[Analysis of a case series of workers with mobbing syndrome]. / Analisi di una casistica di lavoratori con patologia da mobbing.

Mobbing represents nowadays a major challenge for Occupational Medicine. We examined, during the last seven years, 253 patients who asked medical assistance for psychopathological problems by them ascribed to mobbing in the working environment. All patients underwent occupational health visit, psychological counselling (including personality tests administration), and psychiatric evaluation. A clinical picture probably due to mobbing was diagnosed in 37 workers: 2 cases of Post-Traumatic Stress Disorder (PTSD), 33 of Adjustment Disorder (AD), and 2 of anxiety disorder. Regarding mobbing typology, we found 19 cases of vertical mobbing (by an employer/manager to employees), 14 cases of strategic mobbing, 3 cases of horizontal mobbing (among colleagues), and one non intentional mobbing. In conclusion, a pure mobbing syndrome was diagnosed in a lower proportion than that reported by other investigators. The described interdisciplinary approach appears useful for the diagnostic assessment of suspect mobbing cases, that in turn is crucial for prognosis and treatment, as well as in relation to medico-legal issues and work-related compensation claims.

[Occupational risks among public safety and security forces]. / Rischi professionali nelle Forze dell'Ordine.

The present paper tries to identify the occupational risk factors (physical, chemical, biological, psychological), variable depending on jobs and tasks, to which the heterogeneous public safety/security workers are exposed. The fight against criminality and public order maintenance imply (sometimes fatal) traumatic risks, and expose to psychophysical and sensorial tiring, unfavourable macro- and microclimatic conditions, the risk of baropathy (air navigation, underwater activities), noise (generated by firearms and several other sources), vibrations and shakings (automatic weapons, transport vehicles), the risk of electric injury, ionizing (X and gamma rays) and non-inonizing (ultraviolet rays, microwaves and radiofrequencies, electromagnetic fields) radiations. Chemical hazards include carbon monoxide and other combustion products (fires, urban traffic), substances released in chemical accidents, tear gases, lead (firing grounds, metal works, environmental pollution), solvents, lubrificants and cutting oils (mechanic repair and maintenance), laboratory materials and reagents, irritant and/or sensitizing agents contained in gloves. The main biological risks are tetanus, blood-borne diseases (viral hepatitis, AIDS), aerogenous diseases (e.g., tuberculosis, Legionnaire's disease, epidemic cerebrospinal meningitis), dog- or horse-transmitted zoonosis. Finally, emotional, psychosomatic and behavioural stress-related disorders (e.g., burn-out syndrome, post-traumatic stress disorder) are typically frequent. The presence of numerous and diversified hazards among public safety/security forces imposes the adoption of occupational medicine measures, including risk assessment, health education, technical and environmental prevention, personal protective devices, sanitary surveillance and biological monitoring, clinical interventions (diagnosis, therapy and rehabilitation of occupational accidents and illnesses), prompt medico-legal evaluation of occupational-related compensation claims.

[Ergonomy and videoterminals]. / Ergonomia e videoterminali.

After defining some concepts relative to ergonomy and videoterminals (VDT), the paper describes the main health risks for VDT workers (visual, muscle-skeletal and stress disorders). The ergonomic requirements established by the Italian legislation for VDT work are then examined, including illumination, the working environment, the working desk and seat, the video-screen, the keyboard, the upper body position, pauses and physical exercise, training and information. Recent regulations (in particular the law 422/2000) on the sanitary surveillance of VDT workers are finally reported.

Silicotuberculosis in the elderly: report of two cases.

Silicotuberculosis is observed rarely in the current clinical practice. We present two patients (a 72-year-old man and a 84-year-old woman) who developed silicosis after having worked for several decades in the ceramics industry. In both, pulmonary tuberculosis complicated the clinical picture several years after retirement. The first subject presented a multicavitary lesion in the apex of the right lung, which subsequently evolved with fibrosis. The other developed bilateral tubercular bronchopneumonia and right tubercular pleurisy, that improved after prolonged antimycobacterial polychemotherapy. The two cases confirm that patients with silicosis are at an increased risk of developing tuberculosis, and show that, nowadays, silicotuberculosis may represent a geriatric problem. In the elderly, recognition of tuberculosis associated with silicosis is often difficult. Occupational history, radiology (conventional chest radiography and computed tomography) and microbiology (identification of Mycobacterium tuberculosis in sputum and pleural exudate) are helpful for the correct diagnosis, which, in turn, is important for prognosis and treatment, as well as in relation to medico-legal issues and occupational-related compensation claims.

[Proposal for an outline to be used in the assessment of chemical risk according to the legislative decree 25/20002]. / Proposta di uno schema utilizzabile per la valutazione del rischio chimico ai sensi del decreto legislativo 25/2002.

We present an operative outline for the evaluation of chemical risk in the work environment, according to the legislative decree 25/2002. It includes the following points: identificative data of the company, scope and field of application, description of the working activities, preventive and protective measures, medical report (including biological monitoring), environmental monitoring, conclusive evaluation. The scheme is a quali-quantitative instrument for the employer and his collaborators to establish whether the chemical risk present in the single productive sites can be considered "moderate" or "not moderate".

[Mobbing: analysis of an ambulatory case load]. / Mobbing: analisi di una casistica ambulatoriale.

We present twenty outpatients (11 males; 9 females) who asked medical assistance, during the last two years, for psychopathological problems by them ascribed to "mobbing" in the work environment. Six subjects were employed in public institutions, 14 in private companies. All patients underwent occupational health specialistic visit, psychological counselling (including personality tests administration), and psychiatric evaluation. A psychopathological picture reasonably correlable to "mobbing" was diagnosed in four subjects only (20% of the cases), i.e. in a lower proportion than that reported by other investigators.

[Disability and occupational medicine: definitions, scope, and operative examples]. / Disabilità e medicina del lavoro: definizioni, ambiti, esempi operativi.

2003 is the year of disability. This paper briefly illustrates the multiform relationships between occupational medicine and disability, discussing the complex legislation on this matter. A historiographic account is presented of the image of the disabled individual through the centuries. The main terms regarding disability are defined according to current legislation. Current Italian laws are difficult to interpret and to be put into effect. In this process, the occupational physician may be asked to perform several duties, including diagnosis and certification, fitting the disabled to work, safeguarding his/her moral and legislative rights, prevention and sanitary surveillance. Some professional experiences of the authors (regarding certification of the working capability, medico-legal recognition, and adaptation to work) are finally presented.