[Ergonomics and occupational therapy]. / Ergonomia e terapia occupazionale.

Occupational ergonomics mostly deals with risk assessment and design/redesign of the work layout, oriented to enhance the worker's safety and wellbeing and the system's efficiency. Risk assessment is the fundamental phase, conducted through international standards and guidelines, according to the different areas. Then the risk level is connected with preventive or corrective measures. This second phase is direct to organizational, ergonomic, engeneering interventions but it behaves in essential way the employer participation. At this scope, educational, training and technological tools are available. Ergonomics configure itself as a valid complement in the return-to-work phase, providing for workstation adjustment or job modification, contributing to enhance safety and comfort and to reduce the risk of injury and disability in the worker.

[Treadmills in rehabilitation medicine: technical characteristics and selection criteria]. / Il treadmill in medicina riabilitativa: caratteristiche tecniche e criteri di selezione.

The treadmill is a commonly used means of testing and training patients with cardiopulmonary diseases. There is growing interest in the use of the treadmill also for rehabilitation of patients with orthopaedic and neurological diseases. Commercially available treadmills show wide differences in terms of structure and function that have a direct impact on the specific rehabilitation protocols. The aims of this paper are: a) to briefly review the physiology and biomechanics of treadmill exercise as compared to overground walking; b) to point out the technical specifications of treadmills suitable for rehabilitation settings; c) to provide guidelines for treadmill selection in the different categories of rehabilitation patients. First, the different physiological and biomechanical characteristics of walking on a treadmill and overground are discussed. Uphill and downhill walking as well as backward walking are also presented together with the spin-offs for rehabilitation practice. Then, the technical features of treadmills (treadbelt, frame, bars, deck, rollers, shock absorption, elevation motor, drive motor, flywheel, display) are described and the specific requisites for the different patient categories undergoing rehabilitation are discussed in detail. Finally, guidelines and a flow-chart for identifying the main technical requisites for appropriate treadmill selection in the different disabilities are provided. A summary table of the technical specifications of the commercially available rehabilitation treadmills is also included.

[Subjective aspects of quality of life in hospital workers]. / Aspetti soggettivi della qualità di vita in operatori ospedalieri.

The work of hospital nurses involves a variety of tasks and duties that can become an underlying cause of stress and personal failure to them both in their private and professional life. In this study we evaluated the perceived quality of life of 32 hospital nurses in two Wards (A and B) through a self-administered questionnaire and semi-structured interview. We found significant differences between the two Wards on two items: "Work organization" (A = 7.7; B = 5.2; H = 5.47; p =.019) which reflects the physical and emotional job demands as well as the work climate, and "Leisure time" (A = 4.0; B = 6.4; H = 4.42; p =.035) which reflects the possibility that the individual has to recovery from fatigue and stress through rest and leisure activities. The economic situation was found to be better for nurses who were married or live with a partner than for those living alone (mean score respectively 7.9 vs. 5.9). Shift-work appeared to affect both sleep and nutrition. Social functioning (relationships with partner, work colleagues, friends) emerged as very important and a source of satisfaction (mean score 7.1). Married and older nurses expressed greater difficulty in managing family commitments and their own personal well being. Administrative and organizational interventions should be addressed to solve these difficulties and prevent them from becoming chronic. A deeper knowledge and consideration of the subjective assessment by hospital workers of their working life is an important means to highlight the crucial factors and help in planning risk-reduction interventions.

[Industrial manufacturing of the wool: pathology secondary to the biomechanical involvement of the upper limbs and the course in relation to work tasks]. / Lavorazione industriale dello lana: patologie secondarie all'impegno biomeccanico degli arti superiori (UEWMSDS) e loro evoluzione in relazione alla mansione lavorativa.

In years 2003-2005, 1248 laborers of Zegna Baruffa - Lane Borgosesia Company (establishment of Borgosesia and Vallemosso) have been visited and we selected 102 cases of pathology from upper extremity work-related musculoskeletal disorders in the units with working risk. Subsequently from April 2005 to May 2006 we have controlled the clinical evolution of the enlisted laborers and we noted that in 54% of the cases the clinical symptomatology has been resolved with a rest works and a correct therapy. The diagnosis, the treatment and the change of working duty can resolve a meaningful number of clinical cases.

Muscle function and functional ability improves more in community-dwelling older women with a mixed-strength training programme.

BACKGROUND: Supervised training can reach a limited number of elderly people. OBJECTIVE: To determine the impact of a 1-year mixed-strength training programme on muscle function (MF), functional ability (FA) and physical activity (PA). SETTING: Twice-a-week hospital-based exercise classes and a once-a-week home session. PARTICIPANTS: twenty-eight healthy community-dwelling men and women on the training programme and 20 controls aged over 75 years. METHODS: Training with two multi-gym machines for the lower limbs at 60% of the repetition maximum (1RM). At-home subjects used elastic bands. MEASUREMENTS: Maximum isometric strength of knee extensors (KE), ankle plantar flexors (PF), leg extensor power (LEP), functional reach (FR), chair rise 1 (CR1) and 10 times (CR10), bed rise (BR), six-minute walking test (6MWT), stair climbing (SC), get-up-and-go (GU&G), one-leg standing (1LS). PA was assessed with the Paqap questionnaire. RESULTS: Women were significantly weaker than men at baseline: -47% for KE and -59% for PF. Training induced significant gains in MF and FA in the training females; males improved significantly only in FA. PA levels increased non-significantly (2%) in all of the training group. CONCLUSIONS: Long-term mixed-strength programmes can improve MF and FA in elderly females, and FA in elderly males.

[Industrial processing of wool: biomechanics and ergonomic aspects]. / Lavorazione industriale della lana: impegno biomeccanico ed aspetti ergonomici.

Workers in a wool processing industry were analyzed for risk factors in development of musculoskeletal disorders from specific repetitive movements that they executed, in all phases of the preparation of wool products ("tintoria", "mescolanza", "finitura", "filatura", "riroccatura", "ritorcitura", "confezionamento"). The evaluation revealed nonergonomic work situations, due to both repetitive movements of the upper extremities as well as prolonged asymmetrical postures of the trunk while moving loads; both of these problems were due to suboptimal interface between the anthropomorphic characteristics of the operators and the technical movements required at the machines. The risk analysis was performed both for cumulative trauma disorders as well as for low back pain, based on formulas in the exisiting literature. Ergonomic interventions were implemented and evaluated for the most stressful situations.

[De Quervain's tenosynovitis and work with hand tools: a case study]. / Tenosinovite di De Quervain e lavoro con utensili. Discussione di un caso clinico.

Work-related musculoskeletal disorders of the upper limbs are a frequent complaint and their pathogenetic mechanism is often related to mechanical overload of the body region involved without traumatic events. The occupational origin of such disorders is much debated, since the clinical pictures are often not specific and may be found in subjects who do not perform hazardous work tasks. A better understanding of the relationship between clinical symptoms, diagnosis, and functional capacity would provide a deeper knowledge in decision making for return to work and rehabilitation strategies. In this paper we present a case study of a worker using scissors who developed De Quervain's syndrome in the dominant hand. A methodology for the biomechanical investigation of the work task and the possible occupational aetiology of the clinical picture are discussed according to the findings of the specific literature.

A functional assessment methodology for alcohol dependent patients undergoing rehabilitative treatments.

PURPOSE: We propose a functional assessment approach for patients with alcoholic dependence of working age undergoing aerobic training. The background is the WHO indication (ICIDH-2) to use measurable 'activities' as a means to assess the individual 'participation' in social life which also implies work capacity. Defining sustainable energetic levels for the individual is an important issue for both the quantification of an effective training and the evaluation of possible improvements following training. METHODS: Fifty-six 'alcohol dependent' patients, as defined by DSM IV (Diagnostic and Statistical Manual of Mental Disorders), admitted to our Unit in a 16 month-period participated in the study. Eighteen healthy subjects served as controls (Group C). Out of all the 56 patients, 33 (Group A) underwent an aerobic training and 23 subjects (Group N) underwent the same pharmacological and psychological therapy but without aerobic training. Patients were assigned to the treatment (A) or no treatment (N) group according to a 'quasi-experimental' design (i.e. temporal selection criteria). The evaluation protocol consisted of submaximal symptom-limited tests. The tests consisted of bouts of 'basic' activities (walking, lifting, arm-work) to be performed at different intensities. We estimated the total energetic work (TW) performed in the tests by means of formulas available in the literature. The maximal energetic intensity (EI) reached during the tests was also estimated and expressed in MET (multiple of the basal metabolism). RESULTS: Significant differences in work capacity were observed between patients and healthy subjects at baseline. Group A significantly increased TW after rehabilitation, while Group N did not increment their performance at the re-test. CONCLUSIONS: The proposed approach could be useful in the functional assessment of deconditioned subjects with alcohol dependence in working age, and could monitor the changes in work capacity following training.

Comparison between the CR10 Borg's scale and the VAS (visual analogue scale) during an arm-cranking exercise.

Two subjective assessment scales (VAS and Borg's CR10) are compared in a group of 15 young and healthy subjects performing an arm-cranking incremental steady-state exercise. Arm-ache and breathlessness were evaluated at each step, together with the measurement of heart rate (Hr) and blood lactate (Bl). Both arm-ache and breathlessness show a slight positively accelerating increase with workload as evaluated by CR10, while there exists a linear increase by VAS. A very good linear correlation (0.99, p < 0.05) was found between subjective assessments given on the CR10 and a simple combination of Hr and Bl. Reproducibility of both the scales and of the physiological variables was found to be good.

[Evaluation of the risk related to repetitive work activities: testing of several methods proposed in the literature]. / La valutazione del rischio connesso ad attività lavorative ripetitive: sperimentazione di diversi metodi proposti dalla letteratura.

Pathologies due to the repetitive activity of the upper limbs constitutes a growing part of the work-related musculo-skeletal disorders. At the moment, there are no universally accepted and validated methods for the description and assessment of the work-related risks. Yet, the criteria fundamentally characterizing the exposure are rather clear and even. This study reports a practical example of the application of some recent risk assessment methods proposed in the literature, combining objective and subjective measures obtained on the field, with the traditional activity analysis.

[A project for the occupational reintegration of impaired subjects]. / Un progetto per il reinserimento occupazionale di soggetti svantaggiati.

In this paper we have explained the criteria for an integrated socio-medical intervention (Local Health Care Institution, Cooperation, Scientific Institute of Care and Research) within the frame of a Communitary Initiative titled "Local network for return to work of persons with social disadvantage". The goal of the Initiative is to "create and experiment new facilities to support intervention strategies for return-to-work, and to start a virtuous circle matching the demands of both the disadvantaged persons and the local labour market". In the paper we describe the functional evaluations, performed in the Medical Center of Pavia by specialists in the field of Rehabilitation, Psychology and Ergonomy, and the following return-to-work phase, performed by operators of the Cooperation.

[Multifactorial ergonomic evaluation of the hospital nursing activity in assisting not self-sufficient patients]. / Valutazione ergonomica multifattoriale dell'attività infermieristica ospedaliera, nell'assistenza ad ammalati non autosufficienti.

8 Institutes of Health Care and Research of Northern-Central Italy participated in the study, which consisted of on-site investigations, interviews with the chief-nurse, and monitoring of physiological and subjective variables. We studied the most critical phases in the laboratory, by means of video-graphical systems for biomechanical and postural analysis. The outlined profile shows a demanding activity, yielding important risk factors relative to musculoskeletal lesions. The preventive attitude (education, training) must be implemented by ergonomic interventions, aimed to minimize the risk related to manual handling.

Levels of sustainable aerobic workload in dialysis patients.

The aerobic performance of a heterogeneous group of 89 ambulatory medically stable patients on chronic hemodialysis was studied to define individual levels of the most acceptable metabolic workload. The patients performed a step test protocol (3 steps) with a cycle ergometer. Each step (25 Watt) lasted 6 min. Heart rate (HR), oxygen consumption (VO2), ventilation (VE), respiratory exchange ratio (RER), blood pressure (BP) and subjective ratings of dyspnea (CRd) and fatigue (CRf) levels were monitored throughout the test. The test was continued to exhaustion or to values of systolic arterial blood pressure (SABP) >240 mmHg, heart rate (HR) > or = 85% max, or ST changes in ECG. In eleven patients (12.5% of the whole group) the test was interrupted within the first two minutes of exercise. In the remaining 78 patients, the maximum workload sustained for at least 3 min (MSW) was 25 Watts for 43 (48.5%), 50 Watts for 27 (30%), and 75 Watts for 8 (9%) patients. Performance was affected in a statistically significant manner by the subjects' anagraphic age, but not by their dialytic age, hemoglobin (Hb) level or weight. Individual levels of tolerable workload were estimated for 60% of the group from the stability of physiological variables during 3 min, and from subjective ratings at a "moderate" level. This level corresponded to an average of 3.5+/-0.9 METs, at 60% of the HRmax, with a mean BP of 167+/-21/98+/-14 mmHg. This could become a safe starting point for a program of physical retraining.

[Ergonomic evaluation of the physical tasks in "precision fusion" operations]. / Valutazione ergonomica dell'impegno fisico in operazioni di "fusioni di precisione".

In the present paper we performed an "on-site" ergonomic analysis of the work tasks in in-plant industrial workers. Specific work cycles have been identified and analysed. We measured spatial and temporal parameters of the different actions performed by the workers, and we then defined the related risk levels according to the internationally accepted guide-lines. The results obtained indicate the need of an ergonomic intervention with the aim of providing structural changes in the work station.

[An ergonomic study of postures of toll collectors]. / Indagine ergonomica nelle postazioni di "esattori pedaggio".

The working activities of operators in the workstations along the italian motor ways involve repetitive movements of upper limbs and neck with asymmetric postures of the trunk. The tasks examined are characterized by factors potentially dangerous for developing musculo-skeletal disorders, such as repetitivity, and prolonged constrained postures. It is therefore crucial that dimensional and structural characteristics of the workplace are adequately designed, with regard to the anthropometric parameters and the type of activity performed. The results of our "on-site" investigation, using an observational method (OCRA), dedicated computerized modules for postural analysis (software "Vision 3000", Promatek, Ltd.), and recordings of myoelectrical activity (surface EMG) in the muscles of the shoulder girdle, have shown the need of a partial re-designing of the man-workstation system under investigation.

[Functional state and indications for a rehabilitation program of patients in a dialysis center: a multidisciplinary study with ergonomic, physiatrical and psychological evaluation]. / Stato funzionale e indicazioni per un programma di riabilitazione nei pazienti di un centro dialisi: uno studio multidisciplinare con valutazione ergonomica, fisiatrica e psicologica.

The following study describes the functional status of the entire chronic hemodialysis ambulatory population in treatment at our center. The patients were evaluated from 3 points of view: ergonomic, phyiatric and psychological, thus going a snapshot picture in time of their status. Based on these three evaluations, the need for rehabilitation intervention was determined and rehabilitation treatment program was elaborated. The ergonomic evaluation determined the maximal sustained workload (MSW) from O2 consumption, minute ventilation, heart rate, subjective perception of fatigue and dyspnea. The phyiatric examination included a thorough musculoskeletal examination, application of a functional ability instruments (Karnofsky + FIM) and then integrated the results with the ergonomic + psychologic testing in order to generate phyiatric prescription. The psychologist had a conversation with all patients and applied 2 instruments for evaluation of health-related quality of life (CBA-H + SIP). The results of these studies indicated a markedly compromised aerobic capacity, which worsened with age in years rather than with years in dialysis. Phyiatric prescription were considered necessary in 78% of the patients with major goals being re-conditioning and joint mobilization in order to diminish the fragility of independence in this population. The psychological arm of the study revealed good adaptation to chronic dialysis in 75% of the population, with however absorption of a passive lifestyle. The remaining 25% of the population showed severe psychological distress and social withdrawal. Psychological support for this population is necessary to identify families at risk for stress and poor adaptability as well as to help motivate patients who require rehabilitation to participate in therapy.

[Processes of speech production: Application in a group of subjects chronically exposed to organic solvents (II)]. / Studio dei Processi di Produzione della Parola: Applicazione in un Gruppo di Soggetti Esposti Cronicamente a Solventi Organici (Parte II).

The aim of this study was to evaluate the effects of chronic exposition to neurotoxic solvents in a group of laundry operators by means of Vocal Reaction Times (VRTs) measurements. A group of normal subjects, matched for age and educational level, constituted the controls. Vocal Reaction Times were measured by a device that presented to each subject a sequence of words on a computer screen, acquired the acoustic signal and measured VRTs and durations. During the test a random sequence of words was presented to the subjects; the protocol consisted of two immediate reading task and two delayed reading tasks. The test was performed using concrete and meaningless words. Statistical analysis showed that reaction times measured on the acoustic signals were longer for the exposed group than for the controls. The differences between durations were significant for the delayed reading tasks using concrete words and for all tasks using meaningless words. These findings suggest that this technique may be considered a useful tool for the assessment of the preclinical alterations of CNS in the monitoring of individuals chronically exposed to neurotoxic solvents.

A field methodology for ergonomic analysis in occupational manual materials handling.

A methodology is presented for the 'on-site' evaluation of work-related physical activities. In a first session, video recordings were made of six industrial plant workers during their routine occupational tasks. Heart rate (HR) and subjective perception of effort were monitored. The video recordings were then analysed with appropriate software to determine the musculo-skeletal load ('Vision 3000', Promatek, Montreal) and to evaluate energy expenditure ('Energy', University of Michigan). The indirect estimates of energy expenditure were validated in a second session by monitoring the six subjects' oxygen consumption (VO2) during the same activities with a portable telemetric oxygen uptake analyser (Cosmed 'K2', Rome). No statistically significant differences were found between direct measurements of VO2 and the computerised estimates of energy expenditure. Biomechanical parameters obtained in the two sessions did not differ. Therefore, we conclude that the 'Energy' programme and the 'Vision 3000' program provide a fast and reliable profile of job requirements.

[Indicators of dynamic work tolerability in healthy subjects]. / Indicatori di tollerabilità al lavoro dinamico in soggetti sani.

This paper reports a study on the dynamics of tolerability in performing dynamic cycling in healthy subjects. Data on individually tolerable levels (power x duration) was obtained from 9 subjects by means of three submaximal tests on an ergometric bicycle lasting < or = 40 minutes, with constant load (50%, 65% and 80% of maximum VO2 reached during a previous test of increasing difficulty within the limits of the symptoms). During performance of the test we monitored heart rate and subjective perception of fatigue (Borg's 10-point scale). We then defined the individual functions of "isoperception", which expressed the individual trend of the product "power x duration" at identical subjective perception score. On the basis of the metabolic parameters monitored, the individual isoperceptive functions at a "moderate" level of fatigue (3 on the Borg scale) were defined as "tolerability) threshold" for prolonged dynamic cycling. The product "power x duration" defined by the isoperceptive curves at a "moderate" level of fatigue does in fact reflect the individual aerobic capacity that can be sustained for prolonged dynamic activity (under 60 minutes). In order to validate the hypothesis of tolerability of the functions identified, three further short tests were performed (duration < or = 8.5 minutes) on an ergometric bicycle, with measurement of ventilatory and metabolic parameters.

[An anamnestic-observational estimation of the postural-energy-motor commitment of occupational activities via a questionnaire]. / Stima anamnestico-osservazionale dell'impegno posturale-energetico-motorio di attività occupazionali mediante questionario.

A simple questionnaire for the quali-quantitative clinical assessment of the physical requirements in habitual occupational activities has been fixed. The assessment goes through the classification of qualitative, dimensional, temporal parameters referred by the patient as characteristic of the occupational activity. As a result the risk factors related to postures and movements are highlighted, and an esteem of the energy expenditure is obtained from a predictive equation which has been formulated on the basis of some important references. The energy expenditure of three homogeneous occupational phases was estimated through the equation, and then measured during a simulation of the same activities performed in a laboratory by 7 subjects. The estimated and the measured values were compared also with the esteems obtained from validated predictive equations (Garg et al, 1978). The predictivity of our equation was measured. As an on-site assessment, detailed written reports of 18 occupational phases were submitted to 6 differently trained observers and were analyzed through the questionnaire; the variability inter-observer was studied.