[A simplified occupational health and safety management system designed for small enterprises. Initial validation results]. / Modello semplificato di sistema di gestione della sicurezza sul lavoro per piccole imprese. Primi risultati della sperimentazione.

BACKGROUND: Occupational Health and Safety Management Systems (OHSMS) are known to be effective in improving safety at work. Unfortunately they are often too resource-heavy for small businesses. OBJECTIVES: The aim of this project was to develop and test a simplified model of OHSMS suitable for small enterprises. METHODS: The model consists of 7 procedures and various operating forms and check lists, that guide the enterprise in managing safety at work. The model was tested in 15 volunteer enterprises. RESULTS: In most of the enterprises two audits showed increased awareness and participation of workers; better definition and formalisation of respon sibilities in 8 firms; election of Union Safety Representatives in over one quarter of the enterprises; improvement of safety equipment. The study also helped identify areas where the model could be improved by simplification of unnecessarily complex and redundant procedures.

[Study on prevalence of upper and lower airways disorders in woodworkers, using data from medical surveillance reports and exposure registers]. / Indagine sulla presenza di alterazioni delle vie respiratorie superiori ed inferiori in esposti a polveri di legno, utilizzando i dati della sorveglianza sanitaria e dei registri di esposizione.

OBJECTIVES: To evaluate correlations between exposure to wood dust, upper airways symptoms and lung function. METHODS: We have analysed medical surveillance reports of 197 woodworkers with a median wood dust TWA exposure of 2.1 mg/m3. Every worker was examined by an otorhinolaryngologist and had a spirometric test. The results have been analysed with logistic regression to correlate prevalence of symptoms and spirometric data with occupational exposure to wood dust, length of service, regular use of respiratory protection and smoking habits. RESULTS: Epistaxis (prevalence: 10.1%) correlates with no smoking habits (OR = 6.4; p = 0.01); subacute or chronic rhinitis (prevalence: 41.6%) correlates with exposure to wood dust (O = 1.37; p = 0.01) and no use of respirstory protection (OR = 1.68; p = 0.09); subacute or chronic pharyngitis (prevalence: 17.2%) has a weak but significant correlation with length of service (OR = 1.03; p = 0.05); decrease in FEF25-75 (prevalence: 19.8%) correlates with no use of respiratory protection (OR = 2.56; p = 0.02) and exposure to wood dust (OR = 1.29; p = 0.09); pathologic decrease of VC (prevalence: 5.1%) correlates with exposure to wood dust (OR = 1.69; p = 0.05). CONCLUSIONS: this study seems to confirm that chronic irritation of upper and lower respiratory tract are caused by exposure to wood dust below the european 8 hours exposure legal limit of 5 mg/m3.

[Progress of studies promoted by the MODS collaborative group]. / Fase di avanzamento degli studi promossi dal gruppo collaborativo MODS.

In industrialised countries, carpal tunnel syndrome (CTS) is considered an epidemic work-related disease. We have set up the MODS (Malattie Occupazionali Da Sovraccarico biomeccanico, biomechanical overload-related occupational diseases) collaborative group, formed by epidemiologists, ergonomists and occupational physicians to investigate CTS in Italy, applying the methods that epidemiologists commonly use to understand epidemics. Several studies are already ongoing. Two different descriptive studies based on current hospitalisation data are in the reporting phase. A pilot case-control multicentre study (260 cases and 520 controls in 13 centres) is in the final phase of data collection. A longitudinal study on a cohort of 3000 subjects exposed to different risk factors has reached the third year of follow-up. Moreover, a surveillance system has been set up to cover selected districts of the Emilia Romagna region. These studies will generate new information about the prevalence and incidence of CTS in Italy, along with identification of regional, high-risk job titles and work sectors, and the relative influence of non-occupational factors.

[Arterial hypertension in relation to life style and other cardiovascular risk factors. Epidemiologic study of a population of blood donors. Project AVIS]. / Ipertensione arteriosa in rapporto allo stile di vita e altri fattori di rischio cardiovascolare. Studio epidemiologico in una popolazione di donatori di sangue. Progetto AVIS.

The objectives of this research were to determine the prevalence of essential and borderline hypertension in a population of blood donors and their families and to determine if there is a correlation between blood pressure and lifestyle and/or other cardiovascular risk factors. The study was comprised of 1976 individuals, of whom 1290 were men and 686 were women, aged 18-65 years. The prevalence of essential hypertension was 15.1% for males and 12.5% for females: the prevalence of borderline hypertension was 22.3% for males and 15.7% for females. The population was divided into two groups: the first group included only subjects (1170 men, 543 women) who did not regularly use drugs that could modify the blood pressure and the heart rate, the second group included the entire population. In the first group, the multiple regression analysis indicated, in order of importance: age, BMI (body mass index), and heart rate. These variables were important in determining the systolic blood pressure in both sexes, uricemia for males and glycemia for females. The diastolic blood pressure was dependent on BMI, heart rate, and alcohol in both sexes, and glycemia, LDL cholesterol, and uricemia in the men. In the second group, primary and borderline hypertension are significantly correlated with age, BMI, and uricemia in both sexes and glycemia in females. A program of health and nutritional education could modify some factors related to blood pressure, such as obesity and alcohol consumption. The result would be a reduction of the prevalence not only of essential and borderline hypertension, but also of metabolic diseases such as dyslipidaemias, diabetes and hyperuricemia, with a global reduction of the cardiovascular risk.

[Subtotal colectomy in splenic flexure carcinoma in a patient with transverse colostomy who had undergone gastric resection (Billroth II)]. / Colectomia subtotale per ca. dell'angolo splenico in gastroresecato (Billroth II) portatore di colostomia sul trasverso.

The Authors report a case of subtotal colectomy for splenic flexure adenocarcinoma in a gastro-resected patient bearing a transverse colostomy. They underline the considerable technical difficulties encountered during dissection because of multiple adhesions related to the previous operations (gastrojejunostomy and transverse colostomy). In fact, a gastric resection according to Billroth II and an emergency colostomy for bowel obstruction had been performed 20 years and 30 days respectively prior to the present operation. Nevertheless, reconstructive steps resulted easier and faster with the use of staplers.

Hyperglycemia and prognosis of acute myocardial infarction in patients without diabetes mellitus.

The present study assessed the prognostic value of hyperglycemia--a common feature in the early phase of acute myocardial infarction (AMI)--in 330 nondiabetic patients. Seventy-nine known diabetics and 10 (3%) unknown diabetics--diagnosed before discharge by stable glycosylated hemoglobin greater than 6.9% and by oral glucose tolerance testing--were excluded. Thirty-three (10%) patients died. The mortality rate was higher in women, in patients with anterior AMI, in older patients (greater than 65 years) and in the presence of heart failure. It was highest in patients with cardiogenic shock (24/36 vs 9/294; p less than 0.0001). Admission plasma glucose was significantly higher in nonsurvivors than in survivors (163 +/- 60 vs 114 +/- 36 mg/dl; p less than 0.0001). Mortality rate increased with increasing admission plasma glucose: 3% in normoglycemic patients (less than or equal to 120 mg/dl) versus 15% in patients with borderline plasma glucose (121 to 180 mg/dl) versus 43% in hyperglycemic patients (greater than 180 mg/dl) (p less than 0.0001). Multiple regression (stepwise) analysis identified cardiogenic shock, infarct site and age as the major determinants of mortality, while admission plasma glucose failed to reach full statistical significance (p = 0.067). Hyperglycemia was related to all 3 of these independent prognostic factors; when age and infarct site were accounted for, hyperglycemia was significantly associated with heart failure only and this association was characterized by a remarkable mortality rate. In nondiabetic patients with AMI, hyperglycemia is a correlate of heart failure and, therefore, an important factor of prognosis.