Work resumption after invasive heart procedures, rehabilitation and ergonomic evaluation: from the hospital to the workplace.

Our Institute adopts a multidisciplinary protocol named "CardioWork" for work resumption after invasive cardiac procedures and subsequent rehabilitation: after evaluation of the cardiac functional profile, the occupational physician analyses the work activity prior to the cardiopathological event, identifies the presumed task energy requirement (from specific, published tables), and compares it with the exercise test results. Indications regarding timing and modality of returning to work are formulated accordingly. To verify the reliability of the indications thus provided, we carried out a clinical-functional follow-up study in the workplace, with Holter ECG and Armband measurement of actual energy expenditure. Over the course of two years, we enrolled 36 patients (mostly males, aged between 30 and 70 years), hospitalized after coronary revascularization, valve replacement or cardiac defibrillator implant. After rehabilitation, instrumental diagnostics (Holter ECG, echocardiography, exercise test) showed discrete functional conditions, with better values with regard to cardiac function than exercise capacity and effort tolerance. All subjects were judged fit for the job, in most cases with limitations concerning ergonomic factors, working timetable and/or stress. They returned to work quickly, with good adherence to the indications provided. Workplace Holter ECG did not show appreciable differences compared to the hospital evaluation. In one case, the average energy expenditure measured while working was higher than that inferred from the tables; in the remaining subjects, the actual expenditure coincided with what was expected or was lower. In a minority of cases (39%), the measured average expenditure slightly exceeded the optimal value (35% of the maximal value at the exercise test) recommended at the time of hospital discharge. At the end of the workplace evaluation, it was not necessary to formulate new indications. The study provides further evidence of the effectiveness of the CardioWork protocol in promoting return to work after invasive heart procedures. Though they need continuous updating, the published estimates of presumed task energy requirement remain reliable. In particularly complex cases, it is however advisable to carry out a field check of the ergometric assessments performed at the end of rehabilitation.

[The new Maugeri diagnostic protocol for work-related stress and mobbing (MASD-2)]. / Il nuovo protocollo diagnostico Maugeri per stress lavoro-correlato e mobbing (MaSD-2).

SUMMARY: Occupational stress can exceed the workers' individual capacity to adapt, and cause psychopathological conditions, including adjustment disorder (AD) and post-traumatic stress disorder (PTSD), for which medico-legal reporting is mandatory by law. Since the early 2000s, an interdisciplinary diagnostic protocol has been in use at our Institute to address patients towards an appropriate therapeutic path, in order to promote their psychological well-being and work reintegration. In 2017, the protocol was updated and expanded. The current version (MaSD-2) includes: occupational medicine examination, psychological counselling, psychiatric interview, and psychodiagnostic testing: Short-Negative Acts Questionnaire (S-NAQ), Cognitive Behavioral Assessment 2.0 (CBA-2.0), SCID (Structured Clinical Interview for DSM: Diagnostic and Statistical Manual of Mental Disorders), Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), Maugeri Stress Index - Reduced form (MASI-R). Between 2017 and 2019, we used the MaSD-2 to assess, for suspected psychopathological work-related problems, 198 patients (120 women and 78 men; mean age SD: 47.9 9.0 years). Nine (4.5%), already examined with the original version of the protocol, received diagnostic confirmation (2 cases of paranoid personality disorder, 7 of work-related anxiety-depressive disorder). Of the other 189 subjects, three (1.6%) were not affected by psychiatric disease, 12 (6.3%) had a psychiatric disorder (e.g., anxiety disorder, mood disorder, personality disorder) independent of work, 160 (84.7%) a work-related anxiety and/or depressive disorder. DA was identified in 12 cases (6.3%), and two patients (1.1%) were diagnosed with DA in pre-existent DPTS, for a total of 14 medico-legal reports of occupational disease. Compared to the past, the case record presents a much higher percentage of psychiatric disorders related to occupational stress. This may be due to a greater sensitivity of the new diagnostic protocol, and to a better selection of the patients referred to us. Women and tertiary workers continue to be at greater risk, with significant involvement of health professionals. Diagnoses of DA and DPTS remain rare, confirming the need for a rigorous and cautious interdisciplinary approach, aimed at selecting the cases for which to start medico-legal procedures. Finally, the study calls for adequate preventive measures.

A PPAR-α agonist protects the non-adrenergic, non-cholinergic inhibitory system of guinea pig trachea from the effect of inhaled ammonium persulphate: a pilot study.

SUMMARY: Aim of the study. Inhaled ammonium persulphate (AP) reduces non adrenergic, non cholinergic (NANC) relaxation in the guinea pig trachea, as a part of its inflammatory effects. Peroxisome Proliferator-Activated Receptor (PPAR) stimulation has shown anti-inflammatory properties. This study aimed at evaluating whether the PPAR-α agonist WY 14643 can prevent the reduction in NANC relaxation caused by inhaled AP in the guinea pig trachea. Materials and Methods. Four groups of ten male guinea pigs were treated for three weeks with inhaled AP (10 mg/m3, 30 min per day, group A), saline (group B), AP and WY 14643 (0.36 µM/die, per os, group C), and AP, WY 14643 and the PPAR-α antagonist GW 6471 (0.36 µM/die, per os, group D). NANC relaxations to electrical field stimulation (EFS) at 3 Hz were evaluated in whole tracheal segments as intraluminal pressure changes. Results. The tracheal NANC relaxations were reduced by 90.3% in group A, as compared to group B. In group C, they were reduced by only 22.2%. In group D, they were reduced by 92.6 %. PPAR-α receptors were detected in inhibitory nerve fibers within the trachea as shown by immonohistochemical analysis. Conclusions. The PPAR-α agonist WY 14643 protects the NANC inhibitory system of the guinea pig trachea from the effect of inhaled ammonium persulphate and its protective effect is antagonized by GW 6471. PPAR-α might be exploited.

Imaging and imagination in the diagnostics of asbestosis.

Two cases of asbestosis diagnosed on the basis of anamnestic, clinical, and instrumental criteria, were not confirmed by forensic autopsy ordered by the public prosecutor to ascertain the cause of death. The two cases demonstrate that a suggestive working history can be misleading, in the absence of clear radiological signs and histopathological findings, and that asbestosis must be diagnosed following the criteria consolidated in the scientific literature, as any diagnostic errors can have serious legal consequences.

Job preservation by an office worker with idiopathic cervical dystonia: case report.

BACKGROUND: Work preservation is a main goal in the rehabilitation of chronic disabling diseases. We describe the application of an interdisciplinary protocol, involving the occupational physician, the occupational therapist and the ergonomist, in the case of a 50 year-old office worker with idiopathic cervical dystonia, a movement disorder that can seriously impair work capability. CASE REPORT: The disease was diagnosed at age 25, and subsequently worsened. The man presented postural difficulties and pain. The symptomatology worsened during working shifts, preventing him from doing his job properly. Functional evaluation and ergonomic inspection of the office environment led to the correction of evident critical inadequacies. This allowed the patient to continue working in correct conditions, resulting in improvement of his global health status. CONCLUSIONS: The interdisciplinary rehabilitative approach here described may allow subjects with idiopathic cervical dystonia to keep their jobs by adapting the workplace to the changed physical capabilities.

[Manual handling, job fitness, and musculoskeletal disorders in the Sondrio hospital (Italy) healthcare workers.] / Movimentazione manuale, idoneità alla mansione e disturbi muscolo-scheletrici negli operatori sanitari dell'Ospedale di Sondrio.

OBJECTIVES: Musculo-skeletal disorders (MSD) are a large group of locomotor system pathologies with multifactorial etiology. Healthcare professionals are often exposed to biomechanical overload of the spine and upper limb, for example during patient handling, and represent a working population at risk. METHODS: In order to acquire further knowledge on this subject, we conducted a cross-sectional study (year 2016) among healthcare workers (excluding physicians) of the Sondrio Hospital (Italy), investigating the correlations between manual handling, MDS and job fitness. RESULTS: The sample examined included 667 subjects (74 males and 593 females, mean age: 50 years): 557 (83.5%) certified fully "fit for the job", 109 (16.3%) "partially fit" (with limitations and/or prescriptions), and one "not fit" female worker. Eighty-seven of the 109 partial fitnesses (79.8%) were related to manual handling. In turn, 76 of the 87 limitations/prescriptions for manual handling (87.4%) were due to the presence of musculo-skeletal disorders (accompanied by instrumental diagnosis, and often associated with each other), especially of the lumbo-sacral tract, to a lesser extent of the cervical spine, shoulder or other body districts. Associations between partial job fitness and worker operative units have not been observed. CONCLUSIONS: The data indicate that, among healthcare workers, the biomechanical overload of the limbs and the spine, and the related MSD, are the health problems that most often come to the attention of the occupational physician, posing delicate problems for the "fitness to job" certification. The observed lack of correlation with the operative unit is an expression of the tendency to relocate staff with MSD in tasks at lower biomechanical risk.

Falling asleep at the wheel and distracted driving. The High-Risk Professional Drivers study.

BACKGROUND: Sleepiness at the wheel and driving while engaged in other activities are well known risk factors for traffic accidents. This article estimates the prevalence of these factors among Italian Professional Drivers (PDs) and their impact on reported driving mistakes. METHODS: A cross-sectional study was conducted using anonymous questionnaires. PDs (n=497) were divided into two groups: high-risk PDs (HiRis_PDs) (those who self-reported more than one incident during the last 3 years and/or more than one mistake during the past year) and non-HiRis_PDs (subjects who did not meet the above-mentioned inclusion criteria). Logistic regression analyses were performed to assess the association of self-reported sleepiness and/or risky driving behaviour with the condition of being a high-risk driver. RESULTS: 161 (32.4%) subjects were defined as HiRis_PDs. Forty-one percent of the interviewees experienced at least one episode per month of sudden-onset sleep at the wheel. Twenty-eight point two percent reported a regular use of a hand-held cell phone. Predictive factors for being HiRis_PDs were: at least one self-reported episode per month of falling asleep at the wheel [odds ratio (OR) 5, 95% confidence interval (CI) 3.21-7.80, P<0.001], driving while regularly engaged in other activities (mainly hand-held cell phone use) (OR 6.11, 95% CI 2.90-12.84, P<0.001), and young age (OR 0.96, OR 1 year of age increase, 95% CI 0.94-0.98, P=0.001). CONCLUSIONS: Focusing prevention efforts on recognizing sleepiness at the wheel and on avoiding other distracting activities while driving can reduce the possibility of driving errors on the road by about 5-6 times.

{Health and work after invasive heart procedures, rehabilitation and occupational evaluation]. / Salute e lavoro dopo procedure invasive cardiache, riabilitazione e valutazione occupazionale.

BACKGROUND: Our previous experience with the "CardioWork" protocol (activated in 2005) demonstrated the usefulness of the interaction between occupational physician and cardiologist to facilitate work resumption after invasive heart procedures and subsequent rehabilitation, adapting the work tasks of the patients to the changed physical capabilities. OBJECTIVES: We surveyed the health conditions and employment status of the subjects previously studied, years after their completion of the protocol in order to verify its effectiveness over a long period of time. METHODS: We contacted 125 patients included in the protocol from 2005 to 2011: 4 were deceased; 101 (94 males and 7 females; mean age: 49.2 years) participated in the study. We collected clinical data (from the hospital computer archive), as well as information on prescriptions compliance and occupation (by interview). Respondents were also asked to give a subjective judgment on their health, their re-employment, and the usefulness of the indications regarding job fitness. RESULTS: In addition to the high survival rate, the survey showed maintenance of satisfactory clinical conditions (good left ventricular function, exercise tolerance, rare cardiological relapses, few sick-leave days), adherence to prescriptions, high employment rate, high level of subjective satisfaction. CONCLUSIONS: The study confirms the importance of appropriate rehabilitation after acute cardiac event, and the need for an interdisciplinary approach involving the occupational physician. By following this strategy, patients not only can return to work early, satisfactorily and with minimal risks, but they also tend to keep their work and to reach retirement age in good health.

Renal cell carcinoma and malignant peritoneal mesothelioma after occupational asbestos exposure: case report.

UNLABELLED: Asbestos is the main causal factor for malignant mesothelioma (MM), a relatively rare and aggressive malignancy. Some epidemiological evidence suggests a role of this agent also in the etiology of renal cell carcinoma (RCC), the most common form of kidney cancer. CASE REPORT: After 7 years of asbestos exposure, a 76-year-old asbestos-cement worker came to our notice with left flank pain. Diagnostic imaging disclosed a neoplasm in the upper two thirds of the left kidney, without evidence of metastases. After surgery (nephrectomy with para-aortic lymphadenectomy), histopathology revealed clear cell RCC. One year later, the patient was hospitalized for abdominal pain. Laparoscopy showed diffuse neoplastic infiltration of the peritoneum and liver. Histological and immunohistochemical examination of the bioptic samples led to the diagnosis of biphasic MM. The subject died 2 months later. Autopsy disclosed ascites and diffuse infiltration of the abdominal wall and viscera, without evidence of RCC relapse. CONCLUSIONS: This is the second reported case of association between RCC and peritoneal MM in the scientific literature. Asbestos might be involved in the causation of both malignancies.

[Professional outcomes and psychological health after workplace bullying: an exploratory follow-up study]. / Esiti professionali e salute psicologica a seguito di vessazioni sul luogo di lavoro: uno studio esplorativo di follow-up.

BACKGROUND: The literature shows that workplace bullying can lead to negative consequences for both individuals' health and professional outcomes. Most of these studies used cross-sectional designs and self-report questionnaires and further research is needed in order to explore long-term effects of workplace bullying. OBJECTIVES: This follow-up study aimed to explore professional and psychological outcomes in a sample of subjects who required a specialized and multidisciplinary assessment for psychological problems related, in their opinion, to workplace bullying. METHODS: The sample includes 71 patients with a baseline diagnosis of work-related psychological disorder who were assessed at follow-up by means of a structured telephone interview. The interview included structured questions about professional career developments and psycho-somatic health, and administration of the General Health Questionnaire-12. RESULTS: 62.0% of the participants were currently working and, of these, 59.1% had changed workplace after experiencing mobbing. Patients who changed workplace scored significantly higher on job satisfaction levels (p<0.01) and showed lower levels of social dysfunction (p<0.01) compared to those who did not change their job. Patients with a baseline diagnosis of Adjustment disorder/Post-Traumatic Stress disorder had higher levels of general dysphoria (p<0.04) and social dysfunction (p<0.01) at follow-up than other patients. CONCLUSIONS: These findings  stress the importance of an accurate diagnostic assessment of mobbing-related psychopathological disorder. Victims of workplace bullying require early and continuous psychological support in order to promote their psychological well-being and work reinstatement.

[Occupational risk factors and medical prevention in corrections officers]. / Fattori di Rischio Lavorativo e Prevenzione Medica nella Polizia Penitenziaria.

In Italy, the Law n. 395/1990 defines the tasks and attributions of prison officers. According to the article 25 of the Legislative Decree n. 81/2008, the occupational physician should participate to risk assessment, and carry out the sanitary surveillance. This report analyzes the various tasks of prison staff, identifies the risk factors, and discusses the preventive strategies, including workers formation and education. Biological agents and work-related stress are the main risk factors, as a consequence of prison overcrowding, personnel shortage and work organization complexity. In his preventive action, and particularly in formulating the judgment on work fitness, the occupational physician often clashes with inadequate ministerial funding.

[Discriminating capacity of the MASI-R questionnaire in the perception of work-stress]. / Validità discriminante del MASI-R nella percezione di stress lavoro-correlato.

INTRODUCTION: Workplace mobbing represents a severe type of occupational stress. The aim of this study is to evaluate the discriminant validity of the Maugeri Stress Index-Revised questionnaire (MASI-R) for the perceived work stress assessment. METHODS: A total of 105 patients were enrolled at the Occupational Medicine Uinit of our Institute for mobbing-related issues; they were compared to a control group matched for age, sex and professional category. Work stress perception was assessed in both samples using the self-report questionnaire MASI-R, which is the Maugeri Stress Index short form. RESULTS: Workers who perceived exposure to mobbing scored significantly lower compared to the control group in the four MASI-R scales (p < 0.001) and in the two visual analogue scales measuring job satisfaction (p < 0.001) and life satisfaction (p < 0.001). Further analyses have identified the items which significant discriminate between the two groups of workers. CONCLUSIONS: These findings show a good discriminant validity of the MASI-R questionnaire: workers who perceived exposure to workplace mobbing reveal higher work stress levels compared to the control group in all aspects measured.

[Role of occupational rehabilitation therapy in returning to work: experimental experience]. / Ruolo della terapia riabilitativa occupazionale nel reinserimento al lavoro: esperienze sperimentali.

The experimental experience is the result of combining cultural, clinical and scientific interest in rehabilitative, occupational and forensic mnedicine and in ergonomics. It deals with the rehabilitation and return at work of patients with physical disabilities caused by occupational trauma or disease. The programme described starts with a selection by INAIL and involves with an outpatient surgery inclusion. It is composed of: preliminary physical examination, functional assessment, the formulation of a rehabilitation plan and its successive implementation. At the end of the evaluation plan, there is a final assessment to identify outcome indicators and residual functional and work capacity.

Carbon Monoxide Poisoning: From Occupational Health to Emergency Medicine.

Carbon monoxide poisoning remains a leading cause of accidental poisoning worldwide (both at home and at work), and it is also a cause of suicidal poisoning. Such poisoning can arise following prolonged exposure to low levels of CO or following brief exposure to high concentrations of the gas. In fact, despite exposure limits, high safety standards, and the availability of CO alarms, nearly 50,000 people in the United States visit the emergency department each year due to poisoning. Additionally, CO poisoning in the United States causes up to 500 deaths each year. Despite the widespread nature of this form of poisoning, known about for centuries and whose damage mechanisms have been recognized (or rather hypothesized about) since the 1800s, early recognition, especially of late complications, and treatment remain a medical challenge. A well-designed therapeutic diagnostic process is necessary so that indication for hyperbaric or normobaric therapy is correctly made and so that patients are followed up even after acute exposure to diagnose late complications early. Furthermore, it is necessary to consider that in the setting of emergency medicine, CO poisoning can be part of a differential diagnosis along with other more frequent conditions, making its recognition difficult. The last thirty years have been marked by a significant increase in knowledge regarding the toxicity of CO, as well as its functioning and its importance at physiological concentrations in mammalian systems. This review, taking into account the significant progress made in recent years, aims to reconsider the pathogenicity of CO, which is not trivially just poisonous to tissues. A revision of the paradigm, especially as regards treatment and sequelae, appears necessary, and new studies should focus on this new point of view.

Does job satisfaction predict early return to work after coronary angioplasty or cardiac surgery?

PURPOSE: Few studies have analyzed the relationship between job satisfaction and return to work (RTW) in cardiac patients. The aim of this paper was to investigate whether job satisfaction predicted early RTW in patients sick listed after cardiac invasive procedures. METHODS: A 6-month prospective study was carried out in a sample of 83 patients in working age who had recently been treated with angioplasty or cardiac surgery. Job satisfaction was measured using the scale from the Occupational Stress Indicator during cardiac rehabilitation. Time to RTW was assessed at the 6-month occupational physician examination. Logistic regression analyses were used to study the association between job satisfaction at baseline and early RTW at follow-up, adjusted for socio-demographic, medical (type of cardiac intervention, ejection fraction) and psychological (depression, locus of control, illness perception) factors. RESULTS: Participants with high job satisfaction were more likely to return early to work, with an odds ratio (OR) of 5.92 (95 % CI, 1.69-20.73) in the most-adjusted model, compared to participants with low job satisfaction. Satisfaction with organizational processes was the job satisfaction component most strongly associated with early RTW (OR, 4.30; 95 % CI, 1.21-15.03). CONCLUSIONS: To the best of our knowledge, this is the first prospective study that investigated whether job satisfaction predicts time to RTW after cardiac interventions. The results suggested that when patients are satisfied with their job and positively perceived their work environment, they will be more likely to early RTW, independently of socio-demographic, medical and psychological factors.

Brugada syndrome and job fitness: report of three cases.

Brugada syndrome (BrS) is an inherited arrhythmogenic disorder predisposing patients to a high risk of sudden cardiac death. Specific guidelines on the health surveillance of BrS workers are lacking. We report here three cases requiring assessment of specific job capacity, investigated with an interdisciplinary protocol including 24-h Holter electrocardiography with modified precordial leads, pharmacological test with ajmaline, molecular genetic analysis, electrophysiological study with ventricular stimulation, risk stratification, and occupational medicine evaluation: (1) a female 42-yr-old company manager with positive ajmaline test and CACNA1C gene mutation (judged fit for the job with limitations regarding work-related stress); (2) a male 44-yr-old welder with positive ajmaline test, SCN5A gene mutation, and associated OSAS (obstructive sleep apnea syndrome), who was advised to refrain from night shifts and driving company vehicles; (3) a male 45-yr-old electrical technician with inducible ventricular tachyarrhythmia, who was implanted with a biventricular cardioverter defibrillator, and therefore recommended to avoid exposure to electromagnetic fields and working at heights. We conclude that the collaboration between the cardiologist and the occupational physician allows defining the functional capabilities and the arrhythmogenic risk of BrS workers, to optimize job fitness assessment.

[Occupational toxic neuropathies: morphology in peripheral nerve biopsies]. / Neuropatie tossiche occupazionali: quadri morfologici in biopsie del nervo periferico.

Many peripheral neuropathies are caused by the (acute or chronic) toxic action of metals, solvents, pesticides, and other occupational and environmental contaminants. These agents often reproduce the anatomoclinical pictures of hereditary (e.g., Charcot-Marie-Tooth disease), autoimmune (Guillain-Barrè syndrome), or dysmetabolic (thiamine deficiency, diabetic neuropathy) forms. Toxic peripheral neuropathies can be classified on the basis of etiology, clinical features (sensitive, motor, sensitive-motor), or histopathology: neuronopathies (uncommon, mostly secondary to retrograde axonal degeneration; e.g., arsenic, thallium), axonopathies (acrylamide, esacarbons, CS2, organophosphate-induced delayed neuropathy), myelinopathies (trichloroethylene), mixed forms (axonal and demyelinating: lead). For many substances, experimental research has led to the identification of the molecular and cellular targets of neurotoxicity. Several compounds are active by biotransformation (e.g., the esacarbons n-hexane and MnBK are neurotoxic since they are metabolized to 2,5-hexanedione), Genetic, physiological and environmental factors determine the individual metabolic set-up, and they may give origin to differences in the workers' sensitivity. Cessation of exposure is often followed by (microscopically observable) regenerative phenomena and clinical improvement. The morphology of neuropathies can be studied through peripheral nerve biopsy. Samples of sural nerve (or other nervous trunks of the limbs), adequately fixed, sectioned, and stained, allow the observation of alterations in axonal fibres (e.g., giant-axonal neuropathy, dying back neuropathy), myelin (demyelination), Schwann cells, interstitium, and blood vessels; possible inflammatory infiltrates; fibre density; regenerative phenomena (growth cone, remyelination). In occupational medicine, biopsy is indicated when the anamnestic-clinical picture, laboratory tests, and instrumental exams leave doubts about the nature, type, and entity of the neurological damage. In such cases, current optical and electron microscopy techniques can be very useful for injury evaluation, prognosis, and follow-up.

[The Maugeri Stress Index: a questionnaire to assess work-related psychological stress]. / Il Maugeri Stress Index questionnaire per la valutazione dello stress lavoro correlato.

INTRODUCTION: The European directives concerning the evaluation of work-related stress were absorbed into Italian law by means of Legislative Decree No. 81 of 9 April 2008. AIMS: To develop a new questionnaire to assess the impact of work-related psychological distress and to validate it by testing its factorial structure, its content, its construct and discriminant validity. METHODS: After critically reviewing the literature, we generated an initial item set to identify the items to be used in a preliminary version of the questionnaire, and then used a focus group to test the comprehensibility of the items. The questionnaire was administered to 329 subjects working in state and private organisation and a small sample of 29 subjects complaining of vexation at work. RESULTS: The Maugeri Stress Index (MSI) is reliable (Cronbach alpha: 0.93). Factorial analysis indicated five factors: Well-being, Adaptation, Support, Irritability and Avoidance. The total and subscale scores were significantly different when comparing subjects with and without vexation at work. CONCLUSION: The MSI has a multi-factorial structure, good internal reliability and sufficient discriminant power.

[Work-related stress and mobbing: case series and gender differences]. / Stress lavoro-correlato e mobbing: casistica clinica e differenze di genere.

The attention of international agencies and scientific community on mobbing (bullying) and work-related stress is increasing. However, research on gender differences and etiologic agents is still limited. This study describes the gender differences found in victims of mobbing and work-related stress in an Italian case series. Between 2001 and 2009, at the Occupational Medicine Unit of our Institution we examined 345 outpatients (197 women and 148 men) for suspected psychopathological work-related problems. After interdisciplinary diagnostic evaluation, the diagnosis of "mobbing syndrome" was formulated, according to international criteria (ICD-I0 and DSM-IV), in a minority of cases: 35 subjects. In the other workers, we found pre-existing psychiatric conditions (not related to work), or altered relationships dynamics with the colleagues. Significant gender differences emerged among people with "mobbing syndrome": there was a high prevalence of women (65%), with medium to high level of education; the most affected age group was between 34 and 45 years; several occupations were involved, with a clear preponderance of office workers. Women are mostly harassed for personal aspects related to emotional and relational factors; men for the content of their work. The knowledge of the phenomenon is an essential prerogative to contrast mobbing; this can be realized, at a preventive level, only through effective information and training for workers and employers, who have the legal obligation to preserve the integrity of the mental and physical status of their employees during the work.

[Stress risk evaluation in health personnel: framework and applicative experiences]. / La valutazione del rischio stress negli operatori sanitari: inquadramento del problema ed esperienze applicative.

The Italian legislative decree 81/08 requires stress risk evaluation for all the workers, including health personnel. The present paper compares two different occupational stress evaluation procedures, tested in two North Italy sanitary structures: a) the first through subjective methods, based on self report questionnaires and focus groups; b) the second through an objective approach, utilizing the OSFA (Objective Stress Factors Analysis) method. The comparison of the two experiences indicates that the subjective approach may present several limitations, since it gives a measure of the "felt" stress, not directly related to the nature of the job. On the other hand, the objective approach, and particularly the OSFA method, allows an analysis of the work conditions and the identification of single and specific aspects that can be ameliorated in order to eliminate or reduce the occupational stress sources.