Ostreid herpesvirus type 1 genomic diversity in wild populations of Pacific oyster Crassostrea gigas from Italian coasts.

Ostreid herpesvirus 1 (OsHV-1) is a significant pathogen affecting the young Pacific oyster Crassostrea gigas, worldwide. A new variant, OsHV-1 µVar, has been associated with recurrent mortality events in Europe since 2008. Epidemiological data collection is key for global risk assessment; however little is known about health status and genotypes present in European wild oyster beds. Most studies to date have involved only cultivated individuals during mortality events, and reported low genotype diversity. With this study, conducted along the Italian coasts, we investigated for the first time the presence of OsHV-1 in European natural oyster beds. Analysis of three genomic regions revealed the presence of at least nine different genotypes, including two variants close to the OsHV-1 reference, known since the early 1990s but with no European record reported since 2010, and highlights relevant genotype diversity in natural environment. Phylogenetic analysis distinguished two distinct clusters and geographical distribution of genotypes, with the exception of a variant very closely related to the µVar, which appeared the single genotype present in all the Adriatic sites. Interestingly, these wild symptom free populations could represent, in Europe, an accessible alternative to the import of OsHV-1-resistant oyster strains from the East Pacific, the native area of C. gigas, avoiding the high-risk of non-native marine species and new pathogen introductions.

Granulomatous lesions in a wild mullet population from the eastern Ligurian Sea (Italy): mycobacteriosis vs. pseudotuberculosis.

Mycobacterium spp. and Photobacterium damselae subsp. piscicida are recognized as the most frequent causative agents of granulomatous lesions in fish. Although frequent episodes of mycobacterial infections have been reported in wild fish worldwide, only sporadic cases have been documented to date in Italy. To investigate for the presence of lesions referable to mycobacteriosis and to identify the mycobacterial species involved, a total of 159 wild mullets were fished from the eastern coast of the Ligurian Sea, killed and necropsied. Liver and spleen samples were collected from all fish for histopathological and microbiological analyses. Molecular investigations for identification of Photobacterium damselae subsp. piscicida were performed. Gross examination revealed granulomatous lesions in one animal; microscopically, 42.14% of fish displayed granulomas with various histological features, 19.50% resulted positive at Ziehl-Neelsen staining, and were confirmed as mycobacterial lesions by culture. The identified colonies were characterized as M. fortuitum, M. abscessus, M. flavescens, M. chelonae, M. septicum and M. nonchromogenicum. In all, 35% of animals resulted positive for Photobacterium damselae subsp. piscicida. These data suggest widespread mycobacterial infection also by Photobacterium damselae subsp. piscicida infections in wild fish. Moreover, the pathogenicity of some mycobacterial species, previously considered as saprophytic, was demonstrated.

Metacercariae of Clinostomum complanatum (Trematoda: Digenea) in European newts Triturus carnifex and Lissotriton vulgaris (Caudata: Salamandridae).

Adults of Clinostomum spp. are digenetic trematodes found in fish-eating birds, reptiles and occasionally mammals, including humans. Freshwater snails serve as first intermediate hosts and many fish species and amphibians as second intermediate hosts. To date, amphibian hosts of Clinostomum metacercariae include members of urodele and anuran families in North America, but no data are available on infections of European amphibians, including newts. In this study, we characterize infections of Clinostomum complanatum metacercariae in four smooth (Lissotriton vulgaris) and 18 Italian crested newts (Triturus carnifex) from an artificial pond located in a protected area in Tuscany, Italy. Parasites were surgically removed from the infected newts and identified both morphologically and using sequences of a mitochondrial gene, cytochrome c oxidase I, and the ribosomal markers, internal transcribed spacers. This is the first record of C. complanatum in European newts and, more generally, in amphibians in Europe.

Meta-analysis of studies examining long-term construction injury rates.

BACKGROUND: The construction industry is one of the employment sectors with the highest risk of injuries. AIMS: To evaluate the injury trend in the construction industry from data published from 1987 to 2010. METHODS: All papers with at least two measurements of injuries within a medium- to long-term period were included. The numbers of fatal and non-fatal injuries were examined in two separate groups: 100,000 workers per year and 200,000 worked hours per year. RESULTS: All injuries significantly decreased between the first and the second measurement, with fatal injuries decreasing by 35% and non-fatal ones by 33% in workers/year and by 22% in worked hours/year. There was high heterogeneity among the sources of data for workers/year index (I(2) = 49% for fatal injuries, 99% for non-fatal injuries) but no heterogeneity for worked hours/year index (I(2) = 0). Meta-regression analysis showed a significant linear relationship between time and risk reduction for fatal injuries (r = 0.63; P < 0.001; a 6% reduction per year); trend reduction for non-fatal injuries was not related to the time taken between the measurements. CONCLUSIONS: Fatal injuries have a reduction trend that depends on large interventions, whereas non-fatal injuries are more prone to episodic changes. Furthermore, while the workers/year index allows easier evaluation of the injury rate variation in a single working environment, the worked hours/year index is better at comparing the injury rate variation in different working environments because it reduces the sources of heterogeneity.

Infection dynamics of Cichlidogyrus tilapiae and C. sclerosus (Monogenea, Ancyrocephalinae) in Nile tilapia (Oreochromis niloticus L.) from Uganda.

The infection dynamics of the gill monogeneans Cichlidogyrus tilapiae and C. sclerosus on Oreochromis niloticus with respect to habitat type (reservoir, stream, ponds and cages), host sex, size and seasons was determined between January and November 2008. During the study period, 45.2% of the 650 fish examined were infected with Cichlidogyrus spp. The infected hosts harboured an average of 8.6 ± 3.4 parasites/fish. Across habitat types, the proportion of infected fish was not statistically different. In contrast, the number of parasites recorded on infected fish from different habitat types differed significantly. The highest parasite number was recorded in reservoir-dwelling fish and lowest in stream-dwelling hosts. Concerning sex, more female O. niloticus were infected and harboured a high number of parasites than male and sexually undifferentiated fish. A weak negative relationship was found between rainfall and monthly parasite infections. However, a higher number of parasites and proportion of infected hosts were found during dry than in wet seasons, except in ponds. Results of this study show that differential exposure due to changes in fish behaviour associated with habitat modification and sex may account for the infection difference across the sampled sites. Meanwhile, rainfall and the associated hydrological events are important factors regulating monogenean infections in tropical aquatic environments. The continuous presence of Cichlidogyrus spp. in fish provides evidence of possible parasite outbreaks, indicating the application of biosecurity measures as crucial for the success of intensive fish farming.

Viral encephalopathy and retinopathy outbreak in freshwater fish farmed in Italy.

Viral encephalopathy and retinopathy (VER), otherwise known as viral nervous necrosis (VNN), is a neuropathological condition affecting > 40 species of fish. Although VER affects mainly marine fish, the disease has also been detected in certain species reared in freshwater environments. There are relatively few reports concerning the disease in freshwater species, and there is not much information on clinical signs. Nevertheless, the most common clinical findings reported from affected freshwater species are consistent with the typical signs observed in marine species. In this paper we describe the main clinical signs and the laboratory results associated with the detection of a betanodavirus in hybrid striped bass x white bass (Morone saxatilis x Morone chrysops) and largemouth bass Micropterus salmoides, reared in a freshwater environment. We also detected the virus by real-time PCR and isolated it in cell culture from a batch of pike-perch Sander lucioperca farmed in the same system.

Pulmonary nodules in workers exposed to urban stressor.

By multilayer spiral low-dose computed tomography (LD-CT) of the chest this study assesses the early detection of lung lesions on a sample of 100 traffic policemen of a big Italian city professionally exposed to urban pollutants and 100 controls non-occupationally exposed to urban pollutants matched by sex, age, length of service and cigarette smoking habit. Exposure to urban pollutants in traffic policemen was characterized using the annual average concentrations of PM(10), NO2 and benzene in the period 1998-2008 measured by fixed monitoring stations located in different areas of the city. A significant and increasing number of suspicious lung nodules with diameters between 5 and 10 mm was observed: in traffic policemen (including smokers and non-smokers) vs. controls (including smokers and non-smokers); in total smokers (including traffic policemen and controls) vs. total non-smokers (traffic policemen and controls); in smoker traffic policemen vs. smoker controls and vs. non-smoker traffic policemen; in non-smoker traffic policemen vs. non-smoker controls. The RR of finding cases with at least one lung nodule with diameters between 5 and 10mm in traffic policemen (including smokers and non-smokers) compared to controls (including smokers and non-smokers) is 1.94 (CI 1.13-3.31); in total smokers vs. non-smokers the RR is 1.96 (CI 1.20-3.19). The comparison between the interaction exposure and smoking shows an increase in smoker traffic policemen than in smoker controls (RR=2.14; CI 1.02-4.52). The RR for smoker traffic policemen was higher than in non-smoker traffic policemen (RR=2.09; CI 1.19-3.66). The results of our study show that: (1) while smoker workers have a higher risk for developing solid suspicious lung nodules, the simple routinely exposure to urban pollutants is unable to produce the same kind of increased risk; (2) the interaction of smoking and exposure to urban pollutants greatly increases the risk for the development of solid suspicious lung nodules. In conclusion, the use of chest LD-CT in workers at risk helps identify suspicious solid lung nodules at early stage.

[Meta-analysis: effectiveness of the preventive interventions in agriculture accidents]. / Meta-analisi: efficacia degli interventi preventivi negli infortuni in agricoltura.

The aim of our study is to determine the effectiveness in reducing workplace accidents in agriculture using preventive interventions including awareness and effective knowledge of hazards with workers who followed training-informative programs. On the basis of the data reported in the 11 studies three categories we identified: Reduction in the number of workplace accidents: comparison between groups; Reduction in the number of workplace accidents: before-after comparison; Self-rating of injuries risk reduction. The second category showed significant statistical differences in the subgroup who followed preventive intervention compared to subgroup who did not follow this intervention. The third category showed a significant statistical increase of the Consciousness Index of the agricultural workers who followed the training-informative programs. The results suggested the need to use assessment models more suitable to the nature of the examined variables. A promising area is the evaluation of knowledge of risks achieved by workers exposed to formative-informative programs.

[Algorithm for assessment of exposure to asbestos]. / Proposta di algoritmo per la valutazione stimata dell'esposizione lavorativa ad amianto.

There is no universally approved method in the scientific literature to identify subjects exposed to asbestos and divide them in classes according to intensity of exposure. The aim of our work is to study and develope an algorithm based on the findings of occupational anamnestical information provided by a large group of workers. The algorithm allows to discriminate, in a probabilistic way, the risk of exposure by the attribution of a code for each worker (ELSA Code--work estimated exposure to asbestos). The ELSA code has been obtained through a synthesis of information that the international scientific literature identifies as the most predictive for the onset of asbestos-related abnormalities. Four dimensions are analyzed and described: 1) present and/or past occupation; 2) type of materials and equipment used in performing working activity; 3) environment where these activities are carried out; 4) period of time when activities are performed. Although it is possible to have informations in a subjective manner, the decisional procedure is objective and is based on the systematic evaluation of asbestos exposure. From the combination of the four identified dimensions it is possible to have 108 ELSA codes divided in three typological profiles of estimated risk of exposure. The application of the algorithm offers some advantages compared to other methods used for identifying individuals exposed to asbestos: 1) it can be computed both in case of present and past exposure to asbestos; 2) the classification of workers exposed to asbestos using ELSA code is more detailed than the one we have obtained with Job Exposure Matrix (JEM) because the ELSA Code takes in account other indicators of risk besides those considered in the JEM. This algorithm was developed for a project sponsored by the Italian Armed Forces and is also adaptable to other work conditions for in which it could be necessary to assess risk for asbestos exposure.

Histological classification and expression of markers of canine mast cell tumors.

BACKGROUND AND AIM: Mast cell tumors (MCTs) are malignant neoplasms that are common in dogs. Their biological behavior is variable and unpredictable. The aim of the present study was to analyze the histological classification and expression of markers of canine MCTs. MATERIALS AND METHODS: Thirty samples of canine MCTs were graded according to the histological classification methods of Patnaik and those of Kiupel. The expression of phosphoprotein 53 (p53) and c-kit proteins was quantified by immunohistochemistry using image processing software, ImageJ - a public domain computer program, developed at the National Institutes of Health. RESULTS: It was possible to determine the grade of 100% of the samples. According to Patnaik's classification, 20.00% of the samples were Grade 1, 43.30% were Grade 2, and 36.70% were Grade 3. According to Kiupel's classification, 56.67% of the samples were of high intensity and 43.33% were of low intensity. Grade 1 tumors had the highest expression of p53 and c-kit, and Grade 2 had the lowest expression. The results showed that it is necessary to perform both histological grading methods. The classification into high and low intensity may provide more consistent results than the three-level grading system. However, a smaller number of categories, although it facilitates the classification, may not be sufficient for the prognosis. CONCLUSION: Quantitative evaluation of p-53 and c-kit expression is a useful tool to increase the accuracy of the analysis and to aid in choosing the treatment method for canine MCTs. Histological grading should be combined with other diagnostic methods.

Sand flea (Tunga spp.) infections in humans and domestic animals: state of the art.

Tungiasis is a parasitic disease of humans and animals caused by fleas (Siphonaptera) belonging to the genus Tunga. Two species, Tunga penetrans (L.) and Tunga trimamillata, out of 10 described to date, are known to affect man or domestic animals; the other eight are exclusive to a few species of wild mammals. Tunga penetrans and T. trimamillata originated from Latin America, although the first species is also found in sub-Saharan Africa (between 20 degrees N and 25 degrees S). Hundreds of millions of people are at risk of infection in more than 70 nations, mostly in developing countries. The second species has been reported only in Ecuador and Peru. Males and non-fertilized females of Tunga are haematophagous ectoparasites; pregnant females penetrate the skin where, following dilatation of the abdomen, they increase enormously in size (neosomy) and cause inflammatory and ulcerative processes of varying severity. The importance of Tunga infection in humans concerns its frequent localization in the foot, which sometimes causes very serious difficulty in walking, thereby reducing the subject's ability to work and necessitating medical and surgical intervention. Tungiasis in domestic animals can be responsible for economic losses resulting from flea-induced lesions and secondary infections. Because tungiasis represents a serious problem for tropical public health and because of the recent description of a new species (Tunga trimamillata), it seems appropriate to review current knowledge of the morphology, molecular taxonomy, epidemiology, pathology, treatment and control of sand fleas of the genus Tunga.

Work Related Violence As A Predictor Of Stress And Correlated Disorders In Emergency Department Healthcare Professionals.

AIMS: The aim of the study was to investigate the frequency, type, causes and consequences of violence and aggression experienced by Emergency Department workers during their interactions with patient, their relatives or companions and whether the phenomenon of violence at work is a specific risk factor predicting stress and possible stress related pathologies in emergency health workers. The study proposes a model of effective intervention for the prevention and management of violence and stress. METHODS: A cross-sectional retrospective study was performed with a sample of 323 healthcare workers at Department of Emergency and Acceptance of Level II and the Psychiatric Services of Diagnosis and Care of the University Hospital Policlinico Umberto I, in Rome, Italy, between June 2016 and February 2017. Data collection was conducted by a psychiatrist by means of a questionnaire method administered to each participant and by carrying out individual interviews. The two questionnaires used, both the Health Violence Questionnaire (QVS) and the Workers' Stress Perception Questionnaire (SPQR) were designed ad hoc, after some test sessions intended for the creation of their content. RESULTS: Eighty-seven percent of emergency healthcare workers experienced workplace violence by patients or their relatives. More than half of healthcare workers reported multiple consequences on their emotional sphere, in particular female healthcare professionals and all those who have suffered frequent incidents of violence. Regarding the effects on lifestyle, one third reported an increase in consumption of tobacco, food and sleep disorders and changes from social relationships to social isolation and avoidance of some places. More than one third of healthcare workers reported consequences on their well-being and health, especially the female workers. Distress was associated with frequent workplace violence. Healthcare workers who experienced frequent violence indicated lack of support from hospital administration and ED management as barriers to reporting workplace violence. CONCLUSIONS: The study confirms the diffusion of the workplace violence by patients and/or their relatives against the emergency healthcare professionals, related to the gender, the professional qualification, the role in the organization and the workplace. Almost all male and female healthcare workers reported they had suffered the effects on lifestyle, working habits and wellbeing and health following the workplace violence. Precipitating factors to violent incidents identified by healthcare professionals are consistent with the research literature. Commitment from hospital administrators, ED managers and hospital security is necessary to facilitate improvement and ensure a safer workplace for ED healthcare workers. Our study emphasizes the importance of analyzing, in addition to general job demands, the specific job demands such as the phenomenon of violence, considered a key risk factor, predictor of stress and possible mental disorders in healthcare workers operating in high-risk environments. This study confirms the importance of application of the modified model by Brough and Biggs of integrated multidimensional intervention on the prevention and management of workplace violence and work stress and shall be implemented on all three levels: individual, organizational and situational. The study also highlights the need to implement support strategies for the victims of violence.

Neuroendocrine features in extreme longevity.

In order to evaluate the effects of some neuro-endocrine changes during aging we have studied adrenal, thyroid and pineal secretion in young, healthy old and centenarians. The number of subjects in each hormone group varied. The following parameters were evaluated: serum levels of cortisol, dehydroepiandrosterone-sulfate (DHEAS), free triiodothyronine (FT3), thyroxine (FT4), reverse triiodothyronine (rT3) and thyroid-stimulating hormone (TSH). Urinary 6-hydroxymelatonin sulfate (aMT6s) and free cortisol were measured twice daily. Centenarians exhibited significantly lower TSH levels together with slightly higher rT3 levels than old controls. These changes could be due to reduced 5'-deiodinase activity occurring also in absence of substantial changes of the nutritional pattern. Morning serum cortisol levels were found to be similar in the 3 age groups, whereas the decline of serum DHEAS levels was well evident also after the ninth decade of life. The cortisol/DHEAS molar ratio, which usually increases with age and considered to be an expression of a neurotoxic pattern of the steroidal milieu in the central nervous system, did not shown any further increase in centenarians. The urinary free cortisol and aMT6s excretion declined with age; however only in centenarians and in young controls aMT6s excretion was significantly higher at night than during the day. These findings suggest that the circadian rhythm of melatonin secretion is maintained in centenarians and, based on the limitations of this study, could be considered one factor in successful aging.

[Meta-analysis of respiratory function of workers exposed to asbestos]. / Meta-analisi sulla funzionalità respiratoria nei lavoratori esposti ad amianto.

The monitoring of health conditions in workers exposed to asbestos for prolonged periods is a problematic issue. The Occupational Health physician being required to carry out his activity of prevention of the medical consequences and protection of the workers can use various instruments among which there is the evaluation of lung function. We have performed a meta-analysis on the scientific evidence on this matter in order to identify significant alterations of the lung function parameters in subjects professionally exposed to asbestos compared with controls. By the means of a bibliographic search and the application of selected inclusion and exclusion criteria, we identified 21 articles presenting data from controlled studies. Our results show that the number of controlled trials is very small compared to the totality of studies performed on this matter (1 to 70 ratio) and that the number of the subjects included in the majority of the analyzed studies is oddly divided in the experimental and control group. For this and other reasons the analyzed studies are very heterogeneous. Despite these difficulties, the meta-analysis evidences that some parameters of respiratory functioning are more likely to be influenced by asbestos exposure taking into account the smoking habit and that other parameters are sinergically influenced by both asbestos exposure and smoking. Our meta-analysis points out the necessity to define a common methodology about the technical and operatives procedures in the evaluation of the effects on lung function measures determined by an occupational exposure to asbestos and a thorough examination of the intensity of abnormality levels that could allow using the values obtained from the above mentioned measures in a discriminating diagnostic way.

[Scientific evidence in occupational health: meta-analytical study of the burnout syndrome]. / L'evidenza scientifica in medicina del lavoro: studio meta-analitico sulla sindrome del burnout.

BACKGROUND: According to scientific literature, burnout can be described as a multi-dimensional syndrome with three fundamental dimensions: emotional exhaustion, depersonalization and reduced personal accomplishment. OBJECTIVES: Since attention for this phenomenon is increasing, with a large number of articles published in scientific journals in recent years, we set out to evaluate the scientific evidence on this topic by applying the meta-analytical method. METHODS: All comparative studies performed on burnout were identified and examined in order to compute the Effect Size of the results. Forty studies complied with the inclusion criteria of this analysis for a total of 2,031 burnout cases versus 1,950 controls. RESULTS: Our results revealed a significant disparity in the methods of selecting subjects with burnout. This problem emphasizes the lack of a standardized definition of burnout as a univocal clinical entity and, consequently, the lack of a unanimously agreed procedure for the identification of patients to be included in this diagnostic category. CONCLUSIONS: The wide heterogeneity between studies thus considerably reduces the possibility of comparing them and generalizing the results.

Stress at work: development of the Stress Perception Questionnaire of Rome (SPQR), an ad hoc questionnaire for multidimensional assessment of work related stress.

Stress is an emotional condition, mostly experienced as negative, initially identified and defined by Selye in the mid-thirties of the last Century. Since the first definition, stress concerns the adaptation pro- cess mostly related to environmental changes. An application of stress focuses on the evaluation of its interference on work conditions, and the scientific evidence on work related stress is very ample and rich. We are proposing a new ad hoc questionnaire for the multidimensional assessment of work related stress, called Stress Perception Question- naire of Rome (SPQR) composed of 50 items. The development of this questionnaire is based on a multi-step process: a) Identification of all the relevant topics to work related stress and areas in the scientific evidence and their transformation on specific contents of 60 tentative items; b) Exploratory factor analysis aimed to identify the best items (50) which could guarantee the maximum convergence on single scales (8), and the minimum redundancy between scales; c) Validation of the 8 scales' structure by a confirmatory factor analysis (fully achieved); d) Factor analysis for a second level factor resulting in a single factor identified as the questionnaire total score (Stress Score); d) Reliability analysis of the questionnaire total score and the single scale scores (at optimum level); e) Validation by external criteria of work related stress identified in the presence of personal violence episodes experienced by a group of health workers with different professional profiles and from two different hospitals in Rome. Our results show that the SPQR is a useful and sensitive tool for assessing the presence of emotional stress related problems identifiable in a work environment. The advantage of this questionnaire is that it allows for a multidimensional description of the different components of this problematic area besides its ability to quantify the overall stress level of those who have been administered the SPQR.

Amputation versus conservative treatment in severe open lower-limb fracture: A functional and quality-of-life study.

INTRODUCTION: Severe lower-limb trauma is a major event in a patient's life, and treatment is a challenge that has not been sufficiently studied. The main objective of the present study was to assess the difference in disability between amputees and patients who kept their leg after severe open lower-limb fracture. HYPOTHESIS: The study hypothesis was that amputation allows better functional recovery and quality of life, in the same time-frame. MATERIALS AND METHODS: All male and female patients aged over 18 years admitted to one of the trauma centers of Marseille (France) for major lower-limb trauma with Gustilo IIIb or IIIc fracture were included. Minimum follow-up was 2 years. Two groups were distinguished according to primary treatment: lower-limb salvage, or amputation. Rates of infection and of surgical revision, hospital stay, functional parameters (walking distance, standing, use of canes, running, jumping, driving, and physical and occupational activity) and quality of life (MOS SF-36 score) were compared between groups. RESULTS: The conservative treatment group comprised 27 patients, and the amputation group 24. Rates of infection and of surgical revision and hospital stay were significantly lower in the amputation group (P<0.02). All functional parameters (except return to work) and overall quality of life were significantly better in the amputation group. There was no significant inter-group difference in MOS mental score. CONCLUSION: In severe lower-limb trauma, amputation seems to give better functional and quality-of-life results. It did not, however, improve return to work, and was not better accepted psychologically than long and complex conservative management. LEVEL OF EVIDENCE: IV, retrospective study.

[Mental health and life style changes in young workers]. / Salute mentale ed alterazione delle abitudini di vita dei lavoratori giovani.

Lifestyle's alterations are hazardous for health. On one hand they produce a high rate of mortality and disease, on the other hand they cause a reduction of work outcomes and an increase of occupational accidents with important consequences for both worker's health and his/her financial status. The aim of this study is to review the scientific literature for possible relationships between mental health and lifestyle alterations of young workers. We considered as lifestyle factors the attitudes towards: smoking, alcohol consumption, eating, use of medications and doping substances, physical activity and sleeping. From our study it clearly emerges the existence of correlation between lifestyle habits and mental health; in fact behavioural alterations can produce problems of mental health and vice versa. Furthermore, some work peculiarities can lead to psychic disturbances and/or to unhealthy habits which can themselves cause negative effects on working activity. It is very important for young workers to understand that unhealthy behaviours, which can be corrected, are hazardous in terms of health and safety for both the single worker and the collectivity and that those behaviours can enhances the other working risks. Because there is a close interaction between mental health and lifestyles, it would be necessary a careful promotion of mental health on workplaces and to take all the preventive measures, with particular regard for those related to the work organization, in order to reduce the onset, exacerbation and unmasking of mental disorders and psychological difficulties. In working environment, the occupational health physician and his relationship with the patient are of fundamental importance. During preventive and periodic medical examinations, the occupational health physician should take detailed information on young worker's habits regarding smoking, alcohol consumption, eating, physical activity, sleeping, pharmacological abuse and possible presence of mental disorders and furthermore he/she should actively take part in the information and education process of the worker.

[Evidence based medicine and mobbing]. / Evidence based medicine e mobbing.

The phenomenon of the physical, moral or psychical violence in the working environment, variously indicated as "mobbing", "workplace bullying" or "workplace harassment", is to date object of numerous studies, mostly of epidemiological type, which are yet to clear, in a sufficient way, the aspects of that phenomenon, the possible causes, risk factors, constituent characteristics and consequences. Our search, a systematic review of the existing studies in literature and a meta-analysis of the jobs chosen to such scope, has shown that only a small percentage of the researches conducted on the topic is represented from studies that collected original information on the subject. The results of the meta-analysis show that in the category of the mobbed workers the psychosomatic disturbs, stress, and anxiety are greater than in the group of controls and that the perception of the surrounding environment is more negative in the victims of mobbing compared with the not mobbed workers. The value of such results is reduced by the characteristics and the heterogeneity of the studies.