Measuring and benchmarking the quality of two different organizational ways in delivering infant vaccination.

The aim of this study was the quality of service evaluation of two different organizational ways in delivering infant vaccination according to a Regional Vaccination Plan. Eleven vaccination centres were selected in two Local Health Units (ASLs) belonging to the Regional Health Service of the Lazio Region, Italy. The services offering paediatric vaccinations for children under three years of age, delivered without an appointment (VACP) or with the need for an appointment (VACL), were investigated. The quality aspects under evaluation were communicational efficiency, organisational efficiency and comfort. Subjective data were collected from different stakeholders and involve the elicitation of best and worst feasible performance conditions for the ASLs when delivering VACP/VACL services. Objective data consists in the observation of current performances of the selected vaccination centres. Quality scorecards were obtained from the combination of all data. Benchmarking between VACP and VACL, i.e., two different organisational ways in delivering infant vaccination, can be performed as a result of the probabilistic meaning of the evaluated scores. An expert of vaccination services, i.e., a virtual combination of patients, doctors and nurses, claims the quality of service delivery of the ASLs under investigation with probability 78.03% and 69.67% for VACP and VACL, respectively. In other words, for short, the quality scores of the ASLs were 78.03% for VACP and 69.67% for VACL. Furthermore our results show how to practically improve the current service delivery. The QuaVaTAR approach can result in improvements of the quality of the ASLs for the two different ways of delivering paediatric vaccinations in a simple and intuitive way.

Measles outbreak in the Lazio region of Italy: surveillance and impact on emergency departments and hospitalizations.

BACKGROUND: The World Health Organization's (WHO) Regional Office for Europe had committed to 2015 as the year to eliminate measles from the region but several outbreaks have been reported recently from several areas of the continent. Here we describe an outbreak that occurred in 2010-2011 in Lazio region, Central Italy, and its impact on some health care services (i.e., Emergency Departments (EDs) and hospital clinics). METHODS: We analyzed cases of measles reported to the infectious diseases surveillance system and accesses to EDs and hospitalizations for measles in the Lazio Region (central Italy, population of about 5,730,000 people). RESULTS: In 2010-2011, 2,956 cases were reported to the surveillance system (incidence rate: 18.4 and 33.3 per 100,000 in 2010 and 2011, respectively). The incidence rates varied greatly with the territory. The outbreak occurred mainly among children <1 year old and among adolescents, most unvaccinated and did not seem to be related to cases imported from Eastern Europe. Complications were reported in 37.4% of the cases. The epidemic was mainly related to an accumulation of adolescents susceptible to measles due to unsatisfactory vaccination coverage in the early nineties. The outbreak had a strong impact on the health system with 2,881 ED visits and 1,168 hospitalizations. Outbreak-associated costs were considerable. CONCLUSIONS: An additional intervention should be considered aimed at improving routine immunization coverage in children and at planning catch-up vaccination of 6-18 year olds not previously vaccinated. Further, timely surveillance is needed and specific protocols should be implemented to limit secondary cases.

Immunization coverage and timeliness of vaccination in Italian children with chronic diseases.

Since children with chronic diseases represent a primary target for immunization strategies, it is important that their immunization coverage and timeliness of vaccines is optimal. We performed a study to measure immunization coverage and timeliness of vaccines in children with type 1 diabetes, HIV infection, Down syndrome, cystic fibrosis, and neurological diseases. A total of 275 children aged 6 months-18 years were included in the study. Coverage for diphtheria-tetanus-pertussis (DTP), polio (Pol), and hepatitis B (HBV) vaccines approximated 85% at 24 months, while measles-mumps-rubella (MMR) coverage was 62%. Immunization coverage for seasonal influenza was 59%. The analysis of timeliness revealed that there was heterogeneity among children with different chronic diseases. A proportional hazard model showed that children with HIV infection had the longest time to complete three doses of DTP, Pol, and HBV, and those with neurological diseases received the first dose of MMR later than the other categories. Causes of missing or delayed vaccination mostly included a concurrent acute disease. Children with chronic diseases should be strictly monitored for routine and recommended vaccinations, and health care providers and families should be properly informed to avoid false contraindications.

[Bus drivers' biomechanical risk assessment in two different contexts]. / La valutazione del carico biomeccanico degli arti superiori nella conduzione di autobus e tram: primi risultati di due esperienze in contesti differenti.

The application of standardize methods for the biomechanical risk assessment in non-industrial cycled activity is not always possible. A typical case is the public transport sector, where workers complain of suffering for shoulder more than elbow and wrist pains. The Authors present the results of two studies involving two public transport companies and the risk of biomechanical overload of upper limbs for bus and tram drivers. The analysis has been made using three different approaches: focus groups; static analysis by using anthropometric manikins; work sampling technique by monitoring worker's activity and posture at each minute, for two hours and for each binomial vehicle-route, considering P5F e P95M drivers and assessing the perceived efforts thorough the Borg's CR10 Scale. The conclusive results show that the ergonomic analysis managed by multiple non-standardized techniques may reach consistent and repeatable results according to the epidemiological evidences.

[Psychiatric disability and work: assessment of a group of patients examined at the Occupational Medicine Outpatient Department of the Turin University in the period 2000-2012]. / Disabilità psichica e lavoro: la valutazione di un gruppo di pazienti esaminati presso l'Ambulatorio di Medicina del lavoro del Dipartimento dell'Università di Torino nel periodo 2000-2012.

Problems at workplace with psychiatric subjects are increasing and the role of occupational physicians is basic to achieve a suitable job role. The purpose of this study is to assess the main occupational factors and to evaluate the judgement of fitness to work in 1109 patients with psychiatric diseases examined in our outpatients department during the period 2000-2012. These subjects were sent to our service by family doctors or, more frequently, by the companies seeking for judgement of the working residual capacities. The psychiatric diseases were classified according to the DSM IV; for each group considered, we evaluated the production sector, the specific job role, the pharmacological therapy as compared to the final judgement. The most frequent diagnoses were depressive and anxious disorders. The pharmacological therapy does not seem to be related to the final judgement but the small number of subjects defined as unfit to work does not allow a final evaluation. The study suggests the relevance of team work among the different actors of prevention to achieve a successful management of these workers in a specific job role.

[Silica classification and labelling under REACH and CLP regulation]. / Il problema della classificazione ed etichettatura della silice cristallina alla luce del REACH e del regolamento CLP.

Following literature data the evaluation CLP classification and labelling criteria doesn't support the decision to classify respirable crystalline silica (RCS) as carcinogen and suggests to consider RCS as:--STOT (Specific Target Organ Toxicant) RE (Repeated Exposure) cat.l by inhalation in case of concentration > or = 10%--STOT RE cat. 2 by inhalation in case of concentration 1 divided by 10%--Not classifiable as dangerous for human in case of concentration < 1%.

[The issue of medico-legal assessment of noise induced hearing loss: comparison of methods]. / II problema della valutazione medico-legale della ipoacusia da trauma acustico cronico: confronto tra metodi.

Audiogram classification is crucial for hearing protection of workers occupationally exposed to noise. The methods that have been proposed are based on two principles: the morphological evaluation of the audiometric curve (eg. Merluzzi-Pira-Bosio--MPB) or the average hearing loss on different frequencies (eg. Albera-Beatrice--AB). The purpose of this study was to classify audiograms compatible with chronic acoustic trauma performed at the Occupational Medicine Outpatient Clinic of CTO Hospital in Turin from 2004 to 2011 with the methods outlined in Guidelines published by SIMLII. A substantial agreement among the methods was observed. While MPB is the most appropriate method for secondary prevention, the AB would seem more appropriate for the verification of a permanent weakening that has to be reported to the competent legal authorities.

[Exposure talc effects on lung function: longitudinal study on variability of respiratory parameters in talc workers]. / Effetti dell'esposizione a polvere di talco sull'apparato respiratorio: studio longitudinale delle modificazioni delle prove di funzionalità respiratoria nei lavoratori dell'industria del talco.

The study analyzes the variability of respiratory parameters in 59 workers exposed to talc at least 5 years. Cigarettes smoke seems to be the only one variable causing a FEV1 decrease while cumulative exposure doesn't influence any variable analyzed. The talc dust exposure below TLV ACGIH value has not effects on lung function. The function alterations showed are not correlated to task and to cumulative exposure.

[The radon exposure in mine: risk evaluation, risk assessment and health effects]. / L'esposizione a radon in miniera: valutazione del rischio, misure di prevenzione ed effetti sulla salute.

In mining sector, the natural presence of radon determines an exposition which deserves substantive consideration. The results of radon measure from '90 years in a talc mining show levels of radon below to the threshold limit of 400 Bq/m3, values influenced from air forced systems. The epidemiologic studies updated in a cohort of talc workers between 1946 and 1995 showed no excess for lung cancer mortality. No excess was found for lung cancer mortality in miners exposed to low dose of radon.

[Ergonomic risk assessment: aspects applicable in the light of current standards]. / La valutazione dei rischi ergonomici: aspetti applicativi alla luce dell'attuale normativa.

The Italian decree law 81/2008 mentions the application of ergonomic principles as a basic tool for the prevention. In this regulation we can not find the definition either of Ergonomics nor of the competences required for its correct application. The Authors consider that occupational physicians have a suitable competence and knowledge on the matter, thanks to their highly specialized training. Actually, the ergonomic doctrine shows up in the daily practice of occupational physicians, who regularly base their activity on the evaluation of the binomial "worker-task": in the management of fitness to work judgements they try to combine operating conditions with worker's psychophysical state, not confining themselves to a simple expression ofa medico-legal certificate. However, the legislative references to specific regulations raise difficulties to occupational physicians in dealing with aspects such as gender, age, reference values and methodological choices. The Authors debate these difficulties in the application of rules.

[Occupational cardiovascular diseases diagnosis]. / La diagnosi delle cardiovasculopatie da lavoro.

In Italy cardiovascular diseases (CD) are the main cause of death. On the number of cardiovascular diseases attributable to occupational exposure is very limited. The INAIL list of occupational diseases identifies four types of exposure able to cause a specific CD while the list of DM 19.12.2009 cites two CD with high probability to be linked to occupational exposure and two as possible occupational origin. The literature analysis shows that only the noise occupational exposure (possible origin) could cause a high prevalence of CD and that there are two different relevant occupational risk factors as stress and shift work. Consequently also CD are classifiable as work related diseases. In consequence of the difficulty to identify a good tool to evaluate the weight of occupational exposure on origin of CD, it could be advisable to focus mainly on the identification of specific activities of health prevention and promotion and to define a standard strategy of cardiopathic patient's fitness to work evaluation.

[A cross-sectional survey on childhood immunization coverage and reasons of non-compliance in Lazio Region, Italy (2007)]. / Indagine campionaria sulle coperture vaccinali in età pe- diatrica e sui motivi di mancata vaccinazione nella regione Lazio (2007).

During 2007, Laziosanità conducted a cross-sectional survey on childhood immunization coverage in Lazio Region. The survey, implemented in collaboration with the 12 LHUs of the Region, aimed at assessing immunization coverage among children, with 24 months of age or older, at regional and district level. In addition, the survey assessed reliability of the routine surveillance system and immunization records at peripheral level. Finally, delay in immunization schedule, and major reasons for non-compliance, as reported by the mothers, were analyzed. The survey results allowed to identify weakness in the routine surveillance system, low coverage levels for specific LHUs, and strategies for improvement of immunization coverage.

[Risk assessment of manual handling of loads: the choice of reference values in light of Leg. 81/2008]. / Valutazione del rischio da movimentazione manuale dei carichi: la scelta dei valori di riferimento alla luce del D.Lgs. 81/2008.

Italian law on safety at work does not clarify specific levels of load for safe manual material handling. For this reason professionals appointed for safety need to define new target range value for the correct application of D.Lgs. 81/2008 law. Authors, discussing about indication of the national laws and international rules, suggest the assumption of a load of 25 and 20 kg as reference values for male and female adult and healthy workers. They also examine the graduation of the acceptable loads in relation to workers' age and the Lifting Index values to be adopted as action limit and exposure limit.

[The evaluation of workplace visual characteristics and ophthalmologic requirements to define fitness to work]. / Valutazione delle esigenze visive del posto di lavoro e requisiti oftalmologici per l'idoneità alla mansione specifica.

It's necessary to proceed to an evaluation of visual function to define principal ophthalmologic requirements and fitness to work in relation of workplace characteristics. We also have to consider the effects of age on visual function, the specific work risks on eyes and sight care especially for near sight. The evaluation of these parameters permits to verify the compatibility between the psychophysics characteristics of workers and the requests of tasks and then to define fitness to its work. Moreover to the visual functions we have to consider organic visual conditions like conjunctivitis, blepharitis, stenosis of lacrimal gland, dacriocystitis, retinic diseases, muscular motility alteration of the eyes, glaucoma. Our study shows the relation between ophthalmologic requirements of workers and some job groups like professional drivers, technical clerks, precision work, height level workers and proposes a standard method to define fitness to work. Our standard method permits a specific and homogeneous evaluation of fitness to work.

[The role of occupational physician in the application of the 2006 "agreement on workers' health protection through the good handling and use of crystalline silica and products containing it": the experience in mining sector]. / Il ruolo del medico competente nell'applicazione dell'accordo europeo sulla silice: l'esperienza nel settore estrattivo.

The 2006 "Agreement on Workers' Health Protection Through the Good Handling and Use of Crystalline Silica and Products Containing it" between social parts defines a standardization of exposition control methods and medical surveillance. The Occupational Physician is integral part in exposition evaluation process and risk stratification in which derives the medical surveillance program. This study presents a first application of the European agreement in mining sector and the role of Occupational Physician in the evaluation of the risk to define methods of prevention. In particular it will be precised the choice of homogenous groups, the classification of exposed workers from results of workplace monitoring, the choice of technical prevention and individual protection equipments, and then the strategy of medical surveillance.

[Application of a protocol for assessing occupational fitness of workers with UE-WMSDS in a second-level hospital center: first results]. / Applicazione di un protocollo di valutazione dell'idoneità lavorativa di soggetti affetti da UE-WMSDS in un centro ospedaliero di secondo livello: primi risultati.

It's presented a cluster of 99 workers affected by UEWMSDs examinated in the Occupational Medicine Department--University of Turin. The object of the evaluation is the critical exam of ergonomic informations, the evalution of the fitness to work and the customed return to work.

Cluster of measles cases in the Roma/Sinti population, Italy, June-September 2006.

Three clusters of measles cases occurred between June and September 2006, in the Roma/Sinti populations in three different Italian regions: the Bolzano-South Tyrol in northern Italy; Lazio in central Italy; and the island of Sardinia in the southwest.

[Risk of infection in a hospital environment]. / Il rischio infettivologico in ambiente ospedaliero.

The infectivologic risk in hospital environment. After a brief introduction on the historical development of the question of infectivologic risk in health services in general, and, in particular, in hospitals, the principal epidemiologic characteristics of viral hepatitis B and C, of HIV/AIDS and of TBC are examined as well as the potential cancerogenic role of the viral hepatitis. Guide-lines on staff health observation are also presented along with work-fitness criteria.