[Work capacity and re-entry into the workforce for the cardiac patient]. / Idoneità lavorativa e reinserimento al lavoro del cardiopatico.

BACKGROUND: Treatment and rehabilitation of patients with heart disease is focused on survival, work resumption, achievement of a state of subjective well-being and compliance with behavioural changes in order to prevent progression of the atherosclerotic process. OBJECTIVES: To propose a specific job fitness evaluation method for workers with heart disease, based on analysis of occupational factors influencing the cardiovascular system and the definition of a clinical and functional profile of the patient, with special regard to aspects influencing vocational attitude. METHODS: A literature review was performed. RESULTS AND CONCLUSION: Although resumption of work is not the sole objective in the rehabilitation process, it remains an important goal not only for economic reasons, but also because it is beneficial for most patients' psychological well-being. However, it must be admitted that specific job fitness evaluation is rarely performed during rehabilitation programmes of cardiac patients and this can cause problems at the time of return to work. Doubts and uncertainties are also due to the lack of standardized evaluation methods and to the clinical peculiarity of these patients, mainly due to the risk of sudden disability. The job fitness evaluation method used in this study allows physicians to perform assessments based on objective data, so improving patients' confidence in their work capacity. To achieve a satisfactory application of the method, close cooperation between the cardiologist and the occupational physician is necessary.

Exercise training in mild hypertension: effects on blood pressure, left ventricular mass and coagulation factor VII and fibrinogen.

The aim of this study was to assess the effects of aerobic exercise on resting and 24-hour blood pressure (BP), left ventricular mass (LVM), plasma fibrinogen and factor VII (FVII). For this purpose 14 sedentary subjects with untreated diastolic BP between 90 and 104 mm Hg completed a 12-week supervised exercise program. At the end of this period, 8 subjects resumed a sedentary life-style and were reexamined 2 months later (detraining). Baseline, posttraining and postdetraining examinations included resting BP assessment, ambulatory BP monitoring, cardiopulmonary stress test, echocardiography and measurements of plasma fibrinogen and FVII. Exercise-mediated increase in aerobic fitness (VO2 max + 24%) was associated with a significant reduction in resting systolic and diastolic BP (p < 0.01), mean systolic and diastolic 24-hour BP (p < 0.001) and LVM index. As for the coagulation parameters only the concentration of fibrinogen significantly decreased (p < 0.01) whereas FVII remained unchanged. The 8 subjects that resumed a sedentary life-style were reexamined 2 months later: their resting BP, 24-hour BP and fibrinogen concentration returned to baseline values; only the effect on LVM was conserved. Our study underlines the usefulness and safety of regular physical exercise in mild hypertension. Most of the patients (11 of 14) had their BP normalized and a significant reduction in LVM and fibrinogen concentration was observed, leading to an overall improvement in coronary risk profile.

[Physical training exercise reduces the plasma levels of fibrinogen in subjects with mild hypertension]. / L'esercizio fisico allenante riduce i livelli plasmatici di fibrinogeno in soggetti con ipertensione lieve.

We evaluated the behaviour of plasma fibrinogen in subjects undergoing physical training in a prospective non-controlled open study, carried out in 14 sedentary, mildly hypertensive individuals (mean age 52 +/- 5 years). Subjects underwent 3 months of controlled physical training (3 times a week) tailored to reach, at each session, 80-90% of maximal heart rate based upon a baseline test. Before and after the period of training, resting systolic and diastolic blood pressure, 24-hour systolic and diastolic blood pressure, plasma fibrinogen, body mass index (BMI), maximum oxygen consumption (VO2max), serum cholesterol and triglycerides were evaluated. After training VO2 max increased (24 +/- 5 vs 30 +/- 5 mL/Kg/min, p < 0.01); there were no variations in BMI (24 +/- 2 vs 23 +/- 2 Kg/m2, p = 0.35), cholesterol (220 +/- 30 vs 213 +/- 36 mg/dL, p = 0.41) or triglycerides (117 +/- 51 vs 118 +/- 37 mg/dL, p = 0.58). Resting systolic (148 +/- 10 vs 133 +/- 10 mmHg, p < 0.01) and diastolic blood pressure (97 +/- 5 vs 85 +/- 6 mmHg, p < 0.01) and 24-hour systolic (135 +/- 6 vs 129 +/- 5 mmHg, p < 0.01) and diastolic blood pressure (86 +/- 7 vs 81 +/- 6 mmHg, p < 0.01) decreased; plasma fibrinogen also decreased (324 +/- 60 vs 278 +/- 53 mg/dL, p < 0.01). Eight individuals tested 5 months after cessation of training, showed a return of fibrinogen, blood pressure and VO2 max to baseline values.(ABSTRACT TRUNCATED AT 250 WORDS)

[Health surveillance and prevention in the service industries: the problems and outlook]. / Sorveglianza sanitaria e prevenzione nel terziario: problematiche e prospettive.

The great expansion of the services industry in the developed countries of the world is producing profound changes in the composition of the work force and, consequently, also in the health needs that are traditionally part of occupational medicine. Of all the medical disciplines, occupational medicine is most strongly affected by social and economic changes. In recent years experience has been acquired both at national and international level that can identify the new health needs in practical terms. The aim of this paper is to describe such experience with particular reference to the situation in Italy. The authors describe the shift of prevalent diseases from occupational to work-related diseases, the problems concerning the human, social and economic cost of these diseases, prevention and control strategies, relationships between company health services and the national health service and possible synergic action of the public and private sectors.

[New problems in occupational medicine: findings on the risk of coronary heart disease in the services industry]. / Nuovi problemi in medicina del lavoro: indagine del rischio di coronaropatia nel terziario.

The distribution of the major coronary risk factors: total and HDL cholesterol, blood pressure, smoking and body mass index, was studied during the course of a routine screening of 1404 male bank employees in Northern Italy. The recent Italian and international consensus conferences and particularly the results from the Italian areas of the WHO-MONICA Project were taken as reference points. There was a widespread coronary risk in the bank employees who had a 5-10% excess of cholesterol, corresponding to a 10-20% increase in the theoretical risk of coronary heart disease. Compared to the data produced by the Lipid Research Clinics (USA), coronary risk appeared higher for all the surveyed factors in the Italian general population, and particularly in bank employees. Greater stress at home and at work and above all the change from the traditional, poor Mediterranean diet to a richer diet might provide an explanation for these results. A new perspective is thus opened for occupational health due to the new health problems produced by the cultural and technological changes occurring in the country.

Can glycosylated hemoglobin be a job stress parameter?

Glycosylated hemoglobin (HbA1c) levels are evaluated as a possible integrated measure parameter of chronic job stress. HbA1c and fasting blood glucose levels in 100 healthy male printing workers (pressmen) exposed to noise, rotating shifts, and overwork were compared with levels measured in 200 healthy male clerical workers not exposed to those stressors. While blood glucose levels and their variability were found to be approximately the same in both groups, HbA1c levels were found to be 8.64% higher among the pressmen and this difference was significant at p less than .001. These findings support the hypothesis, and further research to confirm the test is suggested.