[Evaluation of the dustiness of a bakery: an integrated system with an experimental electronic device]. / Valutazione della polverosità ambientale in un panificio: un sistema integrato con un dispositivo elettronico sperimentale.

In this paper we describe a novel approach to environmental control in a bakery, based on an integration system of qualitative and quantitative information. The aim is to identify prevention policy for allergic disease. Specifically, the dust concentration evaluated continuously by deposimeters and the realization of chemical-analytical investigations on flours samples, used in the production cycle, have given qualitative evaluation on powders dispersion; the integration of an electronic device, characterized by measurement reliability and low cost implementation, supported the development and evaluation of an environmental monitoring system in a bakery. The environmental control system could be used in other work environments where occupational asthma occurred.

[Risk assessment of work-related upper limb musculoskeletal disorders in thirty factories in the upholstered furniture industry]. / Valutazione del rischio da movimenti e sforzi ripetuti degli arti superiori in trenta aziende del comparto del mobile imbottito.

BACKGROUND: One of the most common procedures for risk assessment of upper limb work-related musculoskeletal disorders (UL-WMSDs) in Italy is the OCRA synthetic index, which is recommended as the preferred method in the ISO standard 11228-3. OBJECTIVE: The aim of the survey was to assess the risk of UL-WMSDs due to repetitive strain and movements in thirty factories of the sofa industry located in a large geographic area of southern Italy. METHODS: The most characteristic working tasks of the manufacturing process were studied: filling preparation workers, leather-cutting operators, sewing and upholstery-assembly workers. The single tasks were carried out almost exclusively manually, with features of a handicraft approach. Data were collected through questionnaires and video tape recordings in each factory. The mean value of the OCRA index of every group of factories was calculated by weighting the values of the index of each single task group with the number of the workers. RESULTS: Figures obtained in the different factories showed values of the OCRA index ranging between 4 and 15. A 2,9 OCRA value was attributed to a low exposure group. CONCLUSIONS: Even though the work tasks analyzed were characterized by long duration of the manufacturing cycle (between 5 and 60 min), a particular but rigorous application of the OCRA procedures made it possible for a detailed risk assessment to be made for each of the working groups analysed.

[Manufacture of upholstered furniture and work-related upper limb musculoskeletal disorders: an industrial sector prevention project]. / Produzione del mobile imbottito: un progetto di ricerca finalizzato alla prevenzione delle patologie da sovraccarico biomeccanico degli arti superiori. Presentazione delle caratteristiche del comparto.

BACKGROUND: In cooperation with the IRCCS Fondazione Maugeri and the IRCCS Fondazione Ospedale Maggiore Policlinico - EPM-CEMOC, of Milan, the Local Health Unit in Bari, Italy carried out a research project, sponsored partly by the Italian Ministry of Health, on upper limb work-related musculoskeletal disorders (UL-WMSDs) in a specific manufacturing sector, the upholstered furniture industry. This "sofa district" is widely represented with approximately 14,000 workers and 500 factories over a wide geographic area of southern Italy. Advanced technology in the manufacturing process is combined with workers performing intensive arm-hand tasks. OBJECTIVES: The aim of the study included: a) assessment of exposure to repetitive strain and movements of the upper limb in a representative sample of the factories using the OCRA method, b) analysis of the annual prevalence and incidence rates, c) definition of possible improvement via ergonomic solutions in the various factories. METHODS: Via a network of occupational physicians a total of more than 6000 subjects were examined over a 5-year period. Case-definition was assessed through standardized procedures. RESULTS: A detailed description of the manufacturing process of the upholstered furniture industry and of the characteristics of the working population is provided Exposed groups at risk were:filling preparation workers, leather-cutting operators, sewing and upholstery-assembly workers. CONCLUSIONS: Data collected in private companies of different size in this extensive industrial "sofa area" emphasize the importance of prevention through adequate ergonomic solutions and the need to improve training programmes covering the whole area.

[From mandatory to participatory prevention: a model applied to the upholstered furniture industry]. / Dalla prevenzione imposta alla prevenzione partecipata: un modello applicativo nel comparto del mobile imbottito.

BACKGROUND: The Italian 2006-2008 National Health Plan emphasizes synergy and cooperation between the agencies formally involved in the prevention of occupational risks, in agreement with social partners. The so-called 'triangle of the sofa industry' is an interregional geographic area south-west of Bari, Italy. In 2003 this area produced 16% of the world-wide upholstered furniture output, with more than 500 plants of varying size. OBJECTIVE: The aim was to set up a network of communication and cooperation between the competent Agencies and Regions in order to address the rising trend of upper limb work-related musculoskeletal disorders. METHODS: The first step of the National Health Service Unit in Bari was to assess risk via a Ministerial research project and implement various information campaigns involving institutions, occupational physicians, private companies and public opinion. In a subsequent phase a synergy between the local Departmenst ofPrevention of the different Regions, the Italian Institute for Insurance Occupational Accidents and Disease (INAIL), the trade unions and the upholstered furniture industry Association was established. RESULTS AND CONCLUSIONS: New joint experimental projects (cutting tools, ergonomic table for assemblers, instruments for isokinetic evaluation) were launched together with training programmes for management, safety technicians and workers. This kind of 'participatory prevention' is more appropriate for the goal of a collaborative effort in order to assist the companies, which is a modern interpretation of the mission of public health prevention operators.

[Upper limb work-related musculoskeletal disorders (UL-WMSDs): a retrospective cohort study in three large factories of the upholstered furniture industry]. / Patologia da sovraccarico biomeccanico degli arti superiori: studio retrospettivo di coorte in tre grandi aziende del mobile imbottito.

BACKGROUND: The epidemiological evidence of work-related musculoskeletal disorders (UL-WMSDs) due to repetitive strain and movements in the various industries has been collected in the literature mainly through cross-sectional surveys. In particular there are no contributions so far regarding the upholstered furniture industry with a longitudinal design. OBJECTIVES: The aim of the study was to evaluate the incidence rate of WMSDs such as hand-wrist and shoulder tendonitis, carpal tunnel syndrome, and epicondylitis in exposed workers of three large companies of the upholstered furniture industry in a large geographic area of southern Italy. METHODS: The OCRA method, recommended by international standard ISO 11228-3 and EN 1005-5, was used for risk assessment. The following work tasks were considered:.filling preparation workers, leather-cutting operators, sewing and upholstery-assembly workers. A total population of 5,278 subjects (exposed n=2927, controls n=2351) was investigated. The person/year at risk parameters were calculated from 1 January 2000, or from the date of engagement if later, until the first diagnosis of WMSD or, in absence of disorders, until the end of the study, i.e. 31 December 2004. Disorders occurring after the first were not considered. A multiple regression analysis was used to evaluate relationships between rates. RESULTS AND CONCLUSIONS: Incidence rates correlated with risk classes of the OCRA index. An incidence rate of WMSDs higher than 1.2 cases per 100 person/year may be considered as a threshold value to suspect an occupational exposure to repetitive strain and movements warranting further investigation. The analysis of single factors did not show a greater predisposition of the female gender, with the single exception of the carpal tunnel syndrome (RR 2.92; 95% CI 1.57-5.43). Shoulder disorders affected mainly male leather-cutting operators (RR 4.97; 95% CI 2.03-12.16) and among all the factors influencing risk (frequency, force, posture, additional risk factors, pauses) posture seems to play a significant role.

[Prevalence of upper limb work-related musculoskeletal disorders (UL-WMSDs) in workers of the upholstered furniture industry]. / Prevalenza delle patologie da sovraccarico biomeccanico degli arti superiori negli addetti del comparto del mobile imbottito.

BACKGROUND: The upholstered furniture industry, the so-called "triangle of the sofa industry", is a geographic area of national and strategic economic importance in southern Italy. The single tasks are carried out mostly manually, with the characteristics of a handicraft approach. OBJECTIVES: The aim of the survey was to assess the prevalence of upper limb work-related musculoskeletal disorders (UL-WMSDs) in 30 factories of the sofa industry located in a large geographic area of the Puglia and Basilicata Regions. METHODS: In the period 1 January-31 December 2003 a network of occupational physicians investigated a population of 5.477 subjects (exposed n=3481, controls n=1996, M=3865, F=1612) in 30 different factories of the area. More than 60 percent of the total workforce studied was employed in large-sized companies (>500 employees). The following work tasks were considered: filling preparation workers, leather-cutting operators, sewing and upholstery-assembly workers. Case-definition was assessed through standardized procedures: symptoms by questionnaire plus physical and laboratory/imaging findings. RESULTS: Cumulative prevalence rates of UL-WMSDs as at 31 December 2003 reached values of up to 30% in high risk groups. Prevalence rates showed good correlation with the concise OCRA index used for assessment of exposure to repetitive strain and movements of the upper limb. The most frequently occurring disorders were tendon-related cysts and wrist tendonitis. Shoulder disorders were more frequent in male and female leather-cutting operators. CONCLUSIONS: This survey showed a significantly high prevalence of UL-WMSDs in sofa industry workers. It did not seem to be confirmed in this study that there was a greater female susceptibility to UL-WMSDs with the exception of carpal tunnel syndrome: gender difference seems to be less relevant at increasing levels of occupational exposure to repetitive movements and exertion of the upper limbs.

[Educational health programs in the construction industry of the Apulia Region, southern Italy]. / Percorsi formativi in edilizia nel territorio dell'AUSL BA/3, Regione Puglia.

31,000 building firms have been registered in the Apulia Region of Southern Italy, and 13.5% are concentrated in the area of the Local Health Bari/3. Especially small and middle-size firms (90% of total number) are assisted with information programs through dedicated local office. Educational and medical audit advanced programs carried out among occupational health professionals are described. A 'pilot project' for the regional health surveillance program in the construction industry is presented.

[Occupational asthma and biological damage: adequate compensation?]. / Asma professionale e danno biologico: tutela privilegiata?

The evaluation of the damage to biological and relational capacities of the subject is the novel approach of the Italian Insurance Regulation Decree N(o) 38/2000 for compensating occupational asthma (OA). In this study we aimed to apply retrospectively the novel rating system to mild OA. From a data base of 201 diagnosis of OA collected in the 1987-97 decade 85 eligible consecutive cases of mild asthma according to the criteria of NIH/WHO guidelines on asthma were studied. Records on compensation were documented for 41 subjects. The average difference between novel scales and the actual rating individually assessed by Italian National Agency for compensation through criteria used at that time was 45.6 +/- 20%. The average difference between novel scales and rating calculated with guidelines considering the measurement of non-specific bronchial hyperreactivity developed by international experts and American Thoracic Society, endorsed by American Medical Association, was 41.5 +/- 12%. Within the actual rating individually assessed with previous Italian Insurance criteria no significant relationship (r=-0.20, p=0.2) was shown with bronchial responsiveness to methacoline expressed as provocative dose causing a 20% fall in FEV1 (PD20FEV1 microg of mch). A significant (p<0.05) relationship was observed with age at the time of OA diagnosis (r=0.37, p=0.017) and with duration of exposure (r=0.34, p=0.034). This study suggests that scales of the Insurance Regulation Decree N(o) 38/2000 grading mild OA underevaluate biological damage/impairment with reference both to previous practice in Italy and to international criteria guidelines. Among the parameters of evaluation methacoline challenge should be considered an adequate tool in measuring biological damage in OA for medicolegal purpose.

Rapid polymerase chain reaction method for specific detection of toxigenic Clostridium difficile.

A rapid polymerase chain reaction (PCR) method for detection of toxigenic Clostridium difficile directly from fecal samples by amplification of toxin A gene fragments was investigated. The technique was applied to monitor the spread of the microorganism in a long-term care ward with a relatively high incidence of overt episodes of diarrhea. The PCR approach has several advantages over traditional methods, rapidly allowing the specific detection of toxigenic Clostridium difficile strains from stool samples in both symptomatic and asymptomatic subjects with toxigenic strains. This PCR method allows early detection of toxigenic Clostridium difficile and could thus represent a powerful tool for the surveillance of epidemics.

Role of structural and extracellular virulence factors in gram-negative anaerobic bacteria.

Gram-negative anaerobic bacteria belonging to the genera Bacteroides, Prevotella, and Porphyromonas represent the most common cause of endogenous, usually mixed, infections occurring after abdominal or gynecologic surgery. Anaerobes are important pathogens in oral-cavity infections as well as in systemic infections that originate from the mouth. Clinical interest in these organisms is linked to the therapeutic problems usually encountered in treating mixed infections. Despite their clinical relevance, very little is known about the pathogenetic mechanism of anaerobic infections. In Bacteroides species, the capsule has been thought to be important, and initially it was considered unique to Bacteroides fragilis, the most common pathogen. It has been claimed that the capsule is involved in adhesion, abscess formation, and impaired phagocytosis. However, other structures such as pili and extracellular substances, including metabolic by-products (e.g., short-chain fatty acids), have to be considered as potentially relevant pathogenetic mechanisms in anaerobic infections. Several extracellular enzymes have been investigated, but no clear evidence is available for establishing their relevance in disease mechanisms. Special attention should be devoted to enzymes able to digest IgA (IgA proteases), a first-line defense mechanism that is active in the mucosal membranes.

Randomized trial of autologous filgrastim-primed bone marrow transplantation versus filgrastim-mobilized peripheral blood stem cell transplantation in lymphoma patients.

Although a large amount of data is available on the effects of filgrastim (granulocyte colony-stimulating factor [G-CSF]) on the mobilization of stem cells in the circulation, data concerning its effects on bone marrow (BM) harvesting is scarce and controversial. We have designed a randomized trial comparing filgrastim-mobilized peripheral blood stem cell (PBSC) transplantation with filgrastim-primed autologous bone marrow transplantation (ABMT). Fifty-five patients affected by non-Hodgkin's (n = 38) or Hodgkin's (n = 17) lymphoma, selected for autologous transplantation over a 12-month period in a single institution, were randomized 2:1 to undergo BM or PB harvest/collection after priming for 3 days with filgrastim, 16 microg/kg body weight daily subcutaneously. BM priming with G-CSF allowed the harvest of a significantly higher number of mononuclear cells (MNC) (0.53 x 10(8)/kg, range, 0.32 to 1.40), as compared with a historical control of unprimed BM harvests (0.43 x 10(8) MNC/kg, range, 0.15 to 0.72, P = .001). After high-dose ablative therapy, median time to neutrophil recovery above 0.5 x 10(9)/L was 12 days for BM and 11 days for PB (P = .219); median time to platelet recovery above 20 x 10(9)/L was 13 days for BM and 11 days for PB (P = .242). The same number of red blood cells, platelet transfusions, and posttransplant G-CSF doses were required in the two groups of patients. Less patients (50% v 70%) became febrile in the group transplanted with mobilized PB, but days of fever/patient and days on antibiotics were overlapping. The median time spent in the hospital after reinfusion was 16.5 and 15.5 days after primed BM and primed PB, respectively (P = .134). These data suggest that in patients with lymphoma submitted to autologous transplantation, the reinfusion of filgrastim-primed BM or filgrastim-mobilized PB leads to similar results, with an advantage of only 1 day in the neutrophil recovery and 1 day on the time spent in the hospital in favor of primed PB. Either option can be chosen on the basis of the availability of a surgery room or cell separator facilities and considering the patients' characteristics and wishes.