[Educational health programs in the construction industry of the Apulia Region, southern Italy]. / Percorsi formativi in edilizia nel territorio dell'AUSL BA/3, Regione Puglia.

31,000 building firms have been registered in the Apulia Region of Southern Italy, and 13.5% are concentrated in the area of the Local Health Bari/3. Especially small and middle-size firms (90% of total number) are assisted with information programs through dedicated local office. Educational and medical audit advanced programs carried out among occupational health professionals are described. A 'pilot project' for the regional health surveillance program in the construction industry is presented.

Salivary markers of work stress in an emergency team of urban police (1 degree step).

INTRODUCTION: Stress is usually defined as the experience of negative events or the perceptions of distress and negative affect that are associated with the inability to cope with them. The parameter most suitable for large-scale field studies is the determination of endocrine activity by measurement of salivary cortisol. The aim of the present study is to identify the presence of sources of stress in an emergency team of urban police and to objective such stress using the PSS (Professional Stress Scale) test and bioumoral markers as salivary cortisol and interleukin 1 /f (IL-IB). MATERIALS AND METHODS: We studied 30 policemen who belonged to an emergency team. Salivary samples were collected at the start and at the end of the work-shift. As control we used the same subjects during the holiday. T test was performed to evaluate the differences between the means, the Chi Square's Test was performed to determine the statistically significant association between PSS subscales and salivary cortisol and ILl-B concentrations. RESULTS: Thirty policeman were evaluated, their mean age was 44,5 years, their mean work experience was 17,1 years. The PSS test indicated high scores in three subscales, they were work load, organizational structure and processes and lack of resources. SALIVARY CORTISOL: The mean concentration at the start of work-shift was higher than at the end of shift-work (p<0,05). T test indicated a statistically significant difference between mean cortisol concentrations at the same hour during the work (start and end) and during the holiday (P<0,05). A statistically significant negative association was noted between the PERC1 and PSS subscale called "work load" (p<0,05). SALIVARY IL-1B: the mean concentration of ILl-B at the start of the work-shift resulted higher than at the end, such reduction was statistically significant (P<0.05). We verified a positive association between the subclass of PSS Test called "conflict with other professionals" and salivary IL-1B concentration at the start of shift-work (p<0,05). DISCUSSION. Several precedent studies agree with our results. Our study has suggested a work related stress in urban police employed in an emergency team. We might conclude that salivary IL-1B and cortisol are useful markers of stress. We think that our findings, surely preliminary, have be corroborated by the study of vegetative parameters (heart rate, heart rate variability) that is still current. It might be useful to evaluate again the cortisol and IL-1B variations after some structure organizational modifications and after training that will teach the workers coping strategies. We might conclude that the stress discovered in this study is not hazardous for the health, if the workers have adequate holidays.

[Changes in the radiologic and spirometric profile in subjects with pulmonary silicosis]. / Evoluzione del quadro radiologico e spirometrico in soggetti affetti da silicosi polmonare.

All admissions with diagnosis of silicosis from 1980 to 2000, in the Occupational Medicine Division of Fondazione S. Maugeri, Cassano Murge (Bari), were examined. From 586 gathered medical records we selected 106 subjects with double admissions and detected their X-rays of chest, FVC and FEV1. The stationary results of their chest X-rays and the light declines of their respiratory functions confirm the slow evolution in time of this pathology.

[Assessment of heart rate variability (HRV) as a stress index in an emergency team of urban police]. / Valutazione della variabilità della frequenza cardiaca (HRV) come indice di stress in addetti al pronto intervento nella polizia urbana.

Stress is usually defined as the experience of negative events or the perceptions of distress and negative affect that are associated with the inability to cope with them. The parameter most suitable for large-scale field studies is the determination of endocrine activity by measurement of salivary cortisol. The aim of the present study is to identify the presence of sources of stress in an emergency team of urban police and to objective such stress using the PSS (Professional Stress Scale) test and bioumoral markers as salivary cortisol and interleukin 1 beta (IL1-B). Moreover it will be determined the Heart Rate Variability (HRV) that is able to mirror the sympathetic-parasympathetic balance. We studied 30 policemen who belonged to an emergency team. Thirty policemen made cardiologic exams as ECG, Heart Eco-doppler and Holter Ecg during the work and during the holiday. Particularly we studied HRV using frequency-domain based HRV measures. The results were evidenced as the differences of the spectral power. As control we used the same subjects during the holiday. T test was performed to evaluate the differences between the means, the Chi Square's Test was performed to determine the statistically significant association between PSS subscales, HRV, salivary cortisol and IL1-B concentrations. The study of HRV demonstrated a statistically significant association between HRV parameters during the holiday, salivary cortisol concentrations and PSS test. IL1-B, instead, was not associated with HRV parameters. Several precedent studies agree with our results. Our study has suggested a work related stress in urban police employed in an emergency team. We might conclude that salivary IL1-B and cortisol are useful markers of stress. The study of HRV parameters gave evidence that LF/HF during the holiday is a useful marker of work stress, because it correlated with cortisol difference during the work. Conclusively we can believe that the HRV parameters evaluated during the work are useful as confront, instead the HRV parameters during the holiday are surest indexes of work stress. Probably the effect of stress on the heart aren't present during the work because the work experience reduces these effects, they appear during the holiday when the imagination could make the conflicts or the problems more complex than they are. It might be useful to repeat this study after some structure organizational modifications and after training that will teach the workers coping strategies. If we consider only the bioumoral and PSS results, we might conclude that the stress discovered in this study is not hazardous for the health when the workers have adequate holidays, but if we evaluate the HRV parameters, we have believe that, for a heart health, it's necessary either to increment the holidays or, it can appear paradoxical, to work again.

[Occupational asthma and biological damage: adequate compensation?]. / Asma professionale e danno biologico: tutela privilegiata?

The evaluation of the damage to biological and relational capacities of the subject is the novel approach of the Italian Insurance Regulation Decree N(o) 38/2000 for compensating occupational asthma (OA). In this study we aimed to apply retrospectively the novel rating system to mild OA. From a data base of 201 diagnosis of OA collected in the 1987-97 decade 85 eligible consecutive cases of mild asthma according to the criteria of NIH/WHO guidelines on asthma were studied. Records on compensation were documented for 41 subjects. The average difference between novel scales and the actual rating individually assessed by Italian National Agency for compensation through criteria used at that time was 45.6 +/- 20%. The average difference between novel scales and rating calculated with guidelines considering the measurement of non-specific bronchial hyperreactivity developed by international experts and American Thoracic Society, endorsed by American Medical Association, was 41.5 +/- 12%. Within the actual rating individually assessed with previous Italian Insurance criteria no significant relationship (r=-0.20, p=0.2) was shown with bronchial responsiveness to methacoline expressed as provocative dose causing a 20% fall in FEV1 (PD20FEV1 microg of mch). A significant (p<0.05) relationship was observed with age at the time of OA diagnosis (r=0.37, p=0.017) and with duration of exposure (r=0.34, p=0.034). This study suggests that scales of the Insurance Regulation Decree N(o) 38/2000 grading mild OA underevaluate biological damage/impairment with reference both to previous practice in Italy and to international criteria guidelines. Among the parameters of evaluation methacoline challenge should be considered an adequate tool in measuring biological damage in OA for medicolegal purpose.

[Strain-gauge plethysmography in angiopathies caused by vibrant tools]. / Pletismografia strain-gauge nelle angiopatie da strumenti vibranti.

The authors compare the results obtained from the strain gauge plethysmography on 79 patients affected by vibrating machines angiopathology with a group of 20 others non exposed to vibrations. The results, analyzed according to the microcirculation vision, lead the authors to suppose that the damage caused by vibrating instruments is revealed at the capillary bed trophic exchange level.

[The evaluation of the thermal threshold in those exposed to vibrations]. / Valutazione della soglia termica in esposti a vibrazioni.

The results of a study carried out on 90 subjects exposed to vibratory trauma of the hand-arm compared to a non-risk control group of 54 subjects are reported. All subjects underwent a medical and neurological examination and Doppler ultrasound of the upper limbs, plethysmography of the hands, electromyography of the bilateral median nerve area and T.T.T. (Thermal Threshold Tester) evaluation of the thermal threshold, were performed. Workers exposed to risks show a higher threshold for hot/cold sensitivity compared to those not exposed. This increase is earlier compared to the onset of vascular and neurophysiological changes detected by plethysmography, Doppler ultrasound and electromyography. Thermal threshold evaluation by T.T.T. would seem to be a useful test for monitoring workers exposed to vibrations.

[Pneumoconiosis in bauxite miners]. / Pneumoconiosi in minatori di bauxite.

The authors examined a group of 40 miners who were being working at an Apulian bauxite mine, presently inactive. Radiographic findings of pulmonary micronodulation without significant reduction of lung functions were showed in 15 miners. Mineralogical analysis of mine dust samples excluded any presence of more than 1% free silica. As a result of this study hypotheses have been formulated about pathogenesis of this moderated and non-invasive pneumoconiosis, showed in long exposed subjects to low silica content dusts.

[3 cases of poisoning caused by wine contaminated with lead]. / Su tre casi di intossicazione da vino contaminato da piombo.

Three cases of lead poisoning of non occupational origin as result of drinking contaminated homemade wine are described. The source of lead most likely was the ceramic inner surface of the container used for wine fermentation and/or the cement used for filling up slots between ceramic tiles. The lead content of wine was found to be 40 mg/l whereas maximum allowed level in Italy is 0.3 mg/l. Treatment with calcium versenate given intravenously solved gastroenteric symptoms. Further investigations were reassessed six months after the acute episode showing both blood and urine parameters still below the normal range for adults occupationally not exposed to lead. Awareness of family physicians in early recognition of these episodes is recommended. Furthermore such hazard should be considered when choice of materials for containers delegated to wine fermentation is made, since home wine making is a widespread practice in our country.