[The Occupational Doctor working in private services appointed by the employer for medical surveillance (Law Decree 81/08, article 39 paragraph 2 letter a): professional, organisational, juridical and forensic implications]. / Il Medico Competente operativo nell'ambito di strutture convenzionate con il Datore di Lavoro (D.Lgs. 81/08, art. 39 comma 2 lettera a): implicazioni professionali, organizzative, giuridiche e medico legali.

The Italian Health and Safety Law (D.Lgs. vo 81/08) allows the Employer to commit to a private H&S Service the execution of the medical surveillance, being the Occupational Doctor ("Medico Competente") an Employee or Collaborator of the Service itself rather than a "freelancer" Professional. The implications of such a choice are discussed, taking in account the point of view of the Employer, the Occupational Doctor and the Control Authority.

[Good practice for medical surveillance by occupational physicians]. / La buona pratica nella sorveglianza sanitaria del medico competente.

Society--employers, workers, trade unions, public--demands the highest standards of professional competence and ethical conduct from occupational physicians. However, defining what exactly constitutes good medical practice and acceptable standards of professional competence and conduct is not so easily done. Good practice in occupational medicine should be aimed not only at improving the effectiveness of preventive action in the strict sense, but also at constantly adopting rigorous methodologies based on evidence and procedures breaking loose from rigid formats, which must be as uniform as possible throughout the country. It's essential, therefore, to develop consensus documents on workers' health surveillance, meeting with approval of occupational health physicians both operating in a free market context or within the framework of public sector health service.

Identification of hidden allergens: detection of pistachio traces in mortadella.

An analytical method based on the detection of specific DNA was developed and applied to mortadella samples with and without pistachio (Pistacia vera). The method is proposed for the detection of traces of pistachio deriving from previous processes or from accidental contamination, since in predisposed individuals pistachios can cause allergic reactions leading to anaphylactic shock. Three pairs of primers were identified and tested by polymerase chain reaction (PCR) on mortadella samples prepared with pistachio. Accidental contamination was also simulated. The optimized PCR was able to detect the presence of pistachio, even at low concentrations. The primers pair PSTC 1-2 is suggested for unambiguous identification of pistachio in mortadella. The limit of detection for this primers pair was 100 mg kg-1. No interference was observed from other spices or ingredients utilized in the formulation of the mortadella. The method enabled the identification of possible traces of pistachio remaining in the production plant after less than thorough washing.

[Research and formal demonstration of evidence of efficiency in occupational medicine]. / Ricerca e dimostrazione formale delle prove di efficacia in medicina del lavoro.

There is an increasing pressure on occupational health professionals to ensure that their practice is based on a quality standard and an evidence of appropriateness. The efficacy-effectiveness of their activity strictly depends on their intellectual and professional integrity, their technical and legal competence, but also on the quality of the relations with the company organisation they are able to establish. We asked to some occupational physician when they considered their interventions in the workplace to be efficacious. Then, accordingto our epexrience, we propose some effectiveness indicators, particular concerning health surveillance and health educttaon, that should be evaluated to verify the health professional agccvity agreement to quality standards.

[Efficacy in occupational medicine: proposals of the regional sections of SIMLII of Lombardy and Emilia Romagna]. / Efficacia in Medicina del Lavoro: le proposte delle sezioni regionali SIMLII della Lombardia e dell'Emilia Romagna.

The efficacy in Occupational Medicine is based on the degree of attainment of workers health and safety care. The Occupational Physician activity, attending on business parts, gives a contribution to the mission of the firm leading to the workers health/safety. The Occupational Physician actions are conditioned by workers features and by the other members of prevention system. It is necessary to verify the efficacy, the efficiency and the adequacy of the Occupational Physician activity finding goals and specific indicators.

[Quality and efficacy in occupational medicine: relationship between quality, efficacy, and surveillance -- Experience of public and private facilities in Emilia Romagna]. / Qualità ed efficacia in medicina del lavoro: rapporti tra qualità, efficacia e vigilanza--Esperienze di strutture pubbliche e private in Emilia Romagna.

Italian legislation concerning health and safety at work establishes minimal requirements, according to European regulations. On the other side it's compulsory for Employers to set themselves at a level "above minimal requirements" according only to technicalfeasibility. It's a duty of Control Bodies (in Italy National Health Service's Work Environment Prevention Services) to verify the respect of law's preview minimal requirements. Quality standards and application guidelines, on the contrary, require collaboration and consensus among all actors involved in the implementation of health and safety managing systems on workplaces: Control Bodies, Professional Officers (Occupational Physicians, Safety Consultants), public and private Consultant Companies working on the field of health and safety at work. In this document some Emilia Romagna Region Control Bodies guidelines are discussed, and two experiences concerning public and private Consultant Companies are presented.

HIV infection in children born to seropositive mothers: a laboratory and clinical follow-up study.

Several serological techniques may be used for the detection of HIV infection, however, in the case of infants, there are no methods that are effective prior to the loss of maternal antibodies. Thus, in such cases, a completed series of serological and virological assay of HIV antibodies should be performed in follow-up studies. Twenty children living in Modena (Italy) were studied since 1985. Seven of these children were of ages ranging from 3 to 10 years. Only one of them was found to be seropositive for HIV. The remaining 13 children were studied from birth. Six had lost maternal antibodies to HIV at a median age of 15.1 months. Four showed decreasing levels of the anti-body by Western blotting. HIV antigen was detected in serum samples from 2 children. The data reported stress the need for longitudinal studies that could lead to reliable methods of diagnosing HIV infections in newborns.

Exposure-effect and exposure-response relationships between occupational exposure to styrene and neuropsychological functions.

A neuropsychological test battery was administered to 50 workers exposed to styrene and to 50 sex-, intelligence-, and age-matched controls. The main styrene metabolites, ie, mandelic acid (MA) and phenylglyoxylic acid (PGA), were measured as exposure indices in the urine collected on Saturday mornings, just before neuropsychological testing. Exposure-response and exposure-effect relationships were found between the intensity of the exposure (as reflected by the sum of MA and PGA) and the scores of the neuropsychological tests. Verbal learning skills were significantly impaired in workers with a sum of MA and PGA higher than 150 mmole/mole creatinine, corresponding to styrene airborne concentrations higher than 25 ppm (mean daily exposure). Logical memory and visuo-constructive abilities were shown to be significantly affected in workers with MA and PGA higher than 300 mmole/mole creatinine, corresponding to exposure levels of more than 50 ppm of styrene in air.

[Spirometric alterations in chromium-exposed welders (author's transl)]. / Alterazioni funzionali respiratorie in saldatori professionalmente esposti a cromo.

Lung function tests were examined on 28 welders using high chromium alloyed electrode for two years. Respiratory function change seem to be related to the duration of employment as welders. On the contrary, obstructive disease and alveolo-capillary impairment were found with same prevalence in groups of workers differently exposed to chromium. It presumably occurs because the exposure to chromium is quite short.

[Chronic non-specific disease of the respiratory system and measurable alterations in workers in the chromium-plating industry (author's transl)]. / Esposizione a cromo ed alterazioni funzionali respiratorie in lavoratori dell'industria galvanica.

Lung function test performed on 26 chromium plating workers showed a high prevalence of obstructive disease and of change in DLCO. The connection between lung function impairment and occupational exposure to chromium is suggested by the relationship between respiratory changes and biological indices of chromium absorption. The prevalence and the severity of ventilatory impairment also show an increasing trend with the duration of the exposure, while the smoking habitus seems not to be important.