Parmesan Association of Occupational Physicians, an important opportunity to establish a dialogue among physicians variously engaged in the promotion of workers' health.