[Restrictions on night work: analysis of case studies in a large Lombardy Hospital]. / Limitazioni al lavoro notturno; analisi della casisitica in un ospedale lombardo di grandi dimensioni.

A high percentage of the division's doctors and employees work at night to guarantee urgent assistance and diagnostic services to patients. Night work is not recommended for persons with rather serious case histories due to the disruption of circadian rhythms or the increased workload required of certain operators during nighttime hours. All of the evaluations of health operators with a limited capacity to work on the night shift in our hospital were analysed, except for female workers restricted from night work during pregnancy or puerperium, as provisioned by the regulation that protects working mothers. Forty-two cases were considered (six physicians and 36 operators in the division) out of a total of 2676 employees assigned to night work and the conditions that led to the formulation of the decision are divided as follows: 16 Mental disturbances currently subject to treatment (depression, post-traumatic anxiety disorder, primary insomnia...), 8 Tumours (breast, colon, Ewing Sarcoma), 7 Neurological disorders (multiple sclerosis, myasthenia), 6 Cardiovascular disease (previous IMA; arrhythmias, arterial hypertension not controlled by theraphy) and 5 others patologies (total 45). The cases will be analysed in detail with an analysis of the characteristics of the exempt group of workers and with reference to the temporary or indefinite nature of the exemption.

[Measles, mumps, rubella and varicella: antibody titration and vaccinations in a large hospital]. / Morbillo, parotite, rosolia e varicella: titolazione anticorpale e vaccinazioni in un ospedale di grandi dimensioni.

The occurrence contagious diseases such as measles, varicella, mumps and rubella in the hospital open creates situations of alarm, due to the potential involvement of workers, but most importantly for the oftentimes harmful consequences for critical patients, such as pregnant women or immunocompromised individuals. In 2007 antibody titration was initiated in our hospital for four infectious diseases, also pursuant to the Lombardy Region Resolution N. VIII/1587 of 22-12-2005 "Decisions regarding vaccinations in children and adults in the Lombardy Region" which indicate the departments in which a priority exists: maternity-neonatal and infectious illnesses. In 2011 a vaccination campaign was launched for unprotected operators in the Health and Medical Management departments: after an interview with the competent physician of reference, the subjects voluntary submitted themselves to vaccination. The protective antibody data encountered over the years are similar to that reported in the literature, with coverage percentages greater than 93% for varicella and rubella, over 89% for measles and over 85% for mumps. Approximately 80% of the operators are protected against all four diseases. However, the dramatic consequences of potential contagion lead us to strongly recommend vaccinations for non-protected subjects. At present 37 operators have been vaccinated with the trivalent MMR vaccine (Measles, Mumps and Rubella) and 14 for Varicella. The antibody response was verified in all cases.

[Risks of repetitive movements in health personnel]. / Rischi da movimenti ripetitivi nel personale sanitario.

To date, scant attention has been devoted to the occupational risk related to repetitive movements in health personnel. Using three database, PubMed, Scopus, and EMBASE, we found 57 papers on this topic, and on possibly related upper limb symptoms and diseases. In these studies, evaluation of the risk, e.g. using the methods currently applied in industry, are lacking. Although in several studies data on the prevalence of upper limb symptoms and disorders are presented, a comparison of results is difficult as different methods were applied. Furthermore, a comparison with adequate controls is frequently lacking, and/or correlation with the risk was not studied. Despite these limitations, an overall evaluation of the results shows that in health personnel the prevalence of upper limb symptoms/disorders is generally high. Highest prevalences were observed for the neck, shoulder, wrist/hand symptoms and for Carpal Tunnel Syndrome (CTS) in dental personnel, for symptoms to the neck, shoulder and wrist/hand in sonographers, and to the neck, shoulder, elbow, and, especially, wrist/hand in laboratory technicians using manual pipettes. In the nursing personnel highly variable prevalences were observed; this is possibly due to the variability of the tasks performed by this occupational group. Repetitive movements of upper limb are a known risk factor for symptoms to the neck, shoulder, elbow, and wrist/hand, and some disorders, as CTS: the high prevalences observed in health workers may be related to this risk. Nevertheless, other factors such as effort, posture and precision work may play an important role too. As a conclusion, available data are insufficient for an adequate evaluation of the occupational risk related to repetitive movements in health workers.

[Focus on risk assessment in health environments: results and perspectives of a multicenter working group]. / Focus sulla valutazione del rischio negli ambienti sanitari: risultati e prospettive di un gruppo di lavoro multicentrico.

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.

[Tuberculosis. Focus on risk assessment and health surveillance in health workers: results and perspectives of a multicenter working group]. / La tubercolosi. Focus sulla valutazione del rischio e la sorveglianza sanitaria dei lavoratori della sanità: risultati e prospettive di un gruppo di lavoro multicentrico.

INTRODUCTION: 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. METHODS: A multidisciplinary working group, led by occupational physicians, examined the activities to prevent TB performed in 9 Italian hospitals and reviewed the literature, with the aim to formulate evidence-based procedures. RESULTS: In the considered hospitals, 23.000 HCW are classified as exposed to TB, out of 32.000 HCW exposed to biological risks; yearly, about 6000 subjects are screened for preventive, periodical or post-exposure surveillance and 110-130 chemoprophylaxis are prescribed. A high proportion of HCW (54-75%) refused or interrupt to assume the drugs. In the period 2004-2008, 14 occupational TB were diagnosed (9/100.000 HCW exposed to biological risks). DISCUSSION: Critical issues are the availability of a specific, written TB control plan, including risk assessment, protocols for identifying, evaluating, managing infectious TB patients, health surveillance, education programs, specifically addressed to increase Standard Precaution adoption and compliance to the screening and to adequate risk perception. Risk assessment identify HCW to be included in TB testing (characterized by low positive predictive value), unrecognized TB and environmental control needed; TB risk classification should include no more than 3 or 4 classes and performed by assessing the issues suggested in the Italian guideline. Tubercolin skin test should be used for HCW screening, adding in vitro test in specific circumstances (for example, skin test positivity in BCG vaccinated HCW); the frequency of the screening should not exceed 2 years. Periodical revision of preventive activities should follow up to date scientific literature and need appropriate data computing.

[Focus on coverage and promotion of anti influenza vaccine in health workers: results and perspectives of a multicenter working group]. / Focus so copertura e promozione della vaccinazione antinfluenzale nei lavoratori della sanità: risultati e prospettive di un gruppo di lavoro multicentrico.

INTRODUCTION: 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. AIMS: To formulate recommendations on vaccination in healthcare settings. METHODS: A multidisciplinary working group, led by occupational physicians (OP), examined the information on seasonal influenza immunisation campaign in 9 Italian hospitals in the period 2005-2009 and reviewed scientific evidence. RESULTS: Many health organizations recommend vaccination of HCW. The literature shows that seasonal influenza vaccination of healthy adult have a modest effect in reducing work day lost; there is no evidence that it affects transmission or it prevents the disease in elderly residents. These observations might be conditioned by methodological limitations. Further studies are required to avoid the risk of bias and in pediatric settings. The rate of flu vaccination among HCW is widely variable and it depends on individual risk perception and information about efficacy and side effects. In the considered hospitals, in the five-years period the vaccination rate ranged between 0 and 29%: the median value was 16-17% in 2005, 2008 and 2009 (only against H1N1 influence), 11% and 13% in 2007 and 2006 respectively. OP participation in the vaccination campaign seems to increase the immunization rate. DISCUSSION: Seasonal influenza immunization of HCW might be effective. We recommend to formalize written procedures in health care settings, to perform data computing and to periodically revise immunization activities and promotion and scientific literature, with the aim to appropriately address resources.

[Focus on health surveillance of health workers exposed to blood-transmissible biological agents: results and perspectives of a multicenter working group]. / Focus sulla sorveglianza sanitaria dei lavoratori della sanità esposti ad agenti biologici trasmissibili per via ematogena: risultati e prospettive di un gruppo di lavoro multicentrico.

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.

[Exanthemic diseases (measles, chickenpox, rubella and parotitis). Focus on screening and health surveillance of health workers: results and perspectives of a multicenter working group]. / Le malattie esantematiche (Morbillo, Varicella, Rosolia e Parotite). Focus su screening e sorveglianza sanitaria dei lavoratori della sanità: risultati e prospettive di un gruppo di lavoro multicentrico.

BACKGROUND: 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. METHODS: A literature review and a seroprevalence study were carried out in 9 hospitals located in north and central Italy, in order to evaluate risk assessment, health surveillance and fitness for work of HCW exposed to V, R, Mu and Me. Antibodies (Ab) against V, R, Mu and Me were determined. For a subgroup of 4 hospitals; sociodemographic, occupational data and sera were collected and analyzed. RESULTS: About 36000 tests on about 9000 HCW were analyzed. Differences in seroprevalence ratios (V 85.7-95.1%, R 47-96.8%, Me 71.4-97.8%, Mu 52.5-87.6%) were detected. In a subgroup, a relevant number of non immune HCW was also found among women infertile age and areas at higher risk. Statistically significant differences were detected only for selected variables and viruses. DISCUSSION AND CONCLUSIONS: Data of multicenter study confirm literature evidences and allow to define good medical practices for manage and minimize the risk of nosocomial transmission of V, R, Me and Mu. Recommendation are issued about serologic screening on HCW exposed to all 4 viruses thorough the modern analytical techniques, in order to assess risk on individual a group basis and to select priorities for intervention. Vaccination should be prescribed for those HCW non immune, selecting areas and HCW according to priorities.

[Carpal tunnel syndrome in handicraft planning]. / La sindrome del tunnel carpale nella panificazione artigianale.

The purpose of this study is to assess the prevalence of carpal tunnel syndrome (CTS) in a group of bakers and to evaluate the presence of a biomechanical risk for upper limbs in the technological cycle. Health assessment (history, clinical examination, upper limbs electromyography) and risk evaluation through Check List OCRA (Occupational Repetitive Actions - Colombini / Occhipinti) have confirmed the initial hypothesis, placing this profession between those at risk for carpal tunnel syndrome.

[Vaccination and immunization in healthcare workers, towards specific infections: measles, varicella, rubella and mumps. The experience in a hospital in Lombardy]. / Vaccinazioni e immunizzazione nel personale sanitario verso infezioni specifiche: morbillo, varicella, rosolia e parotite. L'esperienza di una Azienda Ospedaliera Lombarda.

Lombardy Region, with the Deliberation NoVIII (22-12-2005), about vaccinations in childrens and adults, suggest to offer to the healthcare workers (HCW) of 'Infectious diseases' and of 'Obstetrics and 'Pediatrics' Department, the vaccines for varicella and measles, mumps and rubella (MMR). We performed in 120 HCW of our hospital the dosage of antibodies versus these infectious diseases, in order to protect both workers and critical patients. The study results show that more than 80% of the HCW was immune to all the four infectious diseases. The percentage of immunisation to measles, varicella and rubella exceeded the 90%, while 87.5% of HCW was immune to mumps. We are going to offer the vaccine to the operators that are not immune, but we are also thinking about offer it to the HCW working with critical patient.

[Job fitness management regarding university school of nursings students: our experience over three years (2005-2007)]. / Giudizio di idoneità al tirocinio pratico per studenti del corso di laurea in infermieristica: casistica triennale (2005-2007) dell'Azienda Ospedaliera Ospedali Riuniti di Bergamo.

Based on definition of worker according to D.Lgs.626/94, art.2, c.1 also the University Students before to start their pratical training in Hospital must be submitted to sanitary surveillance by Occupational Health Physician. Aim of this paper is to report about the Job Fitness Management regarding no. 231 University School of Nursing's Students that in some cases has involved the formulation of limitations and/or prescription.

Software implementation and hardware acceleration of retinal vessel segmentation for diabetic retinopathy screening tests.

Screening tests are an effective tool for the diagnosis and prevention of several diseases. Unfortunately, in order to produce an early diagnosis, the huge number of collected samples has to be processed faster than before. In particular this issue concerns image processing procedures, as they require a high computational complexity, which is not satisfied by modern software architectures. To this end, Field Programmable Gate Arrays (FPGAs) can be used to accelerate partially or entirely the computation. In this work, we demonstrate that the use of FPGAs is suitable for biomedical application, by proposing a case of study concerning the implementation of a vessels segmentation algorithm. The experimental results, computed on DRIVE and STARE databases, show remarkable improvements in terms of both execution time and power efficiency (6X and 5.7X respectively) compared to the software implementation. On the other hand, the proposed hardware approach outperforms literature works (3X speedup) without affecting the overall accuracy and sensitivity measures.

Cobalt excretion in urine: results of a study on workers producing diamond grinding tools and on a control group.

A study was carried out on cobalt (Co) excretion in the urine of 12 workers exposed to known cobalt concentrations in the stone cutting diamond wheel production and in six volunteers: four of these were exposed in the same work environment for a whole workshift and the other two were exposed to cobalt in a cabin under experimental conditions. The kinetics of the urinary excretion was multiphase: (i) a first stage of rapid elimination (T 1/2' = 43.9 h); (ii) a second phase of slower elimination (T 1/2'' = 10 days); (iii) a longer period of retention, of the order of years, in subjects with higher exposure. In the control group (4 subjects), the excretion proved to be much faster in the first stage (T 1/2' = 20 h). The different behaviour of the two groups could be related to the different body burden, of cobalt and/or to the possibility of different kinetics induced by continuous exposure to the metal. Moreover, 3 weeks after the removal of the workers from exposure the urinary cobalt concentrations were not within the normal limits of CoU for the general population, (even for workers exposed to cobalt levels of the same order as the TLV). The increase of CoU concentrations in the first 3 h after the end of exposure, stresses the problem of when urine samples for biological monitoring of the workers should be collected. The present study confirms the utility of CoU in discriminating between exposed and non-exposed subjects as well as in assessing high and low level exposure.

Cobalt exposure in 'hard metal' and diamonds grinding tools manufacturing and in grinding processes.

Cobalt is considered to play a major role in the development of 'hard metal' interstitial lung disease, asthma and other adverse health effects. A survey of occupational exposure of workers is a fundamental step to obtain exposure-response information and for preventive action. Process related exposure assessment was performed before and after technical control in small and medium size factories in a large surveillance programme. Cobalt containing airborne dusts were sampled by performing multiple measurements at the workplace of each process in which the types of job and duration of exposure were similar. Samples were analyzed by atomic absorption spectroscopy. Very high exposure levels encountered before technical control were significantly lowered with efficient local exhaust ventilation plant in 'hard metal' and grinding processes, but sometimes the TLV of 0.05 mg/m3 were exceeded. In the manufacture of grinding tools, major steps in cobalt control by local ventilation was not able to keep exposure below the TLV; exposures from 0.12 to 0.75 mg/m3 were recurrent and these need control strategies.

Occupational exposure to metallic cobalt in the Province of Bergamo. Results of a 1991 survey.

The results of a survey on workers potentially exposed to cobalt in the Bergamo Province are reported. Its aim is to assess the number of workers at risk of developing respiratory disease due to the inhalation of metallic cobalt. Interest was shown after an examination of 11 cases of 'hard metal disease', which we diagnosed, in workers who came from different production areas and had different degrees of exposure. A first group of 45 factories with potential cobalt exposure was identified by consulting the archives of the Local Sanitary Units (USSL) and of the Chamber of Commerce, and by use of the telephone directory and requesting information from the producers and users of Widia tools. A second group of 2039 factories was selected from those industrial activities where we had previously ascertained the presence of grinding operations using hard metal tools with diamond wheels. This study is related to all the factories in the first group and 10% of the factories in the second group. More than 304 inspections were carried out. In this context 403 exposed workers were identified. Workplace air measurements (250 samples) and biological monitoring (> 600 samples) to determine the exposure levels to cobalt were performed. The results show an unexpected diffuse occupational exposure in different production areas where the airborne cobalt is frequently underestimated and higher than the TLV.

[Manual lifting of patients: experience at the Riuniti di Bergamo Hospital]. / La movimentazione manuale dei pazienti: esperienza degli "Ospedali Riuniti di Bergamo".

The manual lifting of patients is a risk factor in the working activity of hospital nurses and it causes a high prevalence of low-back pain in these workers. The evaluation of risk has been performed in various Occupational Units of our hospital in accordance with art. 4 of Legislative Decree 626/94. The results of this evaluation, have led to implement the following preventive measures: health surveillance, professional training, purchase of special furniture and ergonomic supports.

[Exposure to the risk of the manual lifting of patients and the results of a clinical study in 4 hospital establishments of northern Italy]. / Esposizione al rischio di movimentazione manuale dei pazienti e risultati dell'indagine clinica in quattro aziende ospedaliere del Nord Italia.

The paper reports the results of a study carried out in four hospitals in northern Italy to assess exposure to patient handling and the consequent risks for the lumbar region of the spine. The methods proposed by the EPM Research Unit were used. Altogether, in the four hospitals there were 148 wards and 5596 staff. Of these, 34 wards and 510 workers were examined. The results of exposure assessment showed that the obstetrics departments had negligible risk (MAPO Index 0-1.5), urology and general surgery departments an intermediate risk (MAPO Index 1.51-5.0), while the departments of medicine, orthopaedics, neurology and rehabilitation had high risks (MAPO Index > 5.0). Of the 510 workers who underwent physical and anamnestic assessment for spinal disorders, 44% worked in the departments of medicine, which are known to have a high risk The prevalence of subjects who reported episodes of acute low back pain in the last 12 months (11.4%) was 5 times that of a group of workers not exposed to manual load handling (2.3%). Analysis of the same disorder referred to each job showed higher prevalences in the non-nursing staff (technical 25%, general 27%). The frequency of degenerative disorders of the lumbar spine was slightly lower than the figure for the country as a whole (6.7%). It is clear that measures for improvement of the environment are required aimed particularly at installing aids and staff training (for the specific risk factor), also so as to better manage the reallocation of workers judged unfit for patient handling who, in the group under study, were 5%.

[Repetitive movement of the upper limbs: results of exposure evaluation and clinical investigation in wood sanding in Bergamo]. / Movimenti ripetitivi degli arti superiori: risultati della valutazione dell'esposizione e dell'indagine clinica nella carteggiatura del legno nel bergamasco.

The authors report their findings regarding a risk assessment study and clinical tests carried out among a group of 121 workers whose job was to sandpaper and buff timber products. The results of the risk assessment indicate that the job in question is at significant risk for the development of WMSDs in relation to the principal risk factors (repetitiveness, force, posture, short recovery periods). The clinical tests, undertaken by medical staff, complied with the anamnestic models proposed by EPM. The results showed that 21 workers were above the anamnestic threshold, and were thus referred for specialist examinations. As a result of the latter, the relevant diagnoses were made. A positive correlation was reported between the occupational exposure level and the clinical abnormalities detected.