Temporal trends in ischemic and hemorrhagic strokes in Northern Italy: results from the cardiovascular monitoring unit in Northern Italy population-based register, 1998-2004.

BACKGROUND: We compared rates and case fatality from a population-based stroke register in Northern Italy between 1998 and 2004 to assess changes over time and to evaluate changes in case diagnosis and management. METHODS: The WHO Multinational Monitoring of Trends and Determinants in Cardiovascular Disease criteria were used to identify suspected fatal or nonfatal events occurring among residents 35-74 years of age. Data on in-hospital treatments, symptoms and diagnostic tools were extracted. Out-of-hospital deaths were also investigated. The annual average relative change (ARC) in death rate, attack rate and case fatality were derived from Poisson models. RESULTS: Death rates due to ischemic stroke (IS) decreased [men: ARC -12.7, 95% confidence interval (CI) -21.3 to -3.2; women: ARC -14.0, 95% CI -23.3 to -3.5]. These reductions are attributable to decreases in case fatality; attack rates of nonfatal IS increased (men: ARC 3.6, 95% CI 0.5-6.7; women: ARC 4.1, 95% CI 0.0-8.2). IS patients showed a higher prevalence of dyslipidemia and hypertension and underwent MRI more frequently in 2004. Both findings may explain the increased proportions of less severe cases. Case fatality and attack rates for hemorrhagic strokes (HS) were stable, with an observed increased prevalence of patients under anticoagulant/antiplatelet treatments. CONCLUSIONS: In this low-IS-incidence population, death rates decreased substantially during the investigated period. More accurate diagnostic tools increase the probability of detecting less severe cases. HS remains a frequently fatal disease with a stable incidence.

The hand pronation phenomenon: a franco-german tale.

The hand pronation phenomenon due to a pyramidal tract lesion is a sign commonly used for identifying a mild paresis, but the first descriptions of this maneuver seem to have been only partially investigated by the historians of neuroscience. Here we illustrate that this sign was most probably originally described by Adolf Strümpell (1853-1925) in 1901 and subsequently re-proposed by the illustrious French neurologist Joseph Babinski (1857-1932) in 1907, although with a slightly different focus of application. Finally, the Pronationsphaenomen was analyzed in detail in the subsequent work of Nikolaus Gierlich (1865-1944), a less-known German neurologist who tried one of the first detailed reports of the phylogenetic significance of this sign, publishing a paper in 1925. These works are reported here, detailing the existing discrepancies, along with notes on the relevant surrounding historical context. In particular, the undervalued contribution of Gierlich to the history of neuroscience and to the phylogenetic approach to semeiotics is analyzed in more detail and acknowledged.

The disease of the moon: the linguistic and pathological evolution of the English term "lunatic".

The public opinion and the scientific community incorrectly believe that the English term "lunatic" was originally related only to insanity, but it also referred to epileptic people. The aim of this article is to clarify the original meaning of the English word "lunatic" by analyzing the evolution of the relationship between psychiatric and neurological diseases and by pointing out the influence of the moon in the history of medicine, in popular traditions, and in English literature. The article also contains a detailed and accurate review of the modern scientific literature on the relationship between moon and epilepsy/psychiatric disorders.

[EMG and forces during manoeuvring of ceiling-based and floor-based patient transfer devices]. / EMG e forze applicate durante l'utilizzo dei sollevatori per pazienti di tipo carrellato e a soffitto.

A laboratory and on-the-field study was conducted to compare Floor-Based (FB) and Ceiling-Based (CB) patients transfer devices. Pushing and pulling forces were measured by means of computer assisted dynamometer. EMG signals were measured. Standardized patient transfers were setup in the room (bed-chair-door-return). FB devices showed pushing and pulling forces higher than CB ones. CB paths were the smoothest and EMG data related to upper arms and trunk muscles showed stable lower loads for CB. The study suggests that CB patient transfer devices reduced the load. CBs seem the best tools for patient handling.

[Well-being in call centres: a multidisciplinary approach to research and evaluation]. / Il benessere nei call center: un approccio multidisciplinare di ricerca e valutazione.

BACKGROUND: The topics of stress and well-being in call centres are the focus of many different disciplines. This article presents the definition and start-up phases of the "Well-being in Telecom Italia Call Centres" project, which was coordinated and supervised by an interdisciplinary scientific committee composed of members from different universities. To address the topic of individual well-being in the organizational context means considering all the main factors that can affect wellbeing. OBJECTIVES: For this reason, the study assessed the topic from three different view-points (psychological/sociological/cultural, physical/chemical/biological, organizational/technological/work-related) in order to obtain an accurate as possible picture of the complex well-being dynamics. METHODS: The study plan shows that merging qualitative methods (interviews, observations, focus-groups) and quantitative methods (questionnaires, physiological response to perceived stress) was a central concern for the research team. RESULTS: The collected data highlighted important differences between psychological and physical well-being and discomfort according to the different kinds of call centre, the respondents'gender and working hours. CONCLUSIONS: This method enabled us to define the specific features of call centre environments, leading to a definition of work in the centres as an activity with high psychological uncertainty, where rigid rules coexist with demands of high levels of flexibility and competence, and suggesting the importance of specific organizational measures in order to improve well-being.

[Ageing and work: technical standards]. / Invecchiamento e lavoro: la normativa tecnica.

Over the last few years, studies on the relationship between ageing and work have attracted growing interest due to the increased probability among workers of developing major health problems as a consequence of ageing of the working population. Negative outcomes for health are possible when an age-related imbalance appears between physical workload and physical work capacity. Interventions based on workload reductions should help to keep workers on the job for as long as allowed by law. Reference masses by age and sex are suggested by the technical standards of the ISO 11228 series, which are also quoted by Italian law D.Lgs. 81/2008, and EN 1005 series, which recommend limits valid also for manual material handling, and pushing and pulling. Decreasing low back pain prevalence or recurrence, in an ageing population with high prevalence of back disorders, could be more effective than many other approaches to enhance workers' quality of life and consequently maintain and improve workers' performance.

[The healthiness of the air: historical analysis of the studies on the relationship between health and air pollution in living and working places]. / La "salubrità" dell'aria: analisi storica degli studi della correlazione tra salute ed inquinamento dell'aria negli ambienti di vita e di lavoro.

The relationship between air pollution and health had already been postulated by ancient authors. In the Eighteenth century, Bernardino Ramazzini, the founder of the Occupational Medicine, reported in its works relevant considerations against air pollution and its damages. During the Enlightenment, the studies on the eudiometry conducted by the physic Marsilio Landriani can be considered a first attempt to connect the measurement of air quality to medical issues. In the following centuries, Industrial Revolution and the diffusion of domestic heating were a determining factor in worsening the air quality. Despite specific legislations on smoke abatement, some air pollution "disasters" occurred during the last century. In conclusion, this historical analysis showed the complex evolution of the knowledge on the relationship between health and air pollution. Nowadays, an important contribution to the current scientific and political debate on this issue has been provided also by the Occupational and Environmental Medicine.

[Results of Regional Project 'Work related Stress' 2004-2006]. / Risultati del Progetto Regionale "Stress ed Attività Lavorativa" 2004-2006.

The present epidemiological study aimed to investigate prevalence and trends of stress-job-related uneasiness and symptoms on a representative sample of Lombardia's working population. Data on occupational events (absenteeism and accidents at work), psychosomatic symptoms and smoke habit have been collected. Prevalence and trends of stress-job-related uneasiness are similar to those reported by the European Foundation in the Report for Sectorial Profiles (2002). The study confirms higher levels of absenteeism in corporations with high prevalence of women and in low socioeconomic level works.

Time trends of myocardial infarction 28-day case-fatality in the 1990s: is there a contribution from different changes among socioeconomic classes?

BACKGROUND/OBJECTIVE: Almost two-thirds of the coronary death rate decrease in the northern Italian Brianza MONICA male population, between 1993-4 and 1997-8, are attributable to a reduction in 28-day myocardial infarction (MI) case-fatality. The present paper investigates the factors associated with MI case-fatality decrease and in particular the role of socio-occupational classes (SOCs). METHODS: Standardised information on acute coronary care and intervention before and during the hospitalisation was collected for all coronary events (n = 1817) registered in 1993-4 and in 1997-8 among 35-64-year-old male residents in Brianza. Deaths within 28 days after MI were carefully investigated. Five SOCs were defined adopting the Erikson-Goldthorpe-Portocarero method. Differences in 28-day MI case-fatality and in acute phase intervention and treatment over time and among SOCs in each period were assessed. RESULTS: 28-day MI case-fatality reduction (27.2%) can be mainly attributed to a decreased proportion of MI events that were fatal before reaching the hospital. In the lower SOCs significant changes in MI case-fatality were detected between 1993-4 and 1997-8. Differences in acute phase intervention and treatment between the periods were observed. SOC differences both in prevalence of out-of-hospital cardiac arrest and in the pre-hospital qualified intervention score were detected in the first period only. CONCLUSIONS: In the study population MI case-fatality reduction can be mainly attributed to a more effective and prompt management before hospitalisation and to an improvement in acute treatment during hospitalisation. This enhancement is made available to the whole population overtaking social differences.

Biological consequences of stress: conflicting findings on the association between job strain and blood pressure.

The primary objective is to verify the relation between job strain and clinic blood pressure in a working population from the Milan municipality (1,909 men, 3,786 women) enrolled from 1992 to 1996. Job strain was investigated through the Karasek model. Clinic blood pressure was evaluated using standard procedures from the MONICA project. The association between the two was calculated controlling for age, education, smoking, body mass index, total and high-density lipoprotein (HDL) cholesterol. Significantly, associations were found for systolic blood pressure in men and for both systolic and diastolic blood pressure in women. However, these results do not reflect biological plausibility. The relationship between job strain and blood pressure is an unfinished business: sample characteristics and measurement methods should be carefully considered.

Laparoscopic versus open incisional hernia repair: an open randomized controlled study.

BACKGROUND: Incisional hernia is a common complication of abdominal surgery, and it is often a source of morbidity and high costs for health care. This is a case-control study to compare laparoscopic versus anterior-open incisional hernia repair. METHODS: 170 patients with incisional hernia were enrolled in this study between September 2001 and December 2004. Of these, 85 underwent anterior-open repair (open group: OG), and 85 underwent laparoscopic repair (laparoscopic group: LG). The clinical outcome was determined by a median follow-up of 24.0 months for LG and OG. RESULTS: No difference was noticed between the two groups in age, American Society of Anesthesiologists (ASA) score, body mass index (BMI), and incisional hernia diameter. Mean operative time was 61.0 min for LG patients and 150.9 min for OG patients (p < .05). Mean hospitalization was 2.7 days for LG patients and 9.9 days for OG patients (p < .05). Mean return to work was 13 days (range, 6-15 days) in LG patients and 25 days (range, 16-30 days) in OG patients. Complications occurred in 16.4 % of LG patients and 29.4 % of OG patients, with a relapse rate of 2.3% in LG and 1.1% in OG patients. CONCLUSIONS: Short-term results indicate that laparoscopic incisional hernia repair is associated with a shorter operative time and hospitalization, a faster return to work, and a lower incidence of wound infections and major complications compared to the anterior-open procedure. Further studies and longer follow-up are required to confirm these findings.

[The adoption of electrical beds in hospital clinic units: evaluation of the impact on workers' low back pathologies]. / La adozione del letto elettrico nei reparti di degenza ospedaliera: valutazione dell'impatto preventivo sulle patologie del rachide degli operatori sanitari.

With the aim of reducing the number of occupational accidents and of judgements of limited work ability among the nurses having as work task the movement of not self-sufficient patients, the Legnano Hospital has defined a project of substitution of the traditional hospital beds with electrical beds. We describe the project of substitution of the beds and the positive results both on the health status of the workers using electrical beds and on the reduction of the falls occurred to the patients.

[The posturological department as clinical support for occupational medicine: clinical cases and results of a hospital unit]. / L'ambulatorio di posturologia come supporto specialistico per la medicina del lavoro--casistica e risultati della pratica clinica di una struttura ospedaliera.

The posturologic visit is a not widely known medical method for the evaluation and the therapy of low back pain. We describe the clinical and instrumental method followed in our posturological clinical unit organized jointly by hospital and university and the clinical cases evaluated in two years. An individual diagnostic evaluation and a personal therapy allowed an almost generalized complete remission of the symptoms and a very low number of reactivation of low back pain after a follow up of one years.

[An integrated prevention intervention for the management of SSUEm118 operator with hearing loss]. / Un intervento di prevenzione integrata per la gestione di un operatore SSUEm118 con disturbi uditivi.

Noise risk is moderate in hospital but there are some areas, as SSUEm118, where the background noise is not negligible. In this context it is important not to underestimate hearing loss even minimal, because the noise interference can cause errors of understanding, as the case in exam: an operator 118. The clinical assessment of this worker with liminar tonal audiometry and vocal audiometry revealed a mild unilateral mixed hearing loss with good voice response. The equivalent sound pressure level (Leq) throughout the SSUEm118 area is under the first attention level, the index NR is comparable to office type environments and the distance between speaker and listener for satisfactory face-to-face communication is suitable. The present study proposes a multi-multidisciplinary approach to define prevention and protection measures and health surveillance plan with audiometric testing and possible judgment of the unfitness to specific work. For this specific case advices given to SSUEm118 administrator allowed a good repositioning of the worker.

[Low back pain, movement impairement syndromes classification]. / Mal di schiena, classificazione secondo le sindromi da disfunzione del movimento.

According to literature up to 85 percent of low back pain (LBP) cannot match a precise pathoanatomical diagnosis, particularly when the association between symptoms and imaging is weak. Effective diagnostic strategy is mainly needed by occupational and rehabilitation medicine. The present study is based on the hypothesis that cumulative effect of repetitive movements and sustained postures, particularly when the movement deviates from the optimal kinesiologic standard, can lead to tissue damage. Therefore this cross-sectional study answers to lack of standardization for LBP diagnosis by means of the classification proposed from Sahrmann within the Movement Impairment Syndromes (MSI) concept. The classification defines 5 categories of LBP: flexion, extension, rotation, extension-rotation and flexion-rotation. The present study results on 84 health workers with LBP match previous published data on the prevalence of MSI categories: 54.8% extension-rotation, 13% flexion-rotation, 11.9% rotation, 3.5% and 16.6% unclassified. MSI could also contribute to better understand LBP severity and the following restricted duty evaluation. Further studies to increase the sample size and to set up randomized clinical trials are needed.

Occupational stress: risk assessment and fitness for work.

The multidimensional and multifaceted aspects of the problem render the role and activity of the Occupational Health Physician (OHP) extremely complex and delicate, as both appraisal and implications cover a number of different domains (psychology, physiology, sociology, economy, work organisation and law), both in terms of risk assessment and stress evaluation, at collective and individual level. In this context, it is not only important to quantify the "external" work load, but mainly the individual "response", which in most cases is the crucial factor of the imbalance. that is, risk assessment has to be made more in "relative" terms rather than according to "absolute" criteria, and not only from the perspective of medical surveillance, but above all from that of risk prevention. When a health disability potentially connected to stress has to be assessed, there are three steps: a) stress exposure must be clearly assessed, both directly and indirectly; b) disease must be clearly identified; c) the biological plausibility of the relationship between stress and disease must be carefully checked, taking into account that stress disorders are typically psychosomatic and multi-causal. Consequently, cooperation with a psychologist and an accurate psycho-diagnostic approach are necessary, as well as consultation with other specialists and pertinent laboratory and instrumental tests.

[Epidemiology of cardiovascular disease among those of working age]. / Epidemiologia delle malattie cardiovascolari in età da lavoro.

BACKGROUND: Cardiovascular mortality from the second half of 1970's has progressively decreased in Italy, in particular in the northern regions, in relation to the reduction of coronary mortality and cerebral-vascular incidents. OBJECTIVES: To concentrate mainly on Italian epidemiological studies that have explored the status of cardiovascular diseases among working adults. METHODS: A review of epidemiological studies carried out in Italy on these topics was made. RESULTS AND CONCLUSION: The marked reduction in coronary mortality rates observed in the last twenty years does not correspond to a concomitant reduction in the incidence of the disease. Therefore, the prevalence of chronic coronary heart disease, in particular in the less severe forms, is increasing in Italy. The demand for the assessment of residual working capacity for these patients is therefore increasing as well. Differences also exist in the socio-occupational gradient in coronary heart disease, reinforcing the need for cooperation between occupational physicians and cardiologists aimed at cardiovascular prevention and health promotion in work settings. In this perspective work stress should be considered as a relevant factor. The good reliability of the Karasek's questionnaire, as well as the association between job stress and blood pressure observed in work- and population-based Italian samples, indicates that this method of evaluating job stress may be used in health monitoring programmes in work settings.

Emergency system prospective performance evaluation for cardiac arrest in Lombardia, an Italian region.

BACKGROUND: The aim of this research is to evaluate quality of out-of-hospital medical services in our country, using performance indicators and a new computerised database. METHODS: (a) EXPERIMENTAL DESIGN: Data were collected prospectively in three emergency dispatch centres for 90 days. Follow-up was evaluated at 1 day and 1 month after the event. This paper presents data on the cardiac arrest cohort only. (b) SETTING: Three emergency dispatch centres in Lombardia. (c) PATIENTS: One hundred and seventy-eight patients in non-traumatic cardiac arrest were enrolled. (d) INTERVENTIONS: None. The study was observational only. RESULTS: Mean interval between phone call and arrival on scene was 8.5+/-3.5 min. BLS manoeuvres were carried out from bystanders only in 15% of the cohort; this was associated with significant mortality reduction (85.7 versus 95.8%, chi(2) P<0.05). One hundred and thirty-three patients (75%) received assistance from BLS crews while only 45 patients (25%) were assisted by ALS medical personel, with a significant mortality reduction (ALS deaths 86.7%, BLS deaths 97%). Total 24 h survival was 9% and survival at 1 month declined to 6.17%. CONCLUSIONS: Quality monitoring produces objective information on interventions and outcomes. Only with this information, is it possible to implement improvement programmes that are planned according to the data presented.

Trends of smoking habits in northern Italy (1986-1990). The WHO MONICA Project in Area Brianza, Italy. MONICA Area Brianza Research Group.

The trends of age-gender specific prevalence of self-reported smoking habits are presented, observed in two population surveys, performed in 1986-87 and 1989-90 in Area Biranza, a northern Italian industrialized district where a WHO MONICA Centre is located. Methods were internationally standardized to obtain comparable data on two independent random samples, each composed of 1,600 subjects, age-sex stratified and extracted from the 25-64 year old residents. A closed question interview was administered to identify smoking condition (smoker, past-smoker, occasional smoker, never smoker), number of cigarettes consumed per day and attained educational level, categorized in compulsory school and post-compulsory school. Serum thiocyanate was measured as a validation index, using a cutpoint of > 100 mumol l-1 to detect false negatives. Trends in smoking prevalence are analyzed taking into account influences of education in the presence of an anti-smoking policy that was started in Italy toward the end of the eighties. Self-reported data, confirmed by serum thiocyanate, show a consistent decline of smokers among males (from 48 to 41%), more evident in younger age groups. In females, smoking prevalence is stable (23-24%), although thiocyanate levels in the whole samples indicate a slight but significant tendency to decrease. Education demonstrates positive influences against smoking, particularly in younger male classes. In females a crossover effect is observable: in the second survey youngest group, education results protective against smoking; the contrary is true in the older groups. Our data, detailing what was initially recognized in previous Italian surveys, may be useful to specify the directions of future preventive actions.

[Evaluation of the socioeconomic status in epidemiological surveys: hypotheses of research in the Brianza area MONICA project]. / La valutazione dello stato socio-economico nelle indagini epidemiologiche: ipotesi di studio nell'ambito del progetto MONICA--"area Brianza".

Socio-economic status (SES) has been reported as a causative factor of increasing health inequalities in industrialized countries. The phenomenon has been particularly investigated for job related diseases, including cardiovascular disease and risk. The group of occupational medicine specialists in the world wide MONItoring program of CARdiovascular disease (WHO-MONICA Project) is now producing a number of hypotheses about the application of internationally defined criteria and tools for SES evaluation in the Italian area of the Project, Area Brianza. After a short review of some main conceptual and methodological problems, a proposal is presented of an SES index, derived from the pooled data of two population surveys carried out in this area. From a randomized sample of 3200 residents, 25-64 years old, stratified by sex and age decade, 1731 subjects, 594 females and 1137 males, employed at the time of the screening were extracted. Four variables were considered: age, education, occupational level and job-strain (according to the Karasek-Theorell model) by which each subject was classified in three levels--high, medium, low--of education and occupation, whose combination was used to obtain as many levels of socio-economic status. This a method of building an SES index is based on a sequence of approximations following two essential criteria: limitation of the variables to be surveyed, through standardized procedures; ability to identify the "low" SES category, presumably more at risk for disease.