[Occupational diseases caused by artificial optical radiation (AOR)]. / Le malattie professionali da radiazioni ottiche artificiali (ROA).

BACKGROUND: Italian national legislation guarantees safety and health for workers exposed to artificial optical radiations (AOR) by Legislative Decree 81/2008. OBJECTIVES AND METHODS: Effects and damages to health resulting from AOR exposure were analyzed from literature data. RESULTS: Ultraviolet radiations (UV), particularly those in the wavelength range between 220 and 310 nm, causes chronic conjunctivitis and kerato-conjunctivitis. Skin cancer caused by UV exposure included basal cell carcinoma, squamous cell carcinoma and melanoma. As regards Infrared Radiations (portion of the spectrum between 780 nm and 1 mm), the biological effect is essentially of thermal nature. Exposure to blue light (portion ofthe spectrum of visible light radiation in a wavelength range between 380 and 550 nm) causes exclusively retinal damage and is considered to be responsible for the development of situations of age-related macular degeneration (AMD). Even if experimental data are available, at the present time there is still no epidemiological evidence of retinal damage caused by blue light. CONCLUSIONS: The forensic criteria for investigating the causality link between occupational exposure to AOR and damage, and the methodology necessary for the assessment process, are reported. Two lists of occupational diseases which were included in the Italian Ministerial Decrees, issued respectively on April 2008 and 11 December 2009, are also considered. Lastly, on the basis of the current existing guidelines and scientific evidence, the authors propose occupational health surveillance protocols for workers exposed to AOR risk.

[Use of computerized stabylometric footboard in evaluation of work suitability at height work in building firms]. / L'utilizzo della pedana stabilometrica computerizzata come ausilio nella definizione della idoneità al lavoro in altezza nel comparto edile.

A relevant part of deadly work accidents and of severe work accidents reported in national specific statistics coming from INAIL is until today caused by workers' falls during their at height work activities. Medical evaluation of eventual workers' hyper susceptibility to fall caused by balance alterations, if included in medical surveillance, is frequently carried out by medical doctors using different subjective tests included in different clinical protocols. Use of a computerized stabylometric footboard on the contrary allows to obtain objective and reproducible data concerning vestibular function which, associated with traditional clinical medical evaluation, seem to better detect eventual presence of balance disturbances, especially those non clinically perceivable by workers and therefore more dangerous. We report results evidenced in a research carried out in a group of 185 workers engaged in building firms and having work tasks including phases of at height work.

[Medical surveillance in university: organizational difficulties, legal problems, scientific e technical specificities. Experience of University of Milan Bicocca]. / La sorveglianza sanitaria nelle università: problemi organizzativi, medico legali e tecnico scientifici. La esperienza della Università di Milano Bicocca.

Our research describes activities of Occupational Health carried out during last year in University of Milan Bicocca by Occupational Doctors. We describe results of medical surveillance in 1153 employees or students exposed to occupational risks for health and safety. We report results obtained, technical difficulties, organizational problems, and preventive actions decided to improve functionality of our activity. Students seem to be less protected and consequently seem to have higher professional safety and health risks.

[Medical surveillance of Italian Red Cross Volunteers: actual limits of law, technical and scientific problems. The experience of Red Cross Provincial Committee of Monza and Brianza]. / La sorveglianza sanitaria dei Volontari della Croce Rossa Italiana: limiti normativi e problematiche tecnico scientifiche. La esperienza del Comitato Provinciale CRI di Monza e Brianza.

Our research describes a medical surveillance, not included in usual Occupational Health activities, carried out in last year among Red Cross Volunteers active in Monza e Brianza Provincial Committee. This medical surveillance has been managed according to internal rules of Red Cross and national specific Laws. We report data concerning medical examination of 1285 volunteers, their consequences on their voluntary activities, problems arisen during and after medical controls. Starting from results of our medical controls, we evaluated legal and organizational possibilities of evolution of medical surveillance of Red Cross Volunteers specifically and more generally of Civil Protection Volunteers, considering specific new law recently promulgated which seem partially not homogeneous with 81/08 Decree.

[Urinary evaluations of drug consumption among workers having high risk of accident: technical difficulties, limits and possibilities of increasing efficacy of the law]. / Le valutazioni bioumorali del consumo di stupefacenti nei lavoratori a rischio di infortunio per terzi: criticità tecniche, limiti e possibilità di incremento della efficacia della norma.

Urinary evaluations of drug consumption among workers having high risk of accident became compulsory in Italian legislation few years ago. We report results of 322.110 single urinary drug detections carried out between 2008 and 2011 on 35.789 subjects. We verified technical difficulties arisen during laboratory detections and organizational difficulties evidenced by Occupational Doctors during collections of samples. We screened 701 positive samples (1.96%), mostly to Cannabinoids and Cocaine, verified using first and second level screening according to national law. Many patients referred regular or irregular use of medicines active on Central Nervous System frequently ignoring their collateral effects. After the evidence of a positive result, during a second medical visit, many workers referred assumption of "natural diet supplements" acquired not in traditional commercial distributors. In two cases we have had the possibility of analyzing these supplements which have shown the presence of law concentrations of drugs in their compositions.

[Evaluation of residual osteomuscular function using computerised movement analysis for building sector workers: specificity and technical problem]. / La valutazione della funzionalità osteomuscolare residua tramite l'analisi computerizzata del movimento nei lavoratori del comparto edile: specificità e problematicità.

Occupational Health Doctors active in building sector firms frequently have to evaluate residual workers' osteomuscular function in patients coming back to work after an accident happened during work time or free time. Definition of their specific individual work suitability is usually carried out utilizing semeiotic tests in which subjective evaluation of every single Medical Doctor is real important in definition of final results and this fact can cause legal controversies. In our research we describe the application of computerised movement analysis on 10 workers of building sector. In every patient examined this technical method has been able to study objectively the tridimensional ranges of motion of most important osteomuscular districts. The possibility to have an objective evaluation of residual osteomuscular function has a relevant importance both in definition of workers' work suitability at the moment in which they start again their activities and in possible future legal conflicts.

[Use of barrier creams in occupational health: utility, limits and actual diffusion in clinical practice]. / L'utilizzo delle creme barriera in Medicina dei Lavoro: finalità, limiti ed attuale impiego nella pratica clinica.

Use of barrier creams among workers exposed to chemical risk has changed during last years and actually seems not to be very largely widespread even if there are not many up to date data about it. We report a research carried out evaluating effective presence in pharmacological market of barrier creams, their chemical characteristics, their composition, their prize. We analyzed the prescription of barrier creams made by 45 Occupational Doctors active in 2730 firms, their knowledge of chemical and pharmacological aspects which can make the difference among creams. We also considered motivations of their frequent or rare barrier cream prescription.

[A survey on dental offices: risk assessment and practicable preventive and protective measures]. / Indagine su un campione di studi odontoiatrici: valutazione dei rischi e misure preventive e protettive attuabili.

The survey was aimed at developing a method and providing valuable tools to be used for risk assessment in dental practices and for the implementation of preventive and protective measures. For these purposes general (inspection card for the definition of risk level for health and safety) and specific tools (check-lists) were used. In each dental office chemical and physical hazards (noise and hand-arm vibration) were assessed. Adequate levels of security were achieved, even if workers' training was evidenced as a critical element. In the 90% of cases, rooms for specific use were available and suitable according the law. The risk of work-related stress was acceptable in almost all the analyzed dental offices. Chemical and specific physical hazards appeared to be below the action level. Biological risk doesn't seem to be a critical element, even though its control could be further improved.

[Work-related stress risk assessment in a home care agency]. / La valutazione del rischio stress lavoro-correlato in una cooperativa di assistenza domiciliare.

The workload, the quality of professional relationships and emotional involvement have a significant impact on distress and burnout in health care-workers; this impact has an hight variability among the different environments and different care facilities (hospital, erderly nursing homes, home care). The risk assessment of work-related stress performed in 2010 in a homecare agency highlighted organizational problems related to the content/context of work and risk factors for health and safety. High turn-over is evidenced as critical among the "sentinel events". The level of job-strain was moderate, even if some critical issues were evidenced especially in the group of physiotherapists; nurses were configured as a homogeneous group with a low level of job-strain. In informative meetings the workers identified the discomfort related to the time for transferring patients from their homes in a high-traffic metropolitan area was identified as the most critical aspect.

[Hepatitis B vaccination coverage and booster dose: results from a survey on healthcare students]. / Copertura vaccinale anti-epatite B e dose di rinforzo: risultati di uno studio su una popolazione universitaria.

This study assessed the immunisation status against hepatitis B in healthcare students and residents, before their hospital internship, as suggested by the "National Immunization Prevention Plan 2012-2014". The concentration of antibodies against hepatitis B was measured in 2,491 subjects (70.90% women), born between 1980 and 1993 and visited between January 1st 2000 and July 15th 2012. Personal and serologic data were collected for each subjects. Individuals with antibody less than 10 mIU/mL (327, 13.3%) were given a booster dose and re-tested 2 months later. The multivariate logistic regression evidenced that immunization is influenced by the gender, the age at first vaccination, the time elapsed between first vaccination and antibody measurement. This study confirms the importance of measuring the concentration of antibodies against hepatitis B among healthcare students, even if they have previously been vaccinated, according to the "National Immunization Prevention Plan 2012-2014".

The contribution of Enrico C. Vigliani (1907-1992) to the international development of occupational medicine and industrial hygiene.

BACKGROUND: One of the last century's greatest personalities in Occupational Medicine was Enrico Carlo Vigliani (1907-1992), director of the "Clinica del Lavoro" in Milan (1942-1977), editor-in-chief of "La Medicina del Lavoro" (1942-1991), Secretary-Treasurer and then President of the "Permanent Commission and International Association on Occupational Health" (1957-1981), the original nucleus of the ICOH. OBJECTIVES: The 20th anniversary of his death provides us with the opportunity to discuss the role of this brilliant scholar in the international development of Occupational Medicine and Industrial Hygiene. METHODS: A comprehensive analysis of Vigliani's scientific works was conducted. In addition, his close collaborators and pupils were interviewed. RESULTS: In the 1930s, as a young doctor, Vigliani, first in the world, demonstrated the effect of lead on porphyrin metabolism. Afterwards he conducted pioneering studies on occupational oncology (benzene-induced leukaemia, bladder cancer due to aromatic amines, asbestos-related tumours), pathogenesis of silicosis, encephalopathy in carbon disulfide poisoning, byssinosis and metal fume fever, so influencing international research and the implementation of preventive measures against these conditions. Vigliani's scientific authority was widely recognized internationally, as confirmed by his role in ICOH. During his period of active service, the Commission developed from an academic institution to a more open association, substantially increasing its membership. Furthermore, he contributed to establishing subcommittees devoted to specific topics (now called "scientific committees"), one of the strengths of the present Commission. CONCLUSIONS: Vigliani's contribution to the development of Occupational Health may be considered as an expression of his genial eclecticism which ranged from clinical medicine to the environment.

[The movement computerized analysis as instrumental support for occupational doctors in evaluation of upper limb pathologies in engineering workers]. / L'analisi computerizzata del movimento come strumento di supporto al Medico del Lavoro nella valutazione dei disturbi muscolo-scheletrici degli arti superiori nel comparto metalmecanico.

The movement computerized analysis of upper limb is a valid support in the definition of residual functional capability and of specific work suitability in complex cases. This methodology of evaluation is able to correctly and objectively define the tridimensional ranges of motion of every patient's upper limb. This fact can be particularly useful for workers coming back to work after a work-related or a not work-related accident of for handicapped workers at the beginning of a new work activity. We report a research carried out using computerized analysis of motion of upper limbs in 20 engineering workers.

[Sentinel events for work-related stress in hospital and their monitoring in the decade 2001-2010]. / Eventi sentinella stress lavoro-correlati in ambito ospedaliero e lore monitoraggio nel decennio 2001-2010.

This survey was aimed at showing the relationship between some working organizational indicators--work-related stress "sentinel events" such as sick leaves and work accident--and some sociodemographic (gender, age) and organizational (homogeneous tasks, departmental areas) parameters. In the decade 2001-2010 a progressive decrease of the absenteeism and work accident rates was evidenced. The absenteeism rate was inversely related to job-qualification and it was higher among female workers. The highest requests of medical visits by auxiliary personnel showed a lower adaptation to job content, looked upon as low-rewarding in this homogeneous task.

[Well-being in call centres: a multidisciplinary approach to research and evaluation]. / Il benessere nei call center: un approccio multidisciplinare di ricerca e valutazione.

BACKGROUND: The topics of stress and well-being in call centres are the focus of many different disciplines. This article presents the definition and start-up phases of the "Well-being in Telecom Italia Call Centres" project, which was coordinated and supervised by an interdisciplinary scientific committee composed of members from different universities. To address the topic of individual well-being in the organizational context means considering all the main factors that can affect wellbeing. OBJECTIVES: For this reason, the study assessed the topic from three different view-points (psychological/sociological/cultural, physical/chemical/biological, organizational/technological/work-related) in order to obtain an accurate as possible picture of the complex well-being dynamics. METHODS: The study plan shows that merging qualitative methods (interviews, observations, focus-groups) and quantitative methods (questionnaires, physiological response to perceived stress) was a central concern for the research team. RESULTS: The collected data highlighted important differences between psychological and physical well-being and discomfort according to the different kinds of call centre, the respondents'gender and working hours. CONCLUSIONS: This method enabled us to define the specific features of call centre environments, leading to a definition of work in the centres as an activity with high psychological uncertainty, where rigid rules coexist with demands of high levels of flexibility and competence, and suggesting the importance of specific organizational measures in order to improve well-being.

[The posturological clinic evaluation in vdt/pc operators: a second level diagnostic instrument in low back pain evaluation]. / La visita specialistica posturologica negli operatori vdt/pc: strumento diagnostico di secondo livello per le lombalgie.

The diagnosis and the therapy of the cases of low back pain in absence of organic spinal column diseases, frequently referred by vdt/pc users in connection with their work activities are frequently unsatisfactory both for the Occupational Doctors and for the patients. The specialized posturological evaluation, composed by a specific clinical examination and by specific instrumental exams, seems to be a valid instrument for a more effective management of patients affected by such clinical cases. The treatments described in this research have eliminated or greatly reduced the pain in these patients, with an efficacy prolonged until at least a year; as it is demonstrated by the few relapses referred by the workers. We think that a more frequent cooperation between Occupational Doctors and Posturologists can improve both the clinical conditions of the patients and the possibilities they have in the years to maintain their complete work ability.

[An integrated prevention intervention for the management of SSUEm118 operator with hearing loss]. / Un intervento di prevenzione integrata per la gestione di un operatore SSUEm118 con disturbi uditivi.

Noise risk is moderate in hospital but there are some areas, as SSUEm118, where the background noise is not negligible. In this context it is important not to underestimate hearing loss even minimal, because the noise interference can cause errors of understanding, as the case in exam: an operator 118. The clinical assessment of this worker with liminar tonal audiometry and vocal audiometry revealed a mild unilateral mixed hearing loss with good voice response. The equivalent sound pressure level (Leq) throughout the SSUEm118 area is under the first attention level, the index NR is comparable to office type environments and the distance between speaker and listener for satisfactory face-to-face communication is suitable. The present study proposes a multi-multidisciplinary approach to define prevention and protection measures and health surveillance plan with audiometric testing and possible judgment of the unfitness to specific work. For this specific case advices given to SSUEm118 administrator allowed a good repositioning of the worker.

[The preventive ergophthalmic evaluation of work places in call centers: a useful instrument for the prevention of work related asthenopic symptoms]. / La valutazione ergoftalmica preventiva dei posti di lavoro nei call center: un valido strumento di prevenzione dei disturbi astenopici occupazionali.

The study of a correct lay-out of work places equipped with VDT/PC in call centres, if carried out before the beginning of work activities needs an interdisciplinary cooperation among OH&S operators. However, such a preventive evaluation can relevantly reduce onset and severity of asthenopic symptoms frequently reported by this kind of operators. Consequently, such preventive evaluation can avoid the necessity of carrying out those complex and expensive structural lay-out modifications, which are frequently needed to reduce VDT/PC workers' asthenopic symptoms.

[The adoption of electrical beds in hospital clinic units: evaluation of the impact on workers' low back pathologies]. / La adozione del letto elettrico nei reparti di degenza ospedaliera: valutazione dell'impatto preventivo sulle patologie del rachide degli operatori sanitari.

With the aim of reducing the number of occupational accidents and of judgements of limited work ability among the nurses having as work task the movement of not self-sufficient patients, the Legnano Hospital has defined a project of substitution of the traditional hospital beds with electrical beds. We describe the project of substitution of the beds and the positive results both on the health status of the workers using electrical beds and on the reduction of the falls occurred to the patients.

[The posturological department as clinical support for occupational medicine: clinical cases and results of a hospital unit]. / L'ambulatorio di posturologia come supporto specialistico per la medicina del lavoro--casistica e risultati della pratica clinica di una struttura ospedaliera.

The posturologic visit is a not widely known medical method for the evaluation and the therapy of low back pain. We describe the clinical and instrumental method followed in our posturological clinical unit organized jointly by hospital and university and the clinical cases evaluated in two years. An individual diagnostic evaluation and a personal therapy allowed an almost generalized complete remission of the symptoms and a very low number of reactivation of low back pain after a follow up of one years.

[The enforcement of the new Italian law on alcohol assumption in work activities with high accident risk in Lombardy]. / Stato di applicazione della normativa sul consumo di alcolici nelle attività ad elevato rischio di infortunio in Lombardia.

The 125/2001, the national law that forbids the alcohol consumption by workers with work tasks having high accident risks, has been activated a year ago. We carried out in Lombardy a research to evaluate the state of enforcement of the law in firms having different work activities. We found a complete application of the law only in very few firms. We think that the Occupational Health doctors should give more attention to the problem of alcohol consumption at the work places, giving the firms their specific scientific and medical support, using the peculiar knowledge of our discipline.