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1.
BMC Musculoskelet Disord ; 20(1): 436, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533791

RESUMO

BACKGROUND: Previous research has indicated that wide international variation in the prevalence of disabling low back pain among working populations is largely driven by factors predisposing to musculoskeletal pain more generally. This paper explores whether the same applies to disabling wrist/hand pain (WHP). METHODS: Using data from the Cultural and Psychosocial Influences on Disability (CUPID) study, we focused on workers from 45 occupational groups (office workers, nurses and other workers) in 18 countries. Among 11,740 participants who completed a baseline questionnaire about musculoskeletal pain and potential risk factors, 9082 (77%) answered a further questionnaire after a mean interval of 14 months, including 1373 (15%) who reported disabling WHP in the month before follow-up. Poisson regression was used to assess associations of this outcome with baseline risk factors, including the number of anatomical sites other than wrist/hand that had been painful in the 12 months before baseline (taken as an index of general propensity to pain). RESULTS: After allowance for other risk factors, the strongest associations were with general pain propensity (prevalence rate ratio for an index ≥6 vs. 0: 3.6, 95% confidence interval 2.9-4.4), and risk rose progressively as the index increased. The population attributable fraction for a pain propensity index > 0 was 49.4%. The prevalence of disabling WHP by occupational group ranged from 0.3 to 36.2%, and correlated strongly with mean pain propensity index (correlation coefficient 0.86). CONCLUSION: Strategies to prevent disability from WHP among working populations should explore ways of reducing general propensity to pain, as well as improving the ergonomics of occupational tasks.

2.
N Engl J Med ; 380(26): 2529-2540, 2019 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-31242362

RESUMO

BACKGROUND: Data regarding high-sensitivity troponin concentrations in patients presenting to the emergency department with symptoms suggestive of myocardial infarction may be useful in determining the probability of myocardial infarction and subsequent 30-day outcomes. METHODS: In 15 international cohorts of patients presenting to the emergency department with symptoms suggestive of myocardial infarction, we determined the concentrations of high-sensitivity troponin I or high-sensitivity troponin T at presentation and after early or late serial sampling. The diagnostic and prognostic performance of multiple high-sensitivity troponin cutoff combinations was assessed with the use of a derivation-validation design. A risk-assessment tool that was based on these data was developed to estimate the risk of index myocardial infarction and of subsequent myocardial infarction or death at 30 days. RESULTS: Among 22,651 patients (9604 in the derivation data set and 13,047 in the validation data set), the prevalence of myocardial infarction was 15.3%. Lower high-sensitivity troponin concentrations at presentation and smaller absolute changes during serial sampling were associated with a lower likelihood of myocardial infarction and a lower short-term risk of cardiovascular events. For example, high-sensitivity troponin I concentrations of less than 6 ng per liter and an absolute change of less than 4 ng per liter after 45 to 120 minutes (early serial sampling) resulted in a negative predictive value of 99.5% for myocardial infarction, with an associated 30-day risk of subsequent myocardial infarction or death of 0.2%; a total of 56.5% of the patients would be classified as being at low risk. These findings were confirmed in an external validation data set. CONCLUSIONS: A risk-assessment tool, which we developed to integrate the high-sensitivity troponin I or troponin T concentration at emergency department presentation, its dynamic change during serial sampling, and the time between the obtaining of samples, was used to estimate the probability of myocardial infarction on emergency department presentation and 30-day outcomes. (Funded by the German Center for Cardiovascular Research [DZHK]; ClinicalTrials.gov numbers, NCT00470587, NCT02355457, NCT01852123, NCT01994577, and NCT03227159; and Australian New Zealand Clinical Trials Registry numbers, ACTRN12611001069943, ACTRN12610000766011, ACTRN12613000745741, and ACTRN12611000206921.).


Assuntos
Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Medição de Risco/métodos , Troponina/sangue , Adulto , Idoso , Biomarcadores/sangue , Estudos de Coortes , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Sensibilidade e Especificidade , Troponina I/sangue
3.
Eur J Prev Cardiol ; 26(17): 1877-1885, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31109187

RESUMO

AIMS: The aim of this study was to investigate the independent associations of occupational (OPA) and sport physical activity (SpPA) and job strain on the incidence of coronary heart disease (CHD) events, and to explore their interplay. METHODS: The study sample included 3310 25-64-year-old employed men, free of CHD at baseline, recruited in three population-based and one factory-based cohorts. OPA and SpPA, and job strain were assessed by the Baecke and the Job Content Questionnaires, respectively. We estimated the associations between different domains of physical activity and job strain with CHD, adjusting for major risk factors using Cox models. RESULTS: During follow-up (median=14 years), 120 CHD events, fatal and non-fatal, occurred. In the entire sample, a higher CHD risk was found for high job strain (hazard ratio=1.55, 95% confidence interval: 1.05-2.31). The joint effect of low OPA and high job strain was estimated as a hazard ratio of 2.53 (1.29-4.97; reference intermediate OPA with non-high strain). With respect to intermediate OPA workers, in stratified analysis when SpPA is none, low OPA workers had a hazard ratio of 2.13 (95% confidence interval: 1.19-3.81), increased to 3.95 (1.79-8.78) by the presence of high job strain. Low OPA-high job strain workers take great advantage from SpPA, reducing their risk up to 90%. In contrast, the protective effect of SpPA on CHD in other OPA-job strain categories was modest or even absent, in particular when OPA is high. CONCLUSIONS: Our study shows a protective effect of recommended and intermediate SpPA levels on CHD risk among sedentary male workers. When workers are jointly exposed to high job strain and sedentary work their risk further increases, but this group benefits most from regular sport physical activity.

4.
Stroke ; 50(3): 610-617, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30786848

RESUMO

Background and Purpose- NT-proBNP (N-terminal pro-B-type natriuretic peptide) is a risk factor for atrial fibrillation and a marker of cardiac function used in the detection of heart failure. Given the link between cardiac dysfunction and stroke, NT-proBNP is a candidate marker of stroke risk. Our aim was to evaluate the association of NT-proBNP with stroke and to determine the predictive value beyond a panel of established risk factors. Methods- Based on the Biomarkers for Cardiovascular Risk Assessment in Europe-Consortium, we analyzed data of 58 173 participants (50% men; mean age 52 y) free of stroke from 6 community-based cohorts. NT-proBNP measurements were performed in the central Biomarkers for Cardiovascular Risk Assessment in Europe laboratory. The outcomes considered were total stroke and subtypes of stroke (ischemic/hemorrhagic). Results- During a median follow-up time of 7.9 years, we observed 1550 stroke events (1176 ischemic). Increasing quarters of the NT-proBNP distribution were associated with increasing risk of stroke ( P for trend <0.0001; multivariable Cox regression analysis adjusted for risk factors and cardiac diseases). Individuals in the highest NT-proBNP quarter (NT-proBNP >82.2 pg/mL) had 2-fold (95% CI, 75%-151%) greater risk of stroke than individuals in the lowest quarter (NT-proBNP <20.4 pg/mL). The association remained unchanged when adjusted for interim coronary events during follow-up, and though it was somewhat heterogeneous across cohorts, it was highly homogenous according to cardiovascular risk profile or subtypes of stroke. The addition of NT-proBNP to a reference model increased the C-index discrimination measure by 0.006 ( P=0.0005), yielded a categorical net reclassification improvement of 2.0% in events and 1.4% in nonevents and an integrated discrimination improvement of 0.007. Conclusions- In European individuals free of stroke, levels of NT-proBNP are positively associated with risk of ischemic and hemorrhagic stroke, independently from several other risk factors and conditions. The addition of NT-proBNP to variables of established risk scores improves prediction of stroke, with a medium effect size.


Assuntos
Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/epidemiologia , Adulto , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Biomarcadores , Isquemia Encefálica/sangue , Isquemia Encefálica/epidemiologia , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Humanos , Hemorragias Intracranianas/sangue , Hemorragias Intracranianas/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento
5.
Head Neck ; 2019 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-31889395

RESUMO

BACKGROUND: Post therapeutic surveillance of head and neck neoplasms is a still debated issue in the current literature: although different works tried to establish frequency, modality, and efficacy of a routine follow-up, little evidence has been produced, in particular considering only sinonasal malignancies. METHODS: A retrospective review of patients treated for sinonasal malignancies in a single tertiary center and followed through a regular program of follow-up was carried out. Rate of recurrence, location, timing, diagnosis, and salvage treatment were the main data analyzed. RESULTS: Of note, 417 patients were included in the study and 117 experienced at least one relapse. Staging, histological type, and previous treatment represent the main clinical factors to be considered to stratify patient's risk of recurrence. CONCLUSION: A regular post therapeutic surveillance can provide an early recurrence detection for patients treated for sinonasal malignancies, offering opportunity for salvage treatment in a high percentage of patients.

7.
Int J Public Health ; 63(6): 723-732, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29802415

RESUMO

OBJECTIVES: The prognostic utility of lifestyle risk factors and job-related conditions (LS&JRC) for cardiovascular disease (CVD) risk stratification remains to be clarified. METHODS: We investigated discrimination and clinical utility of LS&JRC among 2532 workers, 35-64 years old, CVD-free at the time of recruitment (1989-1996) in four prospective cohorts in Northern Italy, and followed up (median 14 years) until first major coronary event or ischemic stroke, fatal or non-fatal. From a Cox model including cigarette smoking, alcohol intake, occupational and sport physical activity and job strain, we estimated 10-year discrimination as the area under the ROC curve (AUC), and clinical utility as the Net Benefit. RESULTS: N = 162 events occurred during follow-up (10-year risk: 4.3%). The LS&JRC model showed the same discrimination (AUC = 0.753, 95% CI 0.700-0.780) as blood lipids, blood pressure, smoking and diabetes (AUC = 0.753), consistently across occupational classes. Among workers at low CVD risk (n = 1832, 91 CVD events), 687 were at increased LS&JRC risk; of these, 1 every 15 was a case, resulting in a positive Net Benefit (1.27; 95% CI 0.68-2.16). CONCLUSIONS: LS&JRC are as accurate as clinical risk factors in identifying future cardiovascular events among working males. Our results support initiatives to improve total health at work as strategies to prevent cardiovascular disease.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Saúde do Trabalhador , Adulto , Emprego/psicologia , Feminino , Humanos , Itália/epidemiologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco
8.
Eur J Vasc Endovasc Surg ; 55(5): 633-639, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29506942

RESUMO

OBJECTIVES: Prevalence data on abdominal aortic aneurysm (AAA) in women, subjects younger than 65 years and in subgroups carrying specific risk factors are scarce. AAA prevalence was evaluated in an Italian population including women and younger subjects, stratifying for the presence of cardiovascular disease (CVD) risk factors and CVD risk score. MATERIALS AND METHODS: A population based cross-sectional study was conducted between 2013 and 2016. Men aged 50-75 and women aged 60-75 years, resident in the city of Varese (northern Italy), were randomly selected from the civil registry. A vascular surgeon performed an abdominal aortic ultrasound scan at four sites using the leading edge to leading edge method. CVD risk score was computed using the ESC-SCORE algorithm. The age and gender specific prevalence was estimated, stratifying by the presence of CVD and cardiovascular risk factors. RESULTS: Among the 3755 subjects with a valid ultrasound measurement, 63 subjects with an AAA were identified (5 referred for surgical intervention), among whom 34 were not previously known (30 men 1.3%, 95% CI 0.9-1.8; 4 women 0.3%, 95% CI 0.1-0.8). Considering age classes in men only, the highest prevalence of screen detected AAA was found in subjects aged 65-70 (1.2%; 95% CI 0.4-2.5) and 70-75 (2.5%; 95% CI 1.4-4.0) years. Among 65-75 year old men, the highest AAA prevalence was found in subjects with a previous myocardial infarction (MI 4.9%, 95% CI 2.0-9.9) and in ever-smokers reporting more than 15 pack years of smoking (4.1%, 95% CI 2.5-6.3). Among the younger subjects, those having an ESC-SCORE higher than 5% or a previous CVD (MI or stroke) showed a prevalence of 1.4% (95% CI 0.3-4.2; prevalence including subaneurysms 6.7%, 95% CI 3.7-11.0%). CONCLUSIONS: In the study population, both a general screening program in 65-75 year old men and an approach targeted to subgroups at higher risk merit evaluation in a cost-effectiveness study. In 50-64 year old men, strategies for population selection should consider CVD risk stratification tools.


Assuntos
Aneurisma da Aorta Abdominal/epidemiologia , Programas de Rastreamento , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , Fumar/epidemiologia , Ultrassonografia
9.
Heart ; 104(14): 1165-1172, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29440185

RESUMO

OBJECTIVES: We investigate the independent and interacting long-term associations of occupational physical activity (OPA) and sport physical activity (SpPA) with the incidence of coronary heart disease (CHD) and cardiovascular diseases (CVD; CHD plus ischaemic stroke) in North Italian male workers. METHODS: 3574 employed men aged 25-64 years, free of CVD at baseline, recruited in three population-based and one factory-based cohorts, were included in the analysis. The Baecke Questionnaire was used to assess OPA and SpPA in 'minutes per week' of moderate or vigorous PA. We estimated the associations between different domains of PA and the endpoints, adjusting for major CVD risk factors, using Cox models. RESULTS: During a median follow-up of 14 years, 135 and 174 first CHD and CVD events, fatal and non-fatal, occurred. Compared with the intermediate OPA tertile, the HRs for CHD among low and high OPA workers were 1.66 (95% CI 1.06 to 2.59) and 1.18 (0.72 to 1.94), respectively (P value=0.07). Decreasing trends in CHD and CVD rates across increasing levels of SpPA were also found, with an HR for CVD of 0.68 (0.46 to 0.98) for intermediate/recommended SpPA compared with poor SpPA. We also found a statistically significant SpPA-OPA interaction, and the protective effect of SpPA was only found among sedentary workers, for both endpoints. Conversely, high OPA workers with intermediate/recommended SpPA levels had increased CHD and CVD rates compared with the poor SpPA category. CONCLUSIONS: Our results provide further evidence on the health paradox of OPA, with higher CVD rates among workers with intense PA at work. Moreover, the protective effect on CVDs of SpPA is prominent in sedentary workers, but it attenuates and even reverses in moderate and strenuous OPA workers.


Assuntos
Doença das Coronárias/epidemiologia , Exercício , Saúde do Trabalhador , Esportes , Acidente Vascular Cerebral/epidemiologia , Adulto , Estudos de Coortes , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Risco , Comportamento Sedentário
10.
Artigo em Inglês | MEDLINE | ID: mdl-29324640

RESUMO

The deregulation of the autonomic nervous system assessed through the heart rate variability (HRV) analysis is a promising pathway linking work stress and cardiovascular diseases. We aim to investigate the associations between HRV High Frequency (HF) and Low Frequency (LF) powers and work stress in a sample of 36 healthy nurses. Perceived work stress was assessed twice one year apart, using the Job Content and Effort Reward Imbalance questionnaires. This allows to classify nurses in three exposure groups: "prolonged high stress" (PHS), "recent high stress" (RHS) and "stable low stress" (SLS). A 24-h ECG monitoring was later performed during a working day (WD) and a subsequent resting day (RD). Statistically significantly lower (p < 0.02) HF and LF means were found in PHS and RHS nurses during the working periods. In the subsequent resting periods, HF means showed increases over time in the RHS (beta = +0.41, p < 0.05), but not in PHS nurses. LF means did not show any substantial increases in the resting periods, in the PHS group with geometric means lower when compared to SLS, in the non-working and resting periods. Our study evidences that both prolonged and recent perceived high work stress were associated with a reduction of HF and LF powers during work. In addition, prolonged stress was associated with a lack of recovery during not-working and resting periods.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Frequência Cardíaca/fisiologia , Estresse Ocupacional/fisiopatologia , Adulto , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
11.
Med Lav ; 107(5): 331-339, 2016 09 26.
Artigo em Italiano | MEDLINE | ID: mdl-27681565

RESUMO

BACKGROUND: Sinonasal cancers are rare, often fatal, tumors with a very high proportion of cases attributable to occupational exposures. The relevance of different carcinogens deeply varies among histological subtypes, with intestinal type adenocarcinomas (ITAC) characterized by a very large proportion of workers exposed to wood dust. The role of occupation in the etiology of other histotypes is less clear and more disputed, with authors questioning the possible occupational origin of non-ITAC cancers. METHODS: We conducted a hospital-based case-control study on 50 consecutives non-ITAC cancers and 50 controls, in Varese, Italy. Relative risks for previous exposure to carcinogens (any or single agent, i.e. wood/leather dust, solvents, metals) were calculated by multivariate logistic regression models adjusted for age, gender, smoking habits and residence (within or outside the Lombardy region). RESULTS: Having been exposed to any occupational carcinogen carried an OR of 3.04 (95%CI: 0.91-10.21). Considering single carcinogens, we observed no increased risk for wood dust exposure (OR=1.02, 95%CI: 0.21-4.94), while a large effect associated with previous exposure to other recognized carcinogens (leather dust, solvents or metals) appeared: OR=7.01 (95%CI: 1.51-32.8). DISCUSSION: Our results highlighted the importance of properly considering sinonasal cancers histological subtypes when investigating the role of occupational carcinogens. Grouping together all sinonasal cancers may end up in underestimating the role of wood in ITAC etiology as well as the relevance of other occupational exposures for non-ITAC tumors. All sinonasal cancers deserve a thorough investigation of the occupational history.


Assuntos
Carcinógenos , Doenças Profissionais/induzido quimicamente , Exposição Ocupacional/efeitos adversos , Neoplasias dos Seios Paranasais/induzido quimicamente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Int J Occup Med Environ Health ; 28(1): 42-51, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26159946

RESUMO

INTRODUCTION: Modifications of hearth rate variability (HRV) constitute a marker of the autonomic nervous system (ANS) deregulation, a promising pathway linking job strain (JS) and cardiovascular diseases (CVD). The study objective is to assess whether exposures to recent and prolonged JS reduce time-domain HRV parameters on working days (WD) among CVD-susceptible nurses and whether the association also persists on resting days (RD). MATERIAL AND METHODS: 313 healthy nurses were investigated twice with one year interval to assess JS based on the demand-control and the effort-reward models. 36, 9 and 16 CVD-susceptible nurses were classified as low JS in both surveys (stable low strain - SLS), recent high JS (high JS at the second screening only-RHS) and prolonged high JS (high strain in both surveys-PHS), respectively. In 9, 7 and 10 of them, free from comorbidities/treatments interfering with HRV, two 24-h ECG recordings were performed on WD and RD. Differences in the time domain HRV metrics among JS categories were assessed using ANCOVA, adjusted for age and smoking. RESULTS: In the entire sample (mean age: 39 years, 83% females) the prevalence of high job strain was 38.7% in the second survey. SDNN (standard deviation of all normal RR intervals) on WD significantly declined among JS categories (p = 0.02), with geometric mean values of 169.1, 145.3 and 128.9 ms in SLS, RHS, PHS, respectively. In the PHS group, SDNN remained lower on RD as compared to the low strain subjects (142.4 vs. 171.1 ms, p = 0.02). Similar findings were found for the SDNN_Index, while SDANN (standard deviation of average RR intervals in all 5 min segments of registration) mean values reduced in the PHS group during WD only. CONCLUSIONS: Our findings suggest that persistent JS lowers HRV time-domain parameters, supporting the hypothesis that the ANS disorders may play an intermediate role in the relationship between work stress and CVD.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Suscetibilidade a Doenças/fisiopatologia , Enfermagem , Doenças Profissionais/fisiopatologia , Estresse Psicológico/fisiopatologia , Adulto , Feminino , Frequência Cardíaca , Humanos , Controle Interno-Externo , Masculino , Recompensa , Estresse Psicológico/psicologia , Fatores de Tempo , Carga de Trabalho/psicologia
13.
Med Lav ; 104(3): 224-35, 2013.
Artigo em Italiano | MEDLINE | ID: mdl-23879066

RESUMO

BACKGROUND: Cutaneous carcinomas are tumors with a potential occupational etiology due to exposure to established carcinogens such as polycyclic aromatic hydrocarbons (PAH), ionizing radiation, ultraviolet (UV) radiation and arsenic. The occupational origin of such neoplasms is hugely underestimated in Italy. OBJECTIVES: To asses the proportion of Squamous Cell Carcinomas (SCC) cases with a previous occupational exposure to carcinogens. METHODS: We systematically evaluated occupational exposure in a series of consecutive cases, discharged in the period 2010-11 from the Dermatology Unit of Varese Hospital, Italy, with a histological diagnosis of SCC. Through a structured telephone interview we identified patients with a potential exposure to skin carcinogens. As a second-level step, an extensive evaluation by an occupational physician was performed to assess the occupational etiology in those selected cases. RESULTS: 105 patients were identified (65 men). 15 male cases out of a total of 85 patients who did the telephone interview, revealed a potential occupational exposure; 7 cases were confirmed as occupational cancers after second-level evaluation (proportion of male occupational cases = 13.2%). UV radiation and PAH were recognized as major causal agents. Applying those results to the national incidence data, we estimated a number of 700 annual occupational cases, 100-fold more than the cases currently evaluated by the Italian National Workers Compensation Authority. CONCLUSIONS: Our results revealed that occupational SCC is still at present a substantially "lost disease" in Italy. Greater attention and enhanced collaboration between specialists is thus needed to overcome this tendency.


Assuntos
Carcinoma de Células Escamosas/epidemiologia , Doenças Profissionais/epidemiologia , Exposição Ocupacional/estatística & dados numéricos , Neoplasias Cutâneas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
15.
Med Lav ; 101 Suppl 2: 50-6, 2010.
Artigo em Italiano | MEDLINE | ID: mdl-21298871

RESUMO

Cardiovascular disease is one of the main causes of death and disability in industrialised and post-industrialised countries, including Italy. Improvements in treatment of the acute phase and the efficacy of prevention programmes contribute greatly to extending patient survival, thus increasing the prevalence of the disease even in the population of working age. Thus it is mandatory to provide adequate rehabilitation programmes in order to achieve full social reintegration of such patients, including return to work, which is an important aspect of their quality of life. This report reviews published papers exploring the main factors influencing return to work of patients suffering from a heart complaint. Criteria are also proposed for the assessment of reintegration at work of cardiovascular patients that take account of the residual clinical and functional working capacity of the patient in relation to the specific environmental and organizational work features. With the tools available to monitor the cardiovascular system during work it is possible to pursue to advantage such a comprehensive rehabilitation programme but close cooperation between the occupational physicians and cardiovascular rehabilitation specialists is required In a preliminary phase this can be achieved in hospital outpatient clinics equipped to develop and test specific protocols.


Assuntos
Cardiopatias/reabilitação , Saúde do Trabalhador , Humanos , Medicina do Trabalho
16.
Med Lav ; 100(6): 438-47, 2009.
Artigo em Italiano | MEDLINE | ID: mdl-20359136

RESUMO

BACKGROUND: Transitional bladder cancer is the most frequent malignant urinary neoplasm. Occupational exposure to aromatic amines and to polycyclic aromatic hydrocarbons are the main risk factors, in addition to cigarette smoking, recurrent inflammatory diseases of the urinary tract, consumption of certain drugs and a positive family history. Nevertheless cases of work-related bladder cancer are poorly identified in Italy. OBJECTIVE: The aim of this study is to assess the screening accuracy of a short structured interview to detect suspected cases of occupational bladder cancer, which may be confirmed in a second step assessment by an occupational physician. METHODS: The study sample consisted of 94 transitional bladder cancer patients, first hospitalised in 2004 and 2005 at the Department of Urology of the Ospedale di Circolo - Fondazione Macchi, in Varese, Italy. Based on data collected through a simple structured interview, it was possible to estimate two occupational exposure indices: one taking into account only the length of employment in industrial settings (DS Index) and the other considering job title in addition (DSM Index). For all cases a second-step assessment by an occupational physician (gold standard) made it possible to establish the occupational origin of cancer and to assess accuracy. RESULTS: Satisfactory values of the area under the ROC curve were found for both indices (AUC 0,81 for DS and 0,87 for DSM). In particular at the same level of sensitivity (90%), the DSM Index showed a better specificity (72%) in comparison to the DS Index (64%). CONCLUSIONS: The short structured interview proposed here proved to be a valuable tool for general practitioners and urologists to detect cases of bladder cancer of suspected occupational aetiology, which can be referred to an occupational physician for further investigations.


Assuntos
Carcinoma de Células de Transição/diagnóstico , Programas de Rastreamento/métodos , Doenças Profissionais/diagnóstico , Neoplasias da Bexiga Urinária/diagnóstico , Idoso , Área Sob a Curva , Carcinógenos Ambientais , Carcinoma de Células de Transição/etiologia , Exposição Ambiental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/etiologia , Exposição Ocupacional , Ocupações , Curva ROC , Fatores de Risco , Fumar/epidemiologia , Inquéritos e Questionários , Fatores de Tempo , Neoplasias da Bexiga Urinária/etiologia
17.
Med Lav ; 98(6): 475-81, 2007.
Artigo em Italiano | MEDLINE | ID: mdl-18041467

RESUMO

BACKGROUND: With the introduction in Italy of the Law regarding alcohol abuse and addiction (Law No.125/01), new tasks and responsibilities were assigned to occupational physicians. This law establishes that in working activities with a high risk of industrial accidents, or which may cause a risk for the safety and health of others, workers are forbidden to consume alcoholic beverages during working hours. In addition, occupational physicians are asked to play a key role in testing workers for alcohol levels. In March 2006 a specific list of job titles was issued which makes the law effective. DISCUSSION AND CONCLUSIONS: The application of this law gives rise to various consequences and ambiguities, in particular for occupational physicians, mainly concerning the identification of workers with alcohol problems, the subsequent control of such workers, including proposals for valid rehabilitation programmes, and assessment of residual work fitness. All these aspects can, to some extent, produce conflicts between privacy rights and the need to ensure the health and safety of workers and third parties. A specific screening package is proposed for the identification of alcohol abuse as well as methods to overcome some of the constraints. Specific and effective guidelines need to be issued by scientific societies and health authorities.


Assuntos
Alcoolismo , Medicina do Trabalho/legislação & jurisprudência , Alcoolismo/diagnóstico , Alcoolismo/prevenção & controle , Humanos , Itália
18.
Med Lav ; 96(3): 191-9, 2005.
Artigo em Italiano | MEDLINE | ID: mdl-16273836

RESUMO

BACKGROUND: Recent changes in work organization have greatly expanded the service industry, where stress perception appears to be the major factor of discomfort. Job stress remains a critical issue in occupational exposure assessments. OBJECTIVES: To assess the compliance and the consistency of the three major constructs (Psychological Job Demand (PJD); Decision Latitude (DL); and Social Support at Work (SSW)) of the Italian version of the Job Content Questionnaire (JCQ) adopted in the MOPSY and JACE studies and their gender-specific distributions in a large sample of civil servant in northern Italy. METHODS: JCQ was administered to 2601 men and 5761 women employed in six different departments of the Municipality of Milan. Two JCQ versions - short and intermediate which differ by the number of items that assess DL for inclusion of SSW, were used in different sub-samples. Compliance was measured in terms of participation rate and percentage of missing items. A construct-specific Cronbach alpha coefficient was used to assess internal consistency. As a measure of external consistency the correlation coefficients between the three constructs were adopted. RESULTS: The participant rate was very high in the entire sample: 75.3% in men and 76.2% in women. The percentage of missing items was small and acceptable, ranging from 3.61% for DL to 6.33% for SSW. The Cronbach alpha coefficients ranged from 0.72 for PJD to 0.88 for SSW. Assumptions for external validity were satisfied in both gender groups. The percentage of perceived high job stress diminished in older men, but the age trend was inverse among women, indicating gender differences in the possibility of improving work conditions and career. Interferences with the family-related load and responsibilities may play a significant role. In both gender groups, a satisfactory SSW level reduced perceived high job stress. CONCLUSIONS: The adopted versions of the JCQ, originally developed in American and north European socio-cultural contexts, demonstrated satisfactory levels of compliance, and internal and external consistency. The JCQ adequately described perceived job stress in the groups of workers under study.


Assuntos
Órgãos Governamentais , Doenças Profissionais/epidemiologia , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , Adulto , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/etiologia , Esgotamento Profissional/psicologia , Demografia , Escolaridade , Feminino , Humanos , Itália , Satisfação no Emprego , Governo Local , Masculino , Centros de Saúde Materno-Infantil , Pessoa de Meia-Idade , Doenças Profissionais/etiologia , Doenças Profissionais/psicologia , Polícia , Responsabilidade Social , Apoio Social , Serviço Social , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Carga de Trabalho
19.
Ital Heart J Suppl ; 4(8): 651-7, 2003 Aug.
Artigo em Italiano | MEDLINE | ID: mdl-14655461

RESUMO

BACKGROUND: Previously reported time trends of myocardial infarction rates in the MONICA Brianza 35-64-year-old population showed a clear decline in coronary heart disease mortality, mostly attributable to concurrent reductions in myocardial infarction attack rates, and to a lesser extent in 28-day case fatality. The aims of this study were to estimate time trends in more recent years (up to 1997-1998) in the same population and in the same age range, and to assess the impact of myocardial infarction among 35-74-year-old residents, an age range never investigated before in Italy using standardized population-based registers. METHODS: The myocardial infarction register in the Brianza population was resumed in 1997-1998, adopting the same standardized methods for data collection and classification of suspect coronary events as the WHO MONICA project, including the age group 65-74 years in addition to age groups usually covered. Age-specific and age-standardized rates of validated coronary mortality rates, of attack rates, and incidence rates and of 28-day case fatality were calculated. Time changes were estimated as the difference in rates. RESULTS: In comparison to the rates among 35-64-year-old residents, the 35-74 age-standardized rates of coronary event mortality in the biennium are more than 3 times higher in women and more than twice in men. Similarly, the attack and incidence rates increased respectively from 243 to 381 and from 197 to 292 per 100,000 in men, from 38 to 107 and from 33 to 87 per 100,000 in women. Statistically significant reductions are observed in coronary death rates, myocardial infarction attack rates and 28-day case-fatality rates between 1993-1994 and 1997-1998 in men. Analogous but not statistically significant changes are reported for women. CONCLUSIONS: In the Brianza MONICA population in the second half of the 1990s, coronary event death rates continued to decrease. In contrast with trends observed in previous years, the prominent quote of the reduction is attributable to case-fatality rates in the acute phase.


Assuntos
Infarto do Miocárdio/mortalidade , Adulto , Idoso , Gráficos por Computador , Doença das Coronárias/epidemiologia , Doença das Coronárias/mortalidade , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Taxa de Sobrevida
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