Work-Related Stress Questionnaire: confirmatory factor analysis for construct validation by the PHRASI study.

OBJECTIVE: The purpose of this study is to validate the 13-item version of the Work-Related Stress Questionnaire (WRSQ) on a representative sample of Italian public health residents. MATERIALS AND METHODS: The WRSQ was administered as part of the Public Health Residents' Anonymous Survey in Italy (PHRASI) from 14 June to 26 July 2022. Collinearity between each questionnaire item was assessed with Kendall's τ statistic. The latent factors identified associating similar items based on the authors' observations were workplace, job demand, support and unpleasant workplace. Goodness-of-fit was assessed with confirmatory factor analysis calculating: Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), Standardized Root-Mean-Residual (SRMR). Cronbach's alpha (α) and Omega McDonald (ω) were calculated to evaluate the reliability of the questionnaire. R 4.2.2 was used to perform the analyses. RESULTS: 379 Public Health residents (58% women) responded to the questionnaire. No significant collinearity was found between the items (τ range -0.31 to 0.49). Confirmatory Factor Analysis showed CFI = 0.975, TLI = 0.967, RMSEA = 0.041 and SRMR = 0.051. Internal consistency of the WRSQ Total Score was α = 0.80 and ω = 0.85. CONCLUSIONS: Although validated in a sectorial subpopulation of healthcare workers, the WRSQ proved to be an excellent tool for assessing work-related stress. Unpleasant workplace latent factors showed lower factor loading and internal consistency than others. This could be due to the fact that topics investigated with unpleasant workplace items (e.g., abuse and discrimination) are experienced on a less regular basis than the ones assessed through the other items.

Extra-auditory effects of noise exposure in school workers and preventive measures: a systematic review.

OBJECTIVE: Noise is still today one of the main causes of occupational diseases; in fact, in Italy in the three-year period 2019-2022, hearing loss represented 15% of all occupational diseases recognized by the National Institute for Insurance against Accidents at Work. The extra-auditory effects related to noise exposure also require particular attention, because they can interfere with mental activities that require concentration, memory and ability to deal with complex problems, causing sleep and learning disorders. For this reason, acoustic comfort is considered a fundamental requirement for obtaining an optimal degree of well-being in closed environments. In schools, a high degree of noise pollution not only makes it difficult for students to listen and learn, but also affects school workers. The aim of this study was to perform a systematic review of international literature and analysis of the preventive measures of extra-auditory effects among school workers. MATERIALS AND METHODS: The presentation of this systematic review is in accordance with the PRISMA statement. The methodological quality of the selected studies was assessed with specific rating tools (INSA, Newcastle Ottawa Scale, JADAD, JBI scale and AMSTAR). Only publications in English were selected. No restrictions were applied for the publication type. We excluded articles not concerned with the extra-auditory effects of noise exposure in school workers and preventive measures, findings of less academic significance, editorial articles, individual contributions, and purely descriptive studies published in scientific conferences. RESULTS: Online research indicated 4,363 references: PubMed (2,319), Scopus (1,615) and Cochrane Library (429) have been consulted; 30 studies were included in this review (5 narrative or systematic reviews and 25 original articles). Regarding the scores of narrative reviews, the INSA score showed an average and a median value of 6.5, thus indicating an intermediate/high quality of the studies. Regarding the scores of systematic reviews, the AMSTAR score showed an average of 6.7 and a median and a modal value of 6, thus indicating a high quality of the studies. The scores assigned to the original articles have an average and median value of 7 and a modal value of 6 and this demonstrates an intermediate/high quality of the studies. CONCLUSIONS: We can assume that, as it is highlighted by this study, to date these consequences are not considered at the legislative level for the protection of exposed workers. The extra-auditory effects impacting health afterward environmental noise exposure are many and widespread. Therefore, there is a need for interventions to be carried out by institutions and that the physician of the schools, during health surveillance, investigates the effects and clinical manifestations, in order to prevent disorders and deficits highlighted by our study.

Workplace violence among healthcare workers, a multicenter study in Italy.

OBJECTIVES: The purpose of this study is to assess the prevalence and determinants of workplace violence and the sociodemographic risk factors associated. STUDY DESIGN: This was a multicenter cross-sectional study. METHODS: The study was performed using self-compiled Italian version of the World Health Organization's questionnaire on workplace violence online by filling in a Google form. The survey was opened from May 2018 to March 2020 and lasted 5-10 min. RESULTS: The sample consists of 3659 healthcare workers, of which 2525 (69%) are females, 1446 (39.5%) are nurses, and 2029 (55.5%) are health workers from northern Italy. The most frequent age group of the sample is 50-54 years (16.7%). A total of 366 (10%) healthcare workers are victims of physical aggression at work in the last 12 months, of which 6.3% with a weapon. The risk of being a victim of physical aggression at work in the last 12 months is significantly associated with the following independent variables: male gender (odds ratio [OR] 1.72, 95% confidence interval [CI]: 1.36-2.17), work in southern Italy (OR 1.59, 95% CI: 1.10-2.28), and being a nurse (OR 2.56, 95% CI: 2.01-3.25). The risk of being a victim of physical aggression at work with a weapon in the last 12 months is significantly associated with work in southern Italy (OR 9.33, 95% CI: 3.83-22.73). A total of 1723 (47.1%) of healthcare workers declare to be a victim of verbal aggression at work in the last 12 months. The risk of being a victim of verbal aggression at work in the last 12 months is significantly associated with the following independent variables: work in northern Italy (adjusted OR [aOR] 1.54, 95% CI: 1.32-1.81), work in southern Italy (aOR 3.68, 95% CI: 2.90-4.68), and be more than 55 years old (aOR 0.73, 95% CI: 0.63-0.85). CONCLUSIONS: The study underlines that the problem of verbal and physical aggression against healthcare workers is still central and is a further starting point for research. The prevalence of violence is difficult to assess because violent incidents are underreported or unreported. The results of the study suggest that increased awareness is needed to develop effective control strategies at the individual, hospital, and national levels to prevent aggression and improve the conditions of victims.

Pharmacists' mental health during the SARS-CoV-2 pandemic in Italy.

OBJECTIVE: The year 2020 was characterized by the outbreak of a new pandemic caused by a novel coronavirus named SARS-CoV-2. To face the pandemic, many countries worldwide imposed general lockdowns, closing all non-essential businesses. As primary care services, pharmacies had to remain open, thus putting pharmacy staff at significant risk of viral infection and overwork. This study aimed to assess the mental health of Italian Pharmacists, considering demographic and occupational characteristics, lifestyle, and habits, during the SARS-CoV-2 outbreak and the subsequent lockdown period (March-May 2020). MATERIALS AND METHODS: A web-based survey was created using Google® Forms to collect data from March 30, 2020, to June 1, 2020. The questionnaire consisted of three sections investigating: (1) demographic and occupational variables, (2) lifestyle and habits variables, (3) psychological distress and perceived well-being. RESULTS: A total of 401 participants completed the questionnaire. Older workers and those with more work experience reported more psychological stress. Older and female workers, who felt lonely at home and reported psychological stress, perceived poor well-being. CONCLUSIONS: Our findings demonstrate that the Sars-CoV-2 outbreak and subsequent lockdown rules affected pharmacists' mental health and that it is important to put in place preventive measures against the occurrence of mental disorders among them.

Telework and its effects on mental health during the COVID-19 lockdown.

OBJECTIVE: During the Covid-19 pandemic, many governments promoted the adoption and development of telework to reduce some of the consequences of the current health crisis on the economy and favor social distancing. The aim of this web-based cross-sectional study was to assess the consequences of the Covid-19 pandemic on job organization, exploring the effects of lockdown measures on the psychological distress and perceived well-being of workers experiencing telework. SUBJECTS AND METHODS: A web-based cross-sectional survey has been used to collect data. The participants answered the questionnaire from April 1 to April 30, 2020. The questionnaire consisted of three sections, which investigated: 1) demographic and occupational variables, 2) lifestyle and habits variables, 3) psychological distress and perceived well-being. The General Health Questionnaire (GHQ-12) has been used to evaluate psychological distress and the 5-item World Health Organization Well-Being Index (WHO-5) to explore subjective well-being. RESULTS: Psychological distress was associated with educational level, with habits, and with reporting poor well-being. Poor well-being was associated with a higher job demand during pandemic, lifestyle and habits variables, and psychological distress. CONCLUSIONS: This is one of the first studies exploring the consequences of the COVID-19 pandemic and lockdown measures on the perceived well-being and psychological distress of workers experiencing telework. It is mandatory to pay more and more attention to the mental health of teleworkers, considering the increasing diffusion and adoption of this type of work organization.

The impact of COVID-19 on doctors' well-being: results of a web survey during the lockdown in Italy.

OBJECTIVE: On March 12, 2020, the World Health Organization (WHO) declared the outbreak of a new Coronavirus disease (COVID-19), to be a pandemic. From the beginning, Italy (in particular the Northern regions) was the first large European country to be hit and one of the most affected countries worldwide. This had a significant impact on the workload and psychological health of health workers. The aim of this web-based cross-sectional study is to assess the consequences of the COVID-19 pandemic on Italian doctors' well-being and psychological distress, in respect of demographic and occupational characteristics, lifestyle and habits during the lockdown period. PATIENTS AND METHODS: We conducted a web-based cross-sectional survey based on Google® Forms to collect data. The participation was available during the lockdown period that started in Italy on March 9, 2020 and it was voluntary and anonymous. The questionnaire explored demographic and occupational variables, lifestyle and habits during the lockdown, perceived well-being and psychological distress. Multivariate logistic regression models were fitted. RESULTS: Our study reported the very alarming psychological conditions of Italian doctors, especially among those who worked in the most affected regions, where a level of psychological distress of 93.8% and poor well-being of 58.9% were registered. These percentages were even higher in the case of female hospital workers with low job seniority, and those caring for COVID-19 patients. CONCLUSIONS: Our findings reported a significant psychosocial impact of the COVID-19 outbreak on Italian doctors, particularly among those working in the most affected regions of the country. Further studies are necessary to better understand the effects of the COVID-19 pandemic on doctors' well-being and mental health over time, in order to implement effective prevention measures.

Work-Related Stress Questionnaire (WRSQ): a new tool to assess psychosocial risks at workplaces.

INTRODUCTION: Work-related stress (WRS) can harm both physical and mental health but it shouldn't only be considered in its negative sense. The evaluation of WRS cannot be separated from the analysis of the subjective perception of workers, usually made by questionnaires. The aim of this pre-pilot study is to identify a new questionnaire capable of exploring as many psychosocial risk domains as possible and with a high internal consistency. MATERIAL AND METHODS: A first version of the questionnaire was administered to a convenience sample selected on a voluntary basis; both socio-demographic and work-related data were collected. A single item test was conducted on a group of 50 workers in order to assess whether the questions were confusing and to understand if they could be improved. The study sample completed the questionnaire at time 1 and time 2 (after 3 days). The 33-item version of the questionnaire was web-based in Google Form. Cronbach's alpha and Pearson's r were calculated. RESULTS: The analysis of the 33-item questionnaire at time 1 shows an excellent reliability with Cronbach's alpha coefficients of 0.93. At time 2 Cronbach's alpha coefficients was 0.94. Based on the test-retest score, the items with the highest scores were selected as part of the final version of the questionnaire (10-item). The reliability of this 10-items version is high with a Cronbach's alpha coefficients of 0.86 both at time 1 and at time 2. Two items have been chosen to explore the "emotional demand" and "dealing with technology". CONCLUSIONS: The pre-pilot study provided a questionnaire with high reliability and high repeatability. In its final version, the questionnaire investigates different psychosocial risk domains and represents a possible useful tool for assessing worker's exposure to them. The Authors reserve to administer the questionnaire to a larger population.

Work-related stress risk and preventive measures of mental disorders in the medical environment: an umbrella review.

OBJECTIVE: Work-related stress (WRS) is widespread among medical doctors. WRS not only affects the physician's mental and physical well-being, but also patient care quality and the overall efficiency of the healthcare system. The aim of this study is to conduct a systematic review of the current preventive measures against mental disorders, work-related stress, and burnout among physicians. MATERIALS AND METHODS: The presentation of this systematic review is in accordance with the PRISMA statement. The methodological quality of the selected studies was assessed with specific rating tools: INSA, Newcastle Ottawa Scale, JADAD scale, and AMSTAR. English publications only were selected. No restrictions applied for publication type. Reviewers excluded articles not concerning the following topics: WRS prevention, WRS risk factors and mental disorders among physicians. Reviewers also excluded findings of less academic significance, editorial articles, individual contributions, purely descriptive studies published in scientific conferences. RESULTS: Online search returned 4748 references on the following databases: PubMed (1638), Scopus (3108) and Cochrane Library (2). 36 studies were included in this review (thereof, 13 reviews and 23 original articles). Narrative reviews were rated on the INSA scale. The mean, median, and modal rating was 6. This indicates an intermediate-high quality of these studies. Systematic reviews were rated on the AMSTAR scale. The mean and median rating was 9, and the modal rating was 8. This indicates a high quality of these studies. The scores assigned to the original articles have a mean, median, and modal rating of 7. This also indicates an intermediate-high quality of these studies. CONCLUSIONS: Work-related stress and mental disorders seem to be widespread among medical practitioners. It is already a priority to adopt preventive measures against these phenomena. However, there is still no consensus on what the most effective measures are. Additional research is needed to formulate evidence-based recommendations.

Bullying at work and work-related stress in healthcare workers: a cross sectional study.

BACKGROUND: Bullying is a serious and growing problem affecting a significant proportion of healthcare professionals, a professional category exposed to work-related stress. Workplace bullying has been defined as a set of negative behaviours consisting in harassment, offense or negative influence on work that are directed to the members of the organization and that occur regularly and repeatedly over a period, becoming part of the context of work. STUDY DESIGN: We performed a cross-sectional study using the HSE questionnaire and defining the sample size considering the number of healthcare workers of a big hospital and then calculating it with EpiInfo™ software. 191 people have been enrolled. METHODS: The study was divided into three steps. The first one to identify, among the workers, those who were exposed to bullying at work and those who were not. The second one has been aimed at assessing the presence of work-related stress through the administration of the HSE questionnaire. The third step has been aimed at performing the statistical analysis of the data. For each single domain explored by the questionnaire the score obtained was treated as a linear variable and the median and interquartile range (IQR) was calculated. After, a non-parametric analysis (Wilcoxon rank-sum test) was performed in order to define the statistical significance of the observed differences. RESULTS: All the 191 questionnaires were self-administered by the Health Care Workers under study and correctly filled in without any multiple or missing responses. Considering the scores obtained to question n. 21, that investigates "bullying at work", we obtained two groups: High-Exposure Group (total, males and females), and Low-Exposure Group (total, males and females). In the High-Exposure Group, two critical domains were found: Demands and Control (total, male and female samples). The differences with the Low-Exposure Group were statistically significant. In the Low-Exposure Group the critical domain was Manager Support (total and female samples). The differences with the High Exposure Group were not statistically significant. CONCLUSION: This study aimed to show how the exposure to bullying can influence the perception of psychosocial risks. It seems that the workers most exposed to bullying also have worse scores on the HSE questionnaire, particularly for two domains: Demands and Control. That is consistent with the most recent scientific literature.

Ocular hypertension management in long-term treatments with intravitreal dexamethasone implants: a 3-year experience.

PURPOSE: A commonly recognized complication of intravitreal steroids is ocular hypertension (OHT).The aim of this study was to investigate the effectiveness of pharmacotherapy in controlling this side effect, even in patients receiving sequential injections. METHODS: A total of 146 injections were performed on 78 patients over 3 years. 78 eyes were treated with 1 injection, 44 eyes were treated with 2 injections; 24 eyes were treated with 3 injections. The intravitreal corticosteroid used in this observational study is 0.7mg dexamethasone, commercially known as 0.7mg Ozurdex®. RESULTS: Following the first injection, mean intraocular pressure (IOP) increased by 1,90 mmHg. Following the second injection, mean IOP increased by 0.23 mmHg. Following the third injection, there was no statistically significant change. Patients with IOP >= 21mmHg (7% of all participants) were started on topical pressure-lowering medications. CONCLUSIONS: Intravitreal dexamethasone implants increased IOP of variable degrees in different patients. However, secondary OHT was effectively controlled with pharmacotherapy alone. This allowed for continuation of dexamethasone therapy.

Work-related stress and cortisol levels: is there an association? Results of an observational study.

OBJECTIVE: Chronic exposure to work-related stress (WRS) stimulates the hypothalamic-pituitary-adrenal (HPA) axis to increase glucocorticoid secretion, including cortisol, and these hormones can be measured both in serum and urine. The Health Safety Executive Toolkit (HSE) questionnaire is used to assess WRS risk objectively. The scope of our study is to investigate whether serum or urinary cortisol levels could be used as alternative objective indicators of WRS, specifically in those subjects who are chronically exposed to it. PATIENTS AND METHODS: 130 patients (75 males and 55 females, mean age 47.7 ± 11.3 years) were evaluated at a specialized Centre for Secondary Hypertension, where both their serum (8 AM) and 24-hours urinary cortisol were measured and they were asked to complete two questionnaires: one questionnaire to collect data about their socio-demographic and job characteristics, and the HSE questionnaire to evaluate WRS. RESULTS: Multiple linear regression analysis showed an association of urinary cortisol with several variables: tobacco smoke (ß = 69.6; p = 0.003); female gender (ß = -37.3; p = 0.041); exposure to physical risks (ß = 51.8; p = 0.032); control score (ß = -22.7; p = 0.039); role score (ß= 39.3; p = 0.020). Age was the only variable associated with serum cortisol levels (ß = -3.6; p = 0.042). CONCLUSIONS: Urinary cortisol levels, but not serum levels, are associated with variables linked to WRS (score control and role) and to socio-demographic variables, namely gender and tobacco smoke. Thus, urinary cortisol can be considered a useful and non-invasive biological indicator to quantify WRS.

Ionizing radiation and stress: the analysis of the medical ray technician.

BACKGROUND: The present study aims to analyzing the relation between the work-related distress with the exposition to ionizing radiations in the radiology technicians, in the hospital environment. MATERIALS AND METHODS: Our present study has been conducted on a group of 36 sanitary technicians (14 women and 22 man, with an average age of 48±10,1 years) working in the Hospital Radiology Pavilion; 28 of them were less-exposed to radio-active emissions (B Category) and 8 were more exposed to radio-active emissions (A Category). The HSE questionnaire has been administered to all the 36 sanitary technicians. The data analysis and statistical elaboration were conducted using the HSE Tools. After that, the non-parametric Mann-Whitney test was applied to the comparison of the medians of two independent samples. RESULTS: The HSE tools questionnaire's analysis (made on the whole population) made evident some criticalities in the domains of the managerial support and of the professionals' relationships: in the B Category group (less- exposed to radio-emissions) further criticalities emerged, in the domain of peer-support and in the change domain. The HSE questionnaire analysis, made adopting the Mann-Whitney non-parametric statistical test, significant statistical differences emerged from 2 questions of the 35 sub-administered questions, regarding the mostly radio-exposed workers. CONCLUSIONS: From the research analysis, the authors deducted the small relevance of the emerged criticalities for the two groups of workers; the researchers also believe that, given the (almost complete) homogeneity of the results emerging from the statistical analysis (done with the Mann Whitney test), the perception of the of the work-related distress risk is irrelevant to the dose of ionizing radio-exposition.

Working over 5,000 m: medical check-up.

Any work activity performed at elevations over 3,000 m above sea level is considered as work at high altitude. The changing environmental conditions result in an adaptation of the human organism, mainly due to a reduced partial pressure of oxygen in the air and a proportional decrease in barometric pressure. We carried out a systematic review of the scientific literature in this field so as to develop a health and risk protocol as well as a procedure of ascent for researchers and staff expected to work in a science research lab at an altitude of 5,100 m asl. We wish to highlight the crucial role that occupational medicine plays in the formulation of a medical protocol used to assess the suitability of staff to work in environments posing high risks to human health, as in this case, and of a protocol of ascent minimizing the risk associated with changes in altitude.

Risk of jugular compression blocks in workers exposed to prolonged upright posture.

BACKGROUND: The working posture affects the peripheral venous circulation, although the current literature does not report any correlation between working posture and the abnormalities of the jugular veins flow. The purpose of this preliminary research is to study, in female workers, the prevalence of Venous Compressive Syndrome (VCS) caused by total block of the internal jugular veins flow, so-called "White Compression". Due to complete compression by postural, muscular, fascial, anatomical or bone anomalies, White Compression is not visible by EchoColorDoppler (ECD) and its flow can only be detected by the rotational movements of the head or by Valsalva's maneuver. METHODS: We studied a sample of female workers with ECD (n=128), in supine and upright position divided into subgroups according to the obliged posture maintained during working hours: group A, seated work (n = 61; 47.7%); group B, standing work (n = 41; 32.0%); group C, mixed (both standing and seated work) (n = 26; 20.3%). The total sample (n = 128) had the mean age of 46 ± 10 years (minimum 18 and maximum 67 years) and mean Body Mass Index (BMI) of 23 ± 4 kg/m2 (min 16 kg/m2 and a maximum of 42 kg/m2). RESULTS: Group A and group C did not show any White Compression in orthostatic and clinostatic position. The 9.75% (p = 0.0125) of Group B had a White Compression in orthostatic position: two female workers on the left side (4.9%) and two female workers on the right side (4.9%). CONCLUSIONS: We conclude that there is a risk of jugular compression blocks in female workers exposed to prolonged upright posture. Yet there is no longitudinal study that identifies the White Compressions as etiology of a chronic neurodegenerative disease. The authors hope that some wider studies can confirm the prevalence of these compressions in standing posture and their patho-physiological consequences.

Italy and Argentina compared: an epidemiological study of occupational diseases.

BACKGROUND: The research presented in this paper analyses the clinic-pathological manifestations and work-related health risks identified among outpatients treated in the hospitals of Rome and Buenos Aires. MATERIALS AND METHODS: The occupational anamnestic data were collected between 2013 and 2014 through questionnaires with specific items aimed at detecting occupational diseases classified by target organ systems in outpatient clinics of cardiology, dermatology, physical medicine, ophthalmology, orthopedics, endocrinology (thyroid and gonads). An inferential statistical analysis was then carried out to evaluate the relationship between nationality, exposure to occupational risks and the prevalence and incidence of the selected pathologies. An univariate statistical analysis was performed for this purpose and, in the case of statistically significant results, a subsequent multivariate analysis was used to evaluate the incidence of occupational risk factors and nationality on the pathology diagnosed in conjunction with other confounding factors such as smoking habits and gender. The total sample consisted of 1090 subjects of both sexes. Risks were grouped into seven categories and diseases into 12 diagnostic groups. We analyzed the correlation between risks and diseases with respect to hospital outpatients and to the total sample then comparing Argentina and Italy's data. RESULTS: Analysis of data revealed a higher prevalence of hypertension and dysmetabolic disorders for DSE (Display Screen Equipment) workers both in Italy and Argentina; however, multivariate analysis showed that smoking represents a confounding factor for this association. A higher prevalence of allergic contact dermatitis (ACD) was found in the population samples of Rome and there appeared to be a correlation between eye disorders/defects and Argentine data source. CONCLUSIONS: Our study suggests the usefulness of collecting occupational anamnestic data from outpatient departments to highlight possible associations between occupational risks, lifestyles and pathologies, so as to implement the appropriate prevention strategies.

Job stress: an in-depth investigation based on the HSE questionnaire and a multistep approach in order to identify the most appropriate corrective actions.

BACKGROUND: Psychosocial hazards and work-related stress have reached epidemic proportions in Europe. The Italia law introduced in 2008 the obligation for Italian companies to assess work related stress risk in order to protect their workers' safety and health. The purpose of our study was to propose an accurate measurement tool, using the HSE indicator tool, for more appropriate and significant work-related stress' prevention measures. METHODS: The study was conducted on 204 visual display unit (VDU) operators: 106 male and 98 female. All subjects were administered the HSE questionnaire. The sample was studied through a 4 step process, using HSE analysis tool and a statistical analysis, based on the odds ratio calculation. RESULTS: The assessment model used demonstrated the presence of work related stress in VDU operators and additional "critical" aspects which had failed to emerge by the classical use of HSE analysis tool. DISCUSSION: The approach we propose allows to obtain a complete picture of the perception of work-related stress and can point out the most appropriate corrective actions.

Fast glycorrhachia and cerebrospinal fluid protein as predictors of sensory block in anesthesia with subarachnoid Ropivacaine.

BACKGROUND: Identify if glycorrhachia and cerebrospinal fluid protein could influence the time of sensory block to T10, the duration and the metameric block's level, after a standard dose of Ropivacaine. METHODS: 80 patients, ASA I - III undergoing to transurethral prostate resection with spinal anesthesia in a prospected open study were recruited. A 0.2 ml liquor's sample was taken; glycorrhachia, by glycemic stix and CSF protein, by urinary stix, were got, before Ropivacaine 0.5% 15 mg injection (0.10 - 0.15 mlsec). After anti-trendelemburg, with 30 ° tilting for 15 min, the onset of sensory block to T10, the maximum metameric level to 15' and the time of sensory block were reported. The data collection were analyzed using the software language R. RESULTS: A significant correlation liquor specific weigh preoperative glycemia (0.749), liquoral specific weigh glycorrhachia (rho = 0.751; R2 = 0.564; P 0.05) and specific weigh CSF protein (rho = 0.684; R2 = 0.468; P 0.05) were reported. Inverse relation CSF weightsensory block level (rho -0.789, P 0.05, R2 0.621) was evidenced. Inverse relation onset time to T10 glycorrhachia (84%) and cephalic block glycorrhachia (76%) were found. Inverse correlation onset time to T 10 CSF protein and cephalic block proteinorrachia was respectively 84% and 67%. A rho of 0.712 with R2 of 51% BMI onset to T10 and rho of 0.681 with R2 of 51% BMI maximum cephalic block with P 0.05 were reported. CONCLUSIONS: The predictability of a iso-hypobaric local anesthetic could reduce the risk of procedure failure and adverse events by further cephalic spread.

Early diagnosis of hearing loss: otoacoustic emissions evoked by distortion products and pure-tone audiometry: Preliminary findings.

OBJECTIVE: Literary studies underline the effectiveness of distortion product otoacoustic emissions (DPOAEs), which are not affected by the collaboration of the subject examined, in the early diagnosis of hearing loss. Aim of the study is to compare the objective technique of DPOAEs with respect to the pure-tone audiometry in early diagnosis of hearing loss. MATERIALS AND METHODS: The clinical research was carried out on 852 workers. All subjects underwent pure-tone audiometry, tympanometry and distortion products. RESULTS: The results show: a) a prevalence of subjects with impaired DPOAEs higher than the prevalence of subjects with impaired audiometries in the studied samples; and, after division by gender: b) a prevalence of subjects with impaired DPOAEs higher than the prevalence of subjects with impaired audiometries only in men; c) a prevalence of impaired DPOAEs and of impaired audiometries in men higher than in women. CONCLUSIONS: The results suggest the higher effectiveness of DPOAEs compared to pure-tone audiometry in making an early diagnosis of hearing loss.

Correlation between urinary nickel and testosterone plasma values in workers occupationally exposed to urban stressors.

BACKGROUND: The purpose of this study is to assess whether occupational exposure to low doses of nickel (Ni) present in urban air can cause alterations in the concentration of plasma testosterone in workers of the Municipal Police of a large Italian city assigned to different types of outdoor tasks. METHODS: 359 male subjects were included in the study and divided on the basis of job, age, length of service and smoking habits. The dosage of the atmospheric Ni was performed by personal dosimetries on a sample of the workers included in the study. For each worker included in the study the dosage of whole blood Ni and of the plasma testosterone was carried out. The total sample was subjected to the independent-samples T-test and the Mann-Whitney U test for variables with 2 modes (smoking cigarette) and the ANOVA test and the Kruskal Wallis test for variables with more than 2 modes (age, length of service and job function). The correlation of Pearson with p at 2 wings between the variables was evaluated in the total sample and after subdivision on the basis of smoking and on the basis of the job. After taking into account the major confounding factors the multiple linear regression was performed on the total sample and after breakdown by tasks. RESULTS: The correlation between the values of urinary Ni and the values of plasma testosterone on the total sample and for all classes of subdivision was found constantly negative. These results were confirmed by multiple linear regression, which indicated the Ni as the only significant variable that can contribute to the alterations of the testosterone. CONCLUSIONS: Based on the results, the Authors suggest that occupational exposure to low doses of Ni present in the urban environment is able to influence some lines of the hypothalamic-pituitary-gonadal axis in exposed workers.

[Urban individual exposure to cadmium and baroreceptor response to posture]. / Esposizione ad inquinanti urbani e riflessi barocettivi posturali.

OBJECTIVE: Outdoor workers are daily exposed to urban pollutants. The aim of the study is to evaluate the relationship between the values of environmental monitoring collected by personal dosimetries and changes in blood pressure due to posture in outdoor workers. MATERIALS AND METHODS: 32 subjects of both sexes were enrolled in the study, we evaluated the values of environmental monitoring of breathable dust, nickel, arsenic, cadmium, lead, benzene, toluene, xylene and 16 PAHs. Blood pressure in supine and standing positions was measured in all subjects. RESULTS: The multiple linear regression analysis showed a significant reduction of orthostatic response of diastolic blood pressure in non-smoking outdoor workers occupationally exposed to cadmium. CONCLUSIONS: The results of our study let us to believe that exposure to low doses of urban polluted cadmium may affect the response of diastolic blood pressure to orthostatism, as per a paraphysiological condition of sympathetic down-regulation.