Protecting hospitals from SARS-CoV-2 infection: A review-based comprehensive strategy for COVID-19 prevention and control.

SUMMARY: SARS-CoV-2-related infection can determine hospital-acquired infections among patients and healthcare workers. Aim of this paper was to review the literature for developing a strategy for protecting healthcare workers, patients, and visitors by COVID-19 hospital infection. A critical and rapid revision of the literature and international standards and Regulations on this topic allowed us to propose an evidencebased strategy in the framework of the workplace risk assessment for preventing nosocomial COVID-19 outbreaks. The virus' high transmissibility, the high prevalence of asymptomatic carriers and false-negative Covid-19 rates on naso- and oropharingeal swabs, put hospitals at high-risk of COVID-19 outbreaks. A comprehensive strategy based on standard precautions, administrative, environmental, and engineering controls, a screening protocol for patients on their admission to hospital, and a testing-based strategy for HCWs within health surveillance programs may prevent the onset of hospital outbreaks, which are a threat to community, patients and HCWs, compromising the sustainability of healthcare facilities.

[Health surveillance of workers exposed in a hadrontherapy center]. / La sorveglianza sanitaria degli esposti in un centro di adroterapia.

SUMMARY: The Centro Nazionale di Adroterapia Oncologica (CNAO) of Pavia is the only Italian structure capable of administering therapeutic radiotherapy treatments with heavy particles (carbon ions, protons) accelerated; in addition to this, it hosts significant research activity, both as basic research and for health-related applications. From the perspective of radioprotection, the most significant risk profile is that linked to external irradiation, from three categories of sources: accelerated external beams (in addition to the treatment beams there are conventional linear accelerators), materials activated following irradiation during treatment or during research activities, unstable isotopes used for diagnostic purposes. The CNAO building has been designed and built to guarantee maximum safety both to the operator and to the patient or visitor, with widely redundant systems in order to exclude the occurrence of accidental irradiation, and to minimize the risk of exposure to activated materials. The cohort of workers shows "atypical" characteristics for healthcare safacilities due to the absolute disproportion between classified and unclassified personnel, the homogeneity of training paths, and demographic characteristics. The health surveillance of the exposed, all classified in category B pursuant to Legislative Decree 230/95, is based on the adoption of the AIRM Protocol, tempered on the specific characteristics of the work process. The main critical issues related to the health surveillance of the exposed CNAO workers come from the energies used, with significant activation capacity, and from the presence of personnel in training.

[Monoclonal gammopathy of uncertain significance (MGUS) and ionizing radiation]. / Gammopatia monoclonale di incerto significato (MGUS) e radiazioni ionizzanti.

SUMMARY: The term monoclonal gammopathy refers to a clinical condition characterized by the presence in serum and/or urine of clonal immunoglobulins, i.e. homogeneous immunoglobulins, structurally identical both as a heavy chain and as a light chain, produced by a B cell clone (1). The prevalence of MGUS is low in young subjects (less than 2% of patients with MGUS are less than 40 years of age, while in the population aged over 50 years it is relatively high (3.2%) and increases considerably with age. Although historically considered to be a benign condition, patients with MGUS are at risk to develop multiple myeloma over time. Therefore, MGUS may be framed as a preneoplastic stage of the plasma cell that precedes the possible development of a multiple myeloma. In a limited percentage of cases, it can be considered the asymptomatic pre-malignant stage preceding multiple myeloma (MM) on a probabilistic basis. Few studies have assessed the prevalence of MGUS in people occupationally exposed to pesticides. Several other studies on atomic bomb survivors in Hiroshima and Nagasaki have revealed a possible association with exposure to ionizing radiation (IR). Routine laboratory tests performed on the subjects exposed to the risk factors studied appear to be indicated for workers from the age of 50 years. The finding of a GMUS in the absence of further laboratory alterations is the most frequent finding and does not require further action, if it is not to plan include blood chemistry tests at least every two years. In this situation, no restrictions appear to be justified on the work activity involving the risk of exposure to IR or pesticides. In case of concurrent presence of alterations that may be indicative or suggestive of an increased risk of evolution in a neoplastic way a close periodicity - every 3-6 months - of haematological checks is recommended. In such cases, it appears justified to move away from activities involving exposure to ionizing radiation for a period of time which should be evaluated on the basis of the evolution of the picture and the progress of laboratory tests during the monitoring period.

[Fit for work judgment and ionizing radiation: discussion of clinical cases]. / Giudizio di idoneità e radiazioni ionizzanti: discussione di casi clinici.

SUMMARY: Introduction. The formulation of the suitability for risk assessment from exposure to ionizing radiation in workers diagnosed with malignant tumor disease entails important implications of a professional, human, social, but also medical-legal, nature. By now, the management of such situations is an event anything but infrequent in the activity of the Authorized Physician: the increase in the number of people staying in wore and the rise in the incidence and prevalence of malignant neoplastic diseases in the working-age population make the problem more relevant than ever. This is not only because of the improvement of the diagnostic and treatment capacity but also for the increased survival that follows from them. The result is therefore an increase in the cases that can potentially reach the antention of the Authorized Physician/Competent Physician who - in compliance with the provisions of current legislation - will be thus called to express the suitability assessment for the specific task by applying criteria that respect the highest and current scientific evidence in this field. Materials and Methods. Through the guided illustration of two clinical cases, it is intended to propose here a - practical and reasoned - path towards the formulation of the assessment on the occupational reintegration of the worker with diagnosis of neoplastic disease. This methodology is applied and developed through the systematic recourse to objective and specific orientation criteria, able to guide the decision-making process of the Authorized Doctor/Competent Doctor. Results. The proposed criteria were applied to workers operating in the healthcare sector and assigned to different types of activities who were at risk from exposure to ionizing sources. Conclusions. The proposed evaluation path is intended to represent a clinical and rational methodology of approach and management to the problem of assessing the suitability of workers with previous neoplastic diseases, all that by fully safeguarding the decision-making autonomy - variable from case to case - which is characteristic of the activity of the Authorized Physician/Competent Physician.

[Cell Phones, Radio Frequencies (RF) and Health: IARC classification and epidemiological updates]. / Cellulari, Radiofrequenze (RF) e salute: classificazione IARC e aggiornamenti epidemiologici.

SUMMARY: In 2013, IARC classified the radiofrequency emitted by mobile phones exposure as possibly carcinogenic to humans (Group 2B). After this classification, several studies were carried out to confirm and to robust or to reject IARC conclusions. Aim of this work was to draw a synthesis of principal scientific evidencies published till September 2019. The analysis of published results could not indicate clear risk profiles, nor surely confirm or reject the hypothesis that exposures to radiofrequency from mobile phones can threat human health. Despite the prevalence of negative studies, some methodological and temporal limitations prevent to draw firm conclusions about the potential health risks for humans, especially for heavy exposed subjects or particular categories such as children or adolescents. Thus, further studies are needed, as well as some methodological improvements, to fully respond to the question about health threats of radiofrequency emitted by mobile phones.

[Active population aging, ICD-ICF clinical model and Occupational and Rehabilitation Medicine]. / Invecchiamento della popolazione attiva, modello clinico ICD-ICF e Medicina del lavoro e della Riabilitazione.

SUMMARY: The aging of the active population is more and more increasing in advanced western societies. This phenomenon also implies a constant increase in the average age of workers in various productive sectors, not least that of health. In this, in fact, alongside the known occupational risks, more and more frequently we are witnessing the emergence of chronic-degenerative pathologies connected with aging, even with symptoms that do not determine an unsuitability for work. In fact, within a scientific landscape accounting little evidence on the effectiveness of complex rehabilitation programs, the use of the ICD / ICF system in therapeutic programming should produce an important turning point, providing health professionals with a conceptual paradigm that supports both the functional assessment and the rational planning of therapeutic interventions, also contributing to the advancement of specialist knowledge. The present work shows how an effective collaboration between occupational physicians and rehabilitation specialists can effectively participate in the evaluation of the patient / worker even in the elderly, with particular regard to the return to work, taking full advantage of the classification and diagnostic tools implemented in the ICD and ICF systems.

[Commuting and work: health effects on an exposed occupational population]. / Pendolarismo e lavoro: effetti sulla salute di una popolazione di lavoratori interessati dal fenomeno.

OBJECTIVES: Commuting is generally described as a modern society issue; despite the relevance of this phenomenon, only few studies investigated occupational and health effects of commuting on workers exposed to it. According to the 15th census of the Italian population, in Italy about 29 millions of people (48,6% of total resident population) daily moved to reach their work. During last ten years, this number increased of about 2.1 millions of people, and also time and distances needed to reach work grew, with a potential high impact on health and environment. Thus, the aim of this study is to analyze the possible relationship between commuting and health effects on a group of workers exposed to this risk factor. METHODS: Our study analyses health effects related to commuting in an exposed occupational population, by means of the self-completed ad-hoc questionnaire provided to workers of different plants in the North of Italy. RESULTS: Our results are consistent with scientific literature ones. Commuting exposed workers showed increased risk of headache and sleep disorders. CONCLUSIONS: Our study is an explorative but structured evaluation of health effects of commuting and a base for further researches.

[Monoclonal gammopathy of uncertain significance (MGUS) and occupational risk factors: criteria to carry out the health surveillance]. / Gammopatia monoclonale di incerto significato (MGUS) e fattori occupazionali di rischio: criteri di attuazione della sorveglianza sanitaria.

SUMMARY: Monoclonal gammopathy of uncertain significance (MGUS) identifies a clinically asymptomatic and laboratory-based situation characterized by a modest monoclonal component (MC). In a limited percentage of cases, on a probabilistic basis, the asymptomatic genepremalignant stage could lead to multiple myeloma (MM). Materials and Methods. Based on literature data and available Guidelines on the subject, the diagnostic criteria and a methodological path are here suggested to the Occupational Physician to formulate a judgment of suitability for the task with exposure risk to RI or pesticides. Results. Some studies have evaluated the prevalence of MGUS in subjects exposed professionally to pesticides. Numerous other studies conducted on the survivors of the atomic bombing of Hiroshima and Nagasaki have highlighted a possible association with exposure to ionizing radiation (IR). The guidelines relating to the diagnosis and management of MGUS cases (with respect to the potential evolution in MM allow) to draw important operational indications for the competent/authorized physician. Conclusions. The routinely use of laboratory tests for subjects exposed to the studied risk factors is generally indicated starting from the worker's 50 years of age. The finding of a MGUS in the absence of further laboratory alterations represents the situation most frequently and does not require further measures, other than those of foreseeing even blood controls at least every two years. In this situation, there are no justified restrictions on work activities with exposure risks to IR or pesticides. If alterations suggestive for an increased risk of evolution in a neoplastic way could be identified, a close periodicity - every 3-6 months - of haematological checks is recommended. In these cases, it appears justified an abstention from activities involving exposure to ionizing radiation for a period of time that will be evaluated based on the evolution of the framework and by the progress of laboratory tests in the monitored period.

[Proposal of a method for assessing the risk of burnout in teachers: the VA.RI.B.O strategy]. / Proposta di un metodo per la valutazione del rischio di burnout negli insegnanti: il VA.RI.B.O (VAlutazione RIschio Burn-Out).

SUMMARY: Introduction. Burnout syndrome (BOS) can be defined as a chronic work strain characterized by three dimensions: emotional exhaustion, depersonalization (or cynicism), reduced professional effectiveness. BOS typically strikes the helping professions like the teachers. Objective. The aims of this study are: 1) clarify the concept of BOS, as currently configured in the international scientific literature; 2) analyze the psychosocial risk factors in teachers; 3) develop a methodology for the assessment and prevention of the risk of BOS in the teachers. Methods. The literature review followed some of the PRISMA guidelines criteria. Results and discussion. The results of the study highlight BOS as a risk factor specific and distinct from labor-related stress. A strategy called VA.RI.B.O is proposed (Burn-Out Recognition) for teachers.

[Work on a building site at high altitude: physiopathological features and entailments for the occupational medicine]. / Il lavoro in un cantiere in alta quota: generalità fisiopatologiche e analisi di una casistica occupazionale.

SUMMARY: Introduction. From a physiological perspective the high altitude is defined by altitudes higher than 3000 meters above sea level: at this altitude the atmospheric pressure is reduced to 525 mmHg and the partial pressure of Oxygen drops to 110 mmHg in the ambient air follows and 60 mmHg in the alveolar air. To stay at altitudes above 3000 m s.l.m. therefore places the human organism in front of a notable reduction of the functional respiratory reserve already in conditions of rest, leading to inevitable repercussions on the ability to sustain physical effort. Materials and methods. A population of 39 workers employed in the construction sector at a high altitude construction site (2200-3480 m) was examined. Data relating to sex, age, body mass index, smoking, residence altitude, mountaineering history (maximum altitude reached over a lifetime, frequency of ascents, time spent at high altitude, both for pleasure and for work) and sport practice were collected. Among them, for 25 workers the data of the ergometric tests in normobaric hypoxia (pO2, desaturation and peak values of heart rate, respiratory frequency, ventilation) conducted with simplified mode were collected. Purpose. The study aims to analyze the health of a group of workers exposed to the risk related to staying at high altitude in light of the indications of the scientific literature on health surveillance. Results. The data relating to the group of workers studied with regard to anamnestic data and to the results of ergospirometric examinations in hypoxic conditions are described. Conclusions. In working conditions at high altitude it is necessary to consider both the effect of high altitude in itself, similar to a sort of substantially unchangeable "background risk", and the ways in which high altitude interacts with other risk factors characteristic of the work site activity (which are the same as for any construction site activity that takes place at sea level), considering also the pathophysiological or frankly pathological conditions of which the worker is a carrier. This evaluation can be articulated on two levels: a first level concerning the suitability of the individual for access and the simple prolonged stay in altitude where the work activity will be performed; a second level regarding the suitability of the worker to carry out the work tasks required by the specific task in the particular environmental conditions.

Macular degeneration: peculiar sunlight exposure in an agricultural worker.

BACKGROUND: Occupational exposure to sunlight, in particular to blue light (wavelength of 380-550 nm), is a risk factor for several pathologies, including chronic retinal photochemical damage and, more specifically, age-related macular degeneration (AMD). Moreover, in addition to the effect of blue light, there is evidence about the role of near ultraviolet light (UV-A) as a risk factor for AMD since, given the wavelength, a precise "turning point" between effect and no effect is not definable. METHODS AND RESULTS: This work reports the case of a woman employed in the agricultural sector from 15 to 25 years of age, with no significant occupational exposure to other risk factors for AMD, who later developed this pathology. The case is of particular interest given that she worked as a "mondina", a task involving the transplanting of young rice seedlings into water-flooded fields and manual weed control. This practice, although replaced by the introduction of pesticides, entailed the exposure to sunlight reflection on the water surface in addition to direct exposure to natural light. CONCLUSION: This brief case-report points out that occupational exposure to the short wavelength component of visible light and UV-A deserve further attention regarding preventive measures and the adoption of adequate personal protective equipment, in particular in productive sectors involving lengthy eye exposure to solar radiation and to the reflectance of surrounding surfaces. Furthermore, the cases of AMD and cataract should receive a complete and accurate occupational anamnesis for a more proper recognition of the possible role of occupational solar radiation exposure in the induction of the disease.

Position Paper on Asbestos of the Italian Society of Occupational Medicine.

The Position Paper (PP) on asbestos of the Italian Society of Occupational Medicine (SIML) aims at providing a tool to the occupational physician to address current diagnostic criteria and results of epidemiological studies, and their consequences in terms of preventive and evaluation actions for insurance, compensation and litigation. The PP was based on an extensive review of the scientific literature and was compiled by a Working Group comprising researchers who have contributed to the international literature on asbestos-related diseases, as well as occupational physicians with extensive experience in the evaluation of risks and the medical surveillance of workers currently and formerly exposed to asbestos. The PP was drafted and reviewed between 2017 and 2018; its final version was prepared according to the guidelines of AGREE Reporting Checklist. All the members of the Working Group subscribed to the document, which was eventually approved by SIML's Executive Committee. The first section addresses industrial hygiene issues, such as methods for environmental monitoring, advantages and limitations of different microscopy techniques, the potential role of microfibers and approaches for retrospective assessment of exposure, in particular in epidemiological studies. The second section reviews the biological effects of asbestos with particular attention to the diagnostic aspects of asbestosis, pleural changes, mesothelioma and lung cancer. In the following section the criteria of causal attribution are discussed, together with different hypotheses on the form of the risk functions, with a comparison of the opinions prevalent in the literature. In particular, the models of the risk function for mesothelioma were examined, in the light of the hypothesis of an acceleration or anticipation of the events in relation to the dose. The last section discusses topics of immediate relevance for the occupational physician, such as health surveillance of former exposed and of workers currently exposed in remediation activities.

[The Italian version of the "Claustrophobia Questionnaire": validation study and perspectives of use for the occupational physician.] / La versione italiana del "Claustrophobia Questionnaire": studio di validazione e prospettive di utilizzo per il medico del lavoro.

OBJECTIVES: Aim of our study was to adapt the Claustrophobia Questionnaire (CLQ) to the Italian context. METHODS: In our study, a sample of 50 claustrophobic patients was compared to 50 healthy people (control group). All of them answered the Claustrophobia Questionnaire and the Stait-Trait Anxiety Inventory Form Y1 and Y2, as well as demographic questions. RESULTS: As it was theoretically expected, our results confirmed the two-factor structure and showed that the Italian version of the CLQ has good psychometric properties. Indeed, it was observed that claustrophobic patients scored higher in claustrophobia than those from the control group. CONCLUSIONS: In conclusion, the Italian version of the CLQ is a reliable and valid instrument to assess claustrophobic fear.

[Stochastic effects of ionizing radiations]. / Gli effetti stocastici delle radiazioni ionizzanti.

OBJECTIVES: Stochastic effects induced by exposure to ionizing radiation rapresent a relevance radioprotection aspect. METHODS: Actually most of the information about radiation-induced oncogenic risk arise from the follow-up of the atomic bombs survivors (Life Span Study, LSS); at this information sources have been added over the last decades also data derived from medical, occupational and environmental studies conducted in various parts of the world and their contribution about number of cases and duration of follow-up period is of great relevance. These sources of information, in fact, provide important data related to very different exposure models compared to the historical of the LSS and closer to those who characterize the employment context in the last decades. RESULTS: Data from these studies seem to outline the evidence for which at the current occupational exposure levels significant ERR/Gy are observed only for lung cancer and for all haematological neoplasms with the exception of chronic lymphocytic leukemia.

[Oncological disease: dimensions of the phenomenon and role ionizing radiation]. / La malattia oncologica: dimensioni del fenomeno e ruolo delle radiazioni ionizzanti.

OBJECTIVES: The continuous scientific advances against neoplastic diseases affecting all areas of oncology biomedical research. Age is an extremely important factor in cancer development, since the incidence of cancer increases significantly with age. Because of aging of the Italian population, although the incidence is kept constant, the number of cancer diagnosis is inevitably going to increase over time only to increasing age. METHODS: Survival after the diagnosis of cancer is one of the main indicators that allow to evaluate the effectiveness of the health system against the cancer disease. The 5-year survival after diagnosis is a widely used indicator. If we consider the relative survival data after 5 years of diagnosis, for cancer cases diagnosed in subsequent three-year periods, from 1990-1992 to 2005-2007, it shows that the 5-year survival has increased significantly over time for both men and women. Many so-called patients "long-term survivors "are of working age and should return to work. This aims to ensure both the mental and social well-being of the worker, both industrial production. For the oncogenic risk assessment by ionizing radiation, the ICRP Publication 60 has referred to the mortality and cancer data collected from 1950 to 1985 by the RERF, Japan-US bi-national institution with headquarters in Hiroshima that leads the research program called Life Span study (LSS), that is the study of the long-term effects on survivors of the bomb A. For the thyroid, instead, reference is made to the data from medical irradiations, as well as for liver and bone, using in this case adapted data relating to exposure to alpha rays (thorium and radio). The interpretation model is the traditional one: the linear dose-effect assumptions without a threshold even at small doses (LNT theory) when epidemiological data are not more informative for statistical uncertainty, although we resort to radiobiological studies. RESULTS: In transferring the risk among different populations ICRP in Publication 103 accommodates the idea that for each type of cancer is more suitable, from time to time, the additive or multiplicative model or a combination of the two. CONCLUSIONS: To study the oncogenic role of occupational exposure to ionizing radiation in the onset of neoplastic disease, the probability of cause (PC), is a "reasonable way to address the problem of evaluation of the likelihood that previous exposure to ionizing radiation (IR) is responsible for an oncogenic event "(Committee on Radiation Protection and Measurements - NCRP - Statement N. 7 of 30/09/92).

[Risk assessment and its appropriateness supporting the physician in the certification of a suspected occupational disease.] / La valutazione dei rischi e la sua appropriatezza a supporto del medico nella certificazione di sospetta tecnopatia.

OBJECTIVES: The topic of appropriateness was defined as the new frontier of development of health interventions. RH Brook in an Editorial published in the BMJ in 1994 defines the appropriateness "… an intervention for which the expected benefits are greater (with a sufficient margin) the possible negative consequences … excluding economic considerations". In workplaces the goal of appropriateness should cover not only the actions of health surveillance and health protocols, but also and primarily all stages of the risk assessment process. METHODS: Only through an assessment of occupational risks that aims to identify, evaluate and measure the real professional risk factors in specific working environments, it is possible to meet the requirements of effectiveness, efficiency and protection of ethical principles in the identification of priorities (according to values of person, community and society) that represent the size of the appropriateness of an intervention. At the same time, the risk assessment should provide to the occupational pyisician instruments to study with scientific, justifiable and reproducible criteria the possible correlation between damage to the worker's health and the occupational risk factors. RESULTS: In the process of reporting of suspected technopathy, both for prevention purposes (according to art. 139 of Presidential Decree 1165/68, art. 10 of Legislative Decree 38/00 and DM 10 June 2014), both for insurance purposes (according to art. 53 of Presidential Decree 1165/68 and Ministerial Decree 9 April 2008), it should be considered two indispensable judgment elements to study the correlation between the disease and the work: on the one hand the level (measured or estimated) of the occupational risk factors; on the other hand the appropriateness of the risks assessment compared to the best and most current scientific evidence (Evidence Based Medicine - EBM), according to technical standards and specific guidelines. CONCLUSIONS: Our study underlines the importance of appropriateness in the risk assessment process to analyze the correlation between the exposure to specific occupational hazards and the suspected technopathy.

[The complaint of suspected occupational disease: news, critical issues and applicative suggestions]. / La denuncia di sospetta tecnopatia: novità e criticità normative, suggerimenti applicativi.

OBJECTIVES: The Legislative Decree n. 151 of 14 September 2015 lays down new provisions concerning the DPR 1124/65. The major developments occur with Article 53 of Presidential Decree 1124/65, which transfer the obligation to send the medical certificate, attached to the report of accident and occupational disease, from the employer to the physician - "every physician lends immediate assistance to an injured worker or to a worker that suffers from an occupational disease" - using telematic systems, either directly or through the health facilities. There are however residual critical issues not easily overcome by the general pratictioner or by the physician not specialist in occupational medicine, because of the impossibility of knowing the real occupational causative agents of disease and the production cycle. So, the general practitioner cannot properly study the link between damage to health and work. In addition, there are no indications for diseases not included by tables (DM 09.04.2008) and lists (DM 10.06.2014), which should be evaluated about the possible occupational origin. Moreover, there is no indication of reporting for the pathologies present in the tables of occupational diseases, but not included in the lists of the DM 10.06.2014, and for the diseases with nosological differences between the tables of occupational diseases and lists, as well as those that the doctor believed to be linked to exposure at work, although not included in the two documents (tables or lists). To date, there are other technical critical issues that the legislation seems to overlook. In any of the laws reported (and even in the recent legislation) is mentioned the key element essential to evaluate, according to technical and scientific criteria, the first occupational origin attribution of a suspected technopathy: the results of an appropriate and specific risk assessment of the recognized causative agent. METHODS: We propose an operational way to create a technical and sustainable system of reporting suspicious technopathies. RESULTS: This system should be based on the figure and the role of occupational physician, both as a "competent" physician, according to the Legislative Decree n. 81/08 (in Italy), both as a doctor inserted in the community and hospital health services (in Lombardy these services are organized in the Health Protection Agencies - ATS - and in the Operative Unit Hospital of Occupational Medicine (UOOML of socio-territorial health companies - ASST). CONCLUSIONS: Complementarily, an organized reporting system should be based on risk assessment (according to art. 17 of Legislative Decree n. 81/08). Other aims are to overcome outdated practices, create a constant channel of dialogue between the territorial and the hospital health centers, send and capture in a structured and efficient way reports of technopathy, track all occupational disease reports and create a dedicated archive.

[The suspension trauma syndrome: preventive features.] / Sindrome da sospensione inerte (sindrome da imbracatura): peculiarità preventive.

OBJECTIVES: The suspension trauma syndrome is a clinical condition that could lead to death, also in short time, by coupling the suspension with loss of consciousness and multiorgan failure. Health risks linked to temporary work in suspension are characterized both by infortunistic ones (for instance: trauma, falls, etc.) and by clinical ones, like the suspension trauma syndrome or compressive issues due to different fall protection systems. METHODS: This study deal with the technical and medical meseasures devoted to the prevention of the suspension trauma syndrome. Italian 81/08 and 164/56 laws prescribes that, when no collective protection systems could be used, any single worker has to used personal safety equipment like energy absorbers, anchoring devices, lanyards, retractable devices, flexible life guides or lines, guides or rigid life lines, harnesses. Persons working in height have to undergo a medical surveillance, devoted in particular to identify such illnesses (frequently cardiologic or muscleskeletal disorders, both temporary or chronical) that prevent the exposures possibly leading to the suspension syndrome. RESULTS: In some cases, the occupational physician could express a judgement of fitness to work in which only specific personal protection devices are allowed and/or the time to dedicate to work in suspension is limited, to efficiently protect the workers' health. CONCLUSIONS: Qualora emergano quadri patologici (in particolare cardiologici ed osteomuscolari) con caratteristiche di cronicità e irreversibilità, è indicato esprimere un giudizio di inidoneità permanente alle attività che prevedono il lavoro in sospensione con imbracatura. In casi specifici, è possibile formulare giudizi di idoneità con limitazioni/prescrizioni rispetto al tempo di sospensione o rispetto alla tipologia di DPI impiegati, in maniera tale da garantire lo svolgimento dell'attività in sospensione minimizzando il rischio di insorgenza della sindrome.

[Not Available]. / Cefalee primarie e lavoro a turni: sudio dell' associazione in una popolazione di lavoratori esposti al rischio.

Primary headaches are characterized by an high prevalence, especially among workers. This issue entails remarkable costs, both direct and indirect. For a great amount, the latter consist in the loss of work days for this disease and in a decrease of occupational efficiency among these patients. Moreover, workers suffering from headache could be at high risk for occupational injuries, due to a reduction in attention and to the possible onset of adverse drug effects of their therapies. Thus, primary headache should not be no longe overlooked as an important occupational disease. Among putative risks factors that could increase the rate of headache's onset in the occupational environment, shift work is of great interest. We studied 97 workers (93 males and 4 females) of a single, chemical plant located in Lombardy (Italy). Considering only male workers, the prevalence of primary headache was found to be significantly high among shift workers compared to workers occupied only during the day (40.4% vs. 21.9%, p=0.043). Our results, although observed on a little population, seem to add some evidence, suggesting a role for shift work to increase the prevalence of headache among workers.

[The health surveillance of workers previously exposed to asbestos: criticality of intervention protocols]. / La sorveglianza sanitaria dei lavoratori ex-esposti ad asbesto: criticità dei protocolli di intervento.

The health surveillance of former-exposed asbestos workers is today a current theme, as well as a social and healthcare need. The long latency periods of asbestos related diseases have determined and determine a constant development of cases of these pathologies. To face with these issues, it is necessary to have available adequate diagnostic, clinical and epidemiological tools, that allow efficient health interventions as well as an acceptance of social and medico-legal requests, claimed by workers exposed to asbestos during their work career. To date, health surveillance protocols available for different Italian regions are uneven. This paper aims to synthetically resume contents of some of these protocols and to discuss them, on the light of emerging literature evidence. Based on these considerations, it is finally proposed a scheme for the health surveillance of former-exposed asbestos workers. This proposal is not intended as a comprehensive treatise, rather than as a preliminary approach of this specific healthcare issue.