Workplace drug testing on urine samples: evidence for improving efficacy of a first-level screening programme.

BACKGROUND: Previous reports revealed poor performance in identifying drugs of abuse users through first-level workplace drug testing (WDT), based on urine samples. In a cross-sectional study, we evaluated: (i) the effect of creatinine normalization of drug values from diluted urine samples (creatinine levels ≤ 20 mg/dL) on the prevalence of drug users; (ii) the independent procedure-related predictors of positivity and dilution. METHODS: Workers' urine samples were collected at the workplace or at our certified laboratory between 2008 and 2012. All samples were analysed for drugs of abuse by immuno-enzymatic method in our laboratory, according to the Italian WDT law. Detectable drugs of abuse concentrations lower than the positive cutoff values were normalized based on mean levels of urinary creatinine. Detectable concentrations of drugs were confirmed by GC/MS. Multivariate logistic regression was used to detect independent procedure-related predictors of positive and diluted urine samples. RESULTS: Of the 3080 urine samples screened, 51 (1.7%) were found positive for some drugs of abuse (26 cannabinoids and 16 cocaine) and 116 (3.8%) were diluted. Seventeen out of 23 diluted urine samples with detectable concentrations of cannabinoids or cocaine were found positive after urine creatinine normalization and GC/MS confirmed both negative and positive results. This increased the percentage of positivity for cannabinoids and cocaine from 1.35% to 2.09% (+55%, p=0.0005), which is closer to the expected prevalence of drug users based on Italian self-reported surveys. Collection of samples in the laboratory was an independent predictor of positivity (OR=2.33, 95%CI 1.27-4.28) and diluted urine sample (OR=1.65, 95%CI 1.04-2.61). CONCLUSIONS: Efficacy of first-level WDT could be improved by well-controlled pre-analytical procedures and urine creatinine normalization of detected concentrations of drugs of abuse.

[Occupational physicians' new attributions and responsibilities]. / Attribuzioni e nuove responsabilità del Medico Competente.

BACKGROUND: With the introduction in Italy of the Law regarding alcohol abuse and addiction (Law No.125/01), new tasks and responsibilities were assigned to occupational physicians. This law establishes that in working activities with a high risk of industrial accidents, or which may cause a risk for the safety and health of others, workers are forbidden to consume alcoholic beverages during working hours. In addition, occupational physicians are asked to play a key role in testing workers for alcohol levels. In March 2006 a specific list of job titles was issued which makes the law effective. DISCUSSION AND CONCLUSIONS: The application of this law gives rise to various consequences and ambiguities, in particular for occupational physicians, mainly concerning the identification of workers with alcohol problems, the subsequent control of such workers, including proposals for valid rehabilitation programmes, and assessment of residual work fitness. All these aspects can, to some extent, produce conflicts between privacy rights and the need to ensure the health and safety of workers and third parties. A specific screening package is proposed for the identification of alcohol abuse as well as methods to overcome some of the constraints. Specific and effective guidelines need to be issued by scientific societies and health authorities.

[Stabilometric parameters associated with musculoskeletal diseases in a group of traffic policemen]. / Parametri stabilometrici associati a disturbi muscoloscheletrici in un gruppo di vigili urbani.

As reported by previous literature, the prevalence of musculoskeletal disorders is high in population of local police officers, due to several risk factors, including awkward posture, jolt/vibrations and stress. The results of our study reveal that the most common musculoskeletal symptoms among local police officers are cervicobrachial pain, low back pain and sciatica. Low-back pain is associated with tasks exposing to awkward posture of the spine (traffic policemen and policemen involved in office-based duties); cervical and upper extremity disorders are related to the exposure to vibrations and to the upper limb posture held by motorcycle police. Among postural parameters, anterior scapular plane, flat back and Barre's vertical resulted possible predictive tests of adaptation of the postural system to the symptom pain in subjects with low back pain. In conclusion, it is necessary to adopt organizational, protective and preventive measures in order to occupational health of local police officers. They include: decrease of time periods during which an awkward posture is held, breaks between duties, prescription of ergonomic shoes, use of low-weight and low-volume duty-packs, and planning of periodical osteopathic check-ups as part of the health program, aimed to uncover initial postural alterations related to musculoskeletal disorders.

[Differences of mortality risk for all causes and for cardiovascular diseases among occupational classes in men living the Northern Italy]. / Differenze del rischio di mortalità per tutte le cause e per malattie cardiovascolari tra classi occupazionali in uomini residenti nel Nord Italia.

To assess socio-occupational (SO) class differences in 8-year risk of all-cause and cardiovascular (CVD) death in an North Italian prospective epidemiological study, five cohorts (four population-based and one factory-based) were investigated at baseline from 1986 to 1995. Follow-up procedures allow to sensor 4339 35-74 years old men up to the end of 1998 for all-cause and cardiovascular deaths. Coronary risk factors were measures according to the standardised methods of MONICA Project. Five SO classes were identified according to the method proposed by Erikson, Golthorpe e Portocarero. Results shows an inverse associations between SO classes and death risk for all-cause and cancer. The higher SO classes showed higher risk of cardiovascular death risk. Possible explanations include high level of job stress among employed managers and professionals.

[Reliability of the Karasek scale in the assessment of perceived occupational stress and gender-related differences in scores. The SEMM study]. / Affidabilità della scala di Karasek per la valutazione dello stress lavorativo percepito e differenze dei punteggi tra sessi. Lo studio SEMM.

In recent years more attention has been paid to the relationship between work organization and job stress and chronic-degenerative diseases. Aims of this report are the assessment of the reliability and internal consistency of the Karasek's Job Content Questionnaire-JCQ and to assess age-specific distributions of core JCQ scores between the gender groups. The study has been carried out in a large group of employees (n. 7871 subjects, 5270 women and 2601 men) of the Municipality of Milano in the years between 1992 and 1996. Decision Latitude (DL), Psychological Job Demand (PJD) and Social Support at Work (SSW) scores were calculated. Reliability of the JCQ was satisfactory, with Cronback's alpha suitable values for DL and SSW and acceptable for PJD. From the distribution of gender- and age-specific mean scores, women show reduced probabilities of developing a favorable career and of perceiving satisfactorily the support from colleagues and supervisors than men when they get older. This results suggest that the Karasek's JCQ is an effective toll to describe perceived job stress conditions in this Italian work setting.