[Perception of risk of biological agents among a group of health workers]. / Percezione del Rischio da Agenti Biologici in un gruppo di Operatori Sanitari.

In the context of "direct" or "indirect" patient care, residual risk of biological agents exposure constitute a hazard for health and safety, that cross and affects all health care workers. For the development and implementation of effective "prevention and control" actions, even against nosocomial infections, it is nevertheless most important to acquire objective information on the level of risk perception demonstrated by relevant staff for assistance. The aim of this contribution was therefore to study the attitudes and behaviours of health sector workers in relation to the specific "biological agents risk". The survey was carried out in a italian hospital, and 25 in the study adhered responsible for the safety and 219 nurses, identified as exposed to biological agents (244 subjects), who were given a specially designed questionnaire. The results of the study, which will be described in detail, has helped to identify critical issues related to the management of "biological agents risk", and at the same time to set up a program for improvement of prevention and protection, aimed at a substantial reduction of the same risk factor.

[Prevention and control of tuberculosis in the hospital setting: the new operative protocol of the polyclinic "Umberto I"]. / Prevenzione e Controllo della Tubercolosi nelle strutture ospedaliere: il nuovo Protocollo Operativo dell'Azienda Policlinico "Umberto I".

The aim of this contribution is to explain a recent tubercolosis "prevention and control" program in health care workers. The same program was implemented in an university hospital since 2007, and revised in 2011 as a result of a new Mycobacterium tubercolosis exposure assessment in the different works environment.

[Workers with alcohol and drug addiction problems. Consensus Document of the Study Group on Hazardous Workers]. / Lavoratori con problemi di alcol e dipendenze. Documento di Consenso del gruppo La.R.A. (Lavoratori Rischiosi per gli Altri).

BACKGROUND: Italian Law 81/08 (so-called "Unified Text of Laws on Health and Safety at Work"), came into force on 15 May 2008 and incorporates provisions related to medical surveillance of drug and alcohol dependency at the workplace. OBJECTIVES: Occupational health traditionally addresses the issue of protection of worker from occupational hazards. The issue of protection of third parties from behaviour of workers resulting from drug and alcohol dependency implies an original methodological approach, involving full cooperation of employer, employees, and health and safety consultants. METHODS: A consensus development meeting was organized under the leadership of the Italian Study Group on Hazardous Workers (La.R.A. group). The meeting brought together physicians of different specialties, legal experts and bioethicists, labour and management policy-makers, to discuss the issue and define the research data available, the standards that were appropriate, and which policies were fair. RESULTS: The efficacy of medical surveillance, including workplace drug-testing, relies on a comprehensive policy, including written and verbal information on the use of alcohol and drugs on the job, training for supervisors and management, employee education, and employee assistance structures. Sample collection and testing should be carried out in accordance with standardized and tested procedures. Small businesses will need assistance, including development of model policies, setting up consortia for testing services and if necessary request for National Insurance benefits to reduce costs. CONCLUSIONS: The recently introduced Italian legislation on occupational safety and health closely resembles Finnish law since it consists of a "double channel" for workplace drug testing. At recruitment, the employer is entitled to ask a job applicant for a certificate of "Job fitness", including drug tests, that can be issued only by a public health institution, where the job applicant works on a well-defined set of tasks which require accuracy, trustworthiness, independent judgement or a very good reaction capacity. The employer may also refer the employee to the public health institution to obtain a certificate in the course of an employment contract when there is a legitimate suspicion that the employee is working while under the effects of drugs or alcohol or that the employee is a drug addict. After recruitment, the physician responsible for medical surveillance of workers (the so-called "Competent Physician") is entitled to perform drug tests on employees. The need for a test is decided by the health care professional, not by the employer, and only a general report on the health of the employee ("fit", fit with restrictions" or "unfit") may be given to the employer. Workers positive for drug tests will be referred to a public health institution for re-testing and treatment.

[Chemical pollutants "exposure assessment" experiences: mathematical modelling vs environmental monitoring]. / Esperienze di "valutazione dell'esposizione" ad inquinanti chimici: confronto tra modelli matematici e determinazioni ambientali.

This contribution presents the employment of two risk estimation mathematical modelling--InfoRisCh and MoVaRisCH--in the context of an exposure assessment updating for different dangerous products in a petrolchemical facility, and therefore the comparison with occupational safety team and environmental monitoring results.

[Alcohol levels determinations in workers communities: a standardised practice proposal]. / Determinazioni alcolimetriche nelle popolazioni lavorative: quale procedura applicativa?

Italian law 125/2001 implementation requires to Occupational Health Physicians to carry out alcohol levels checks in the workplaces. Firstly, this contribution proposes to specify the methodological differences between breathing alcohol concentration, BrAC, and blood alcohol concentration, BAC, and also to show the different sampling strategies. Therefore, a standardised practice proposal for alcohol levels determinations in workers communities is presented, in the contest of a modern Occupational Health services "integrated quality system".

[Radioprotection optimization measures in hospital workers]. / Ottimizzazione delle misure di "radioprotezione" per i lavoratori delle strutture sanitarie.

In this contribution, a revision of ionizing radiations exposed workers' dosimetric data in four hospital structures is showed, and, consequently, recommended optimization measures are identified.

[Usefulness of spiral CT in the prevention of pulmonary barotrauma: presentation of a case report in a hyperbaric operator]. / Utilità della TC-spirale nella prevenzione del barotrauma polmonare: presentazione di un "case report" in un'operatrice iperbarica.

A medical surveillance integrated system for health care workers, engaged in an hyperbaric environment exposure, was set upped and implemented in an university hospital, in accordance with doctrinal, legislative and methodological issues. In particular, a specific attention on anatomic and functional assessment of the respiratory system was applied, through an advanced technique of spiral-CT imaging, with the aim to carry out an early detection of conditions to be predispose "pulmonary barotrauma". Therefore, the present contribution proposes to illustrate clinical and instrumental data, and also to show chest spiral-CT acquired images results, in a 35-years-old nurse on assignment to an hyperbaric oxygen therapy unit. In this experience the described preventive protocol was operated in the context of a modern rational and justifiable, flexible and balanced health protection path.

[Health surveillance activity and characterization of exposure to low levels of chromium: results of a 10-year follow-up]. / Attività di sorveglianza sanitaria e caratterizzazione dell'esposizione a basse dosi di cromo: risultati di un follow-up a dieci anni.

The 626/94 Decree amendment (see Decree 25/2002) regard a series of mandatory measures towards the exposure estimation both for future prevention activities as well as for the efficacy evaluation of measures that have already been carried out. This publication provides an updating on a study of the ten-year follow-up regarding occupational exposure to Cr (VI) in workers exposed to low levels of cromium.

[Determination of blood alcohol among aviation personnel: proposed operative protocol]. / Determinazione dell'alcolemia nel personale aeronavigante: proposta di protocollo operativo.

The problems of the use/abuse of alcohol need a special attention by the Public Authorities, based on the scientific evidences related to the subject. We would like to define in the present paper the procedures for alcohol testing (and drug testing) in the sailors, following the international aviation authorities (ICAO, JAR-OPS-1, FAA) recommendations. A Working Group was established to study both the scientific and the legal aspects of the problems related to alcohol testing in Italy. Experts from the Università "La Sapienza" and from Alitalia studied the alcohol testing issues abroad to set out criteria, guidelines and procedures for random testing in Italy.

[The efficacy of personal prevention measures in controlling the exposure to metals of welders]. / Efficacia delle misure di prevenzione personale nel contenimento della esposizione a metalli dei saldatori.

Biological monitoring of welders employed in a power plant showed urinary nickel levels largely exceeding the reference values (Ni-U welders mean = 43.2, S.D. = 22.1 micrograms/24 h; Ni-U reference values mean = 2.7, S.D. = 1.4 micrograms/24 h). Subsequently urinary excretion levels of other metals (Cr, Zn, Fe, Mn, Cu, Al, Pb) were measured for a more complete assessment of occupational exposure of these subjects; only aluminum and lead were found to slightly exceed the reference values and correlate with urinary nickel levels. As a consequence of these results, some adjustments in personal prevention measures were introduced at the workplace; the subsequent biological monitoring checks showed a progressive reduction in urinary nickel excretion levels over time in all welders.

[Fanconi's anemia: in vitro tests for the individualization of heterozygotes]. / Anemia di Fanconi: tests in vitro per l'individuazione degli eterozigoti.

Fanconi's anaemia (FA) is an autosomal recessive mutation associated with constitutional chromosome aberrations. Patient's cells show increased susceptibility to different mutagens, especially bifunctional alkylating agents. Asymptomatic heterozygotes have a population prevalence of 1 in 300, and have been considered at risk for cancers. It has also been shown that their cells are especially sensitive to some chemicals in vitro. Laboratory tests are presented and discussed which are adequate for FA heterozygotes identification and for understandings the basic defect of this mutation.