Diabetes and work: The need of a close collaboration between diabetologist and occupational physician.

AIM: The Italian Society of Occupational Medicine (SIML), the Italian Diabetes Society (SID) and the Association of Diabetologists (AMD) joined a working group that produced a consensus paper aimed to assess the available evidence regarding the interplay between specific working conditions, including shift- and night-time work, working activities at high risk of accidents and work at heights, working tasks requiring high-energy expenditure, working activities at extreme temperatures and diabetes. DATA SYNTHESIS: Diabetes is a group of metabolic disorders caused by defects in insulin secretion and/or action affecting millions of people worldwide, many of whom are or wish to be active members of the workforce. Although diabetes, generally, does not prevent a person from properly performing his/her working tasks, disease complications can significantly compromise a person's ability to work. Therefore, it appears evident the need to understand the relationship between occupational risk factors and diabetes. The working group included in the document some practical recommendations useful to ensure diabetic workers the possibility to safely and effectively undertake their jobs and to adequately manage and treat their disease, also in the workplace. In this perspective concerted action of all the workplace preventive figures, occupational physicians and diabetologists should be strongly encouraged. CONCLUSIONS: Further studies are necessary to define workplace-based interventions, which should be minimally invasive towards the work organization, allowing diabetic workers to fully realize their work skills while improving their wellbeing at work.

Transition to retirement impact on risk of depression and suicidality: results from a longitudinal analysis of the Survey of Health, Ageing and Retirement in Europe (SHARE).

AIMS: Depression is among the main contributors to older adults' mental health burden. Retirement, one of the major life transitions, has been claimed to influence mental health substantially. Following up on a previous meta-analysis, the study aims to assess from a longitudinal perspective short- and long-term impacts of transitioning to retirement on depression risk and suicidality in older adults across Europe. METHODS: We conducted a longitudinal study using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), collected between 2004 and 2020 in 27 European countries plus Israel. To estimate relative risks (RR) and 95% confidence intervals (95% CIs) for depression and suicidality at seven time intervals before and after retirement, we fitted adjusted generalized estimating equation models for repeated measures. RESULTS: We included 8,998 individuals employed at baseline and retired at follow-up (median follow-up time: 9 years; maximum: 16 years). Compared to the year of retirement, the risk of depression was 11% lower in the following year (RR 0.89; 95% CI 0.81-0.99), 9% lower after 2 years (RR 0.91; 95% CI 0.82-1.00) and after 3 years (RR 0.91; 95% CI 0.81-1.01). Significant estimates remained among females, married individuals, those with an intermediate or higher level of education, former manual workers and those who retired at or before their country's median retirement age. A significant increase in depressive symptoms emerged from the tenth year after retirement among former non-manual workers (RR 1.21; 95% CI 1.05-1.40) and late retirees (RR 1.37; 95% CI 1.16-1.63). No heterogeneity emerged among strata. As for suicidality, we reported an increase in risk only 5 years or more after retirement, namely +30% 5-9 years after retirement (RR 1.30; 95% CI 1.04-1.64) and +47% 10 or more years after retirement (RR 1.47; 95% CI 1.09-1.98). Sensitivity analyses excluding subjects who reported a diagnosis of depression over the study period and those retirees who declared to receive a disability pension confirmed the results obtained in the overall analysis. CONCLUSIONS: Longitudinal adjusted data suggest an independent effect of retiring associated with a reduction in depression and suicidality risk in the short run, with its effect decreasing in the long run. Such trends are particularly evident among selected subgroups of elderly populations. If greater flexibility in pensionable age may help prevent depression late in life, the transition to retirement is to be accompanied by targeted health promotion interventions. In an ageing society, welfare policies should be evaluated, considering their long-term impact on mental health.

[Fitness to work and diagnosis of work-related disease in truck drivers]. / L'espressione dell'idoneità lavorativa e la diagnosi di patologie lavoro-correlate in autisti di mezzi pesanti.

From 2008 to 2011, according to an experimental protocol, 490 truck drivers (mean age 42.5, seniority 26.1 years) were subjected to visits and health check-up. The prevalence of work-related diseases was 4.7%: 15 cases of hearing loss and 8 of lumbosacral disease. In the 9.2% it was necessary to give some restrictions to the truck drivers' fitness to work (because of musculoskeletal disease, heart disease, diabetes etc), 0.8% was judged permanently unfit. We have found also 1% with positive drug test. Health check-up has allowed the diagnosis of many unknown or not controlled disease, first of all metabolic and cardiovascular diseases, which could have been a role in increasing accident or in reducing future workers' fitness to work. In the implementation of health surveillance programs, the occupational physicians must not forget that to ensure adequate safety standards is necessary to evaluate not only drugs assumption, but also the psychological and physical integrity of truck drivers, planning appropriate tests and medical examinations.

[Method of VDR of occupational stress at small sized companies]. / Metodo di VDR dello stress lavoro correlate nelle imprese di piccole dimensioni.

This contribution, which started in the Laboratory "Stress and Work" of Ospedali Riuniti in Bergamo (USC Occupational Medicine and Clinical Psychology USSD), offers a shared location for the risk assessment of work-related stress in the context of small businesses, enhancing, in line with Article 25 of Legislative Decree 81/08, the central role of the doctor. The theoretical frame is about the concept of organizational health (Avallone and Paplomatas, 2005) and the elements of the subjectivity and local cultures of work (Shein, 2000). In this context, the doctor, often the only professionist in prevention in the company, who is able to know the health conditions of workers, is described as a key figure very important in the evaluation of work-related stress.

[History of the health protection of construction workers]. / Storia della tutela della salute dei lavoratori edili.

Construction has been one of the first sectors in which an organized system of occupational health protection has been implemented, as shown by the Egyptian physicians caring for workers and artisans in building sites. During the Middle Ages, first examples of accident prevention legislation in this field may be found among the Lombards. In the same period, craft organizations led to greater social recognition of skilled workers, without a improvement in their health conditions. Ramazzini accurately described some risks of stonemasons and brick-makers (chemical and microclimatic hazards). In the following centuries, the Industrial Revolution led to a population growth in metropolitan areas and increased employment as well as accidents in the construction sector, as demonstrated by some ex-voto paintings in churches. This phenomenon became more evident in postwar recovery, forcing Italy to adopt modern accident prevention rules. Nowadays Italian legislation, complying with EU directive, provides new challenges for occupational physician.

[The role of the occupational physician in disabled return to work]. / Il Ruolo del Medico del Lavoro nel reinserimento lavorativo del disabile.

Workers, former workers or unemployed workers with disabilities of various kinds often come to the Occupational Health Hospital Department (UOOML), requiring a report on their fitness for work that often is generic or not suitable for specific situations: a detailed knowledge of both working and health conditions, mainly disabilities and job items are needed. The UOOML was never directly involved in the proceedings of targeted fitting-up of the disabled people, while some Doctors of the Department of Prevention of ASL have an advisory role participating in the Technical Committee under Law 68 and the 'Disabled Commission'. INAIL (the National Insurance Institute for Occupational Accidents and Diseases), in case of allocation of percentages of disability higher than 33% (necessary requirement for the targeted employment) provides an assessment of the 'residual capacity'. The Company Occupational Physician cooperates and intervenes in the management of the employment of the disabled worker in very different ways and at several stages of the path of integration or reintegration. Considering the prolonged and effective cooperation among the Doctors of the UOOML and the Psysiatrists of our Hospital, we are developing a specific out-patients' department where a report on the fitness for job, as close as possible to the patient/work-task compliance, is provided to the disabled.

[Construction: critical issues and occupational health]. / Edilizia: criticità e tutela della salute.

Construction is strategic in Italy and worldwide, on top for employees number and turnover but also for occupational accidents and diseases. The building site is at high risk and it is difficult to maintain good levels of safety: in recent years they have had an improvement, but the economic crisis did not favour it. The knowledge in the field of prevention is not as widespread as it would be necessary and as requested (OSHA - UE). The Occupational Physician, engaged in risk assessment and management of medical services, must protect the health of workers at high risk for health, aging and performing tiring work, without adequate vocational training and culture, often in precarious conditions of health and lifestyle at risk. There are good experiences around the world and in Italy. Implementation of research in technology and ergonomics, materials and the tools, reduction of workload are needed, improvement of building site organization, of knowledge about health effects, the rehabilitation and reintegration to work. The procedures and processes should improve productivity and at the same time be safer and less dangerous and the lows should be more fitting with the specific characteristics of the construction industry.

[Experiences of environmental and biological monitoring in the construction industry]. / Esperienze di monitoraggio ambientale e biologico in edilizia.

After emphasizing the characteristics of the sector and the difficulty of applying traditional industrial hygiene methods for assessing exposure to chemical agents in the construction industry, we have reviewed the major experiences of environmental and biological monitoring that can be derived from the literature. Although the determination of exposure through environmental measures should be considered the most appropriate instrument, it should be paid for the study of specific activities, while it is preferable in many situations the use of simplified tools (such as algorithms and databases) that allow the risk estimation and enable the adoption of safe work procedures and environmental and individual protection devices.

[Muskuloskeletal disorders in construction industry: hospital cases]. / Le patologie muscoloscheletriche in edilizia: analisi di una casistica ospedaliera.

The authors analyse 493 hospital cases in 356 workers from the construction industry, came to observation for musculoskeletal disorders (average age 48, 2 years, SD 9; work seniority 32, 2 years, SD 9, 7; work seniority in construction industry 27, 3 years, SD 12, 4). The evaluation was required in 305 subjects (85.7% of the sample) to investigate one or more suspected WMDS; in 51 subjects (14.3% of the sample) to express an opinion on fitness to work or residual work capacity. Investigations led to diagnosis of 479 musculoskeletal disorders; the districts most affected are spine and upper limb. 64.7% of the musculoskeletal disorders was evaluated to be work-related, the percentage rises to 68% when considering only cases sent for evaluation of suspected WMDS. The most frequent reasons to exclude relation between the musculoskeletal disorders and work were an high age at diagnosis, presence of comorbidity or outcome of trauma, a disease mismatch exposure.

[Biomechanical overload of the upper limbs and energy expenditure in bricklayers activity]. / Sovraccarico biomeccanico degli arti superiori e dispendio energetico nelle attività di costruzione tavolati e intonacatura in edilizia.

The work explains the method we used for biomechanical overload risk assessment of upper limbs in construction industry, to make boarding with perforated bricks (preparation of mortar and building materials, construction, plastering) and shows the preliminary results obtained. The activity was observed and analysed through simulations of building site; all tasks were filmed with digital cameras; after we applied OCRA check-list to obtain values of biomechanical overload for upper limbs. We found an high risk of biomechanical overload, due to awkward postures and use of strength, for shoulders, elbows and, in particular, for wrists. This data helped us to understand why we found an high prevalence of wrist-WMSD (such as Carpal Tunnel Syndrome) in bricklayers evaluated in health surveillance.

[Ergonomic assessment of main activities in grana padano cheese production]. / Valutazione ergonomica di attività caratteristiche nella filiera di produzione del grana padano.

Aim of this work is to describe results obtained by risk assessment of biomechanical overload for workers involved in grana padano cheese production: from breeding to obtain milk to the finished product in dairy. To analyze operation tasks authors used video recordings, interviewed operators and visited workplaces in order to proceed with evaluation instruments, using internationally recognized technical standards ISO 11228, such as OCRA, NIOSH and Snook and Ciriello's studies. The results show significant risk of biomechanical overload for spine and upper limbs both in breeding and in dairy.

[Return to work of the cardiac patient: work fitness evaluation in Occupational Medicine Division including an Occupational Cardiology Unit and Work-Physiology Lab in Bergamo]. / Unità Semplice di Cardiologia del Lavoro ed Ergometria degli Ospedali Riuniti di Bergamo: percorso per la valutazione dell'idoneità lavorativa del cardiopatico.

Cardiovascular disease in working age still represent a major cause of morbidity and account for a number of fitness to work certificates expressing several limitations and prescriptions. To present the medical assessment conducted in an Occupational Medicine Division including an Occupational Cardiology Unit and work-physiology lab. It is described the history and the structure of the Occupational Cardiology Unit. Our almost forty years long-lasting experience allow us to point out the precious contribution of the Occupational Cardiology Unit to the Occupational Medicine Division, due to a highly specialised and qualified assessment of cardiac patients.

[Restrictions on night work: analysis of case studies in a large Lombardy Hospital]. / Limitazioni al lavoro notturno; analisi della casisitica in un ospedale lombardo di grandi dimensioni.

A high percentage of the division's doctors and employees work at night to guarantee urgent assistance and diagnostic services to patients. Night work is not recommended for persons with rather serious case histories due to the disruption of circadian rhythms or the increased workload required of certain operators during nighttime hours. All of the evaluations of health operators with a limited capacity to work on the night shift in our hospital were analysed, except for female workers restricted from night work during pregnancy or puerperium, as provisioned by the regulation that protects working mothers. Forty-two cases were considered (six physicians and 36 operators in the division) out of a total of 2676 employees assigned to night work and the conditions that led to the formulation of the decision are divided as follows: 16 Mental disturbances currently subject to treatment (depression, post-traumatic anxiety disorder, primary insomnia...), 8 Tumours (breast, colon, Ewing Sarcoma), 7 Neurological disorders (multiple sclerosis, myasthenia), 6 Cardiovascular disease (previous IMA; arrhythmias, arterial hypertension not controlled by theraphy) and 5 others patologies (total 45). The cases will be analysed in detail with an analysis of the characteristics of the exempt group of workers and with reference to the temporary or indefinite nature of the exemption.

[Assessment of the risk of occupation-related stress in the bakery industry at the ASPAN of Bergamo]. / Valutazione del rischio stress lavoro-correlato nelle imprese panificatrici afferenti all'ASPAN di Bergamo.

The attention to developing the subjective dimensions and environmental policies to promote health in the contexts of work is established with the development of "model of organizational health." This model explains the concepts of stress and health in the workplace as phenomena not reducible to the individual dimension, going to intercept the styles of living that characterize organizational practices, significant in the process of health promotion (Avallone and Paplomatas, 2005). The aim of this work consists in the recognition of risk factors and protective measures which characterize the context of the bakery, investigating the size of individual, relational, organizational and socio-economic conditions. The methodology included a phase of analysis of the context, a collection of the principal objective data and a reinterpretation of them inside a narrative and autobiographcial prospective, offered by the subjects interested in the evaluation.

[Exposure to vegetal esters based metal cutting fluids: health effects]. / Esposizione ad oli lubrorefrigeranti vegetali: effetti sulla salute.

The aim of our research is to study respiratory and dermatologic diseases (irritative and allergic) in a cohort of workers exposed to vegetal esters based metal cutting fluids of the latest generation. A cohort of 81 workers (mean age 34.5 years, seniority 17.4 years), with mean exposure to vegetal esters based metal cutting fluids of 2.8 years, has been subjected to clinical evaluations. The investigation did not reveal any disease or disorder of the respiratory system, any folluculitis or any allergic contact dermatitis caused by sensitization to vegetal esters based metal cutting fluids. On the contrary we documented 5 cases of irritant contact dermatitis, even if favored by an improper use of protection devices. According to early results, the introduction of vegetal esters based metal cutting fluids seems to reduce the risk to the worker's health. A longitudinal surveillance is still needed to confirm that even in the medium and long-term sensitizations will not occur.

[Prevalence of contact dermatitis as occupational diseases in a group of construction workers followed up by the 'Territorial Joint Committee of Bergamo' between 2003-2011]. / Prevalenza delle dermatiti da contatto occupazionali in una coorte di lavoratori edili seguiti presso il Comitato Paritetico Territoriale di Bergamo nel periodo 2003-2011.

UNLABELLED: Occupational contact dermatitis is the most represented skin disease within the broad spectrum of occupational dermatoses, that also include skin cancers, skin infections and "scleroderma like disease." The scientific literature has long noted an increase in dermatological disease in the construction industry. MATERIALS AND METHODS: retrospective evaluation (2003-2011), in a group of construction workers followed by the 'Territorial Joint Committee of Bergamo', of the prevalence of allergic and irritant contact dermatitis. DISCUSSION AND CONCLUSIONS: The following report confirms the literature data and reaffirms the need for a careful medical surveillance, as a result of a strict cooperation between the different professionals involved (company physicians, dermatologists/allergists, family physicians).

[The skin cancer in the construction industry]. / La neoplasia cutanea nel settore edile.

UNLABELLED: The risk factors for the development of cutaneous neoplasms are well-known (skin type, ultraviolet rays, familiar occurrence, etc.) and the exposure to ultraviolet light is probably the most important one. Construction workers, due to the characteristics of the work performed (outdoor work), are exposed to UV rays for most of their workday, often in association with the exposure to chemicals (PAHs, solvents) with a role in promoting skin carcinogenesis. The construction industry is therefore a true "test" for the prevention of skin cancer. MATERIALS AND METHODS: description of skin cancer in the construction workers subject to medical surveillance at the "Territorial Joint Committee of Bergamo" (8 basal cell cancers, 1 squamous cell carcinomas and 4 melanomas). PURPOSE: review of the medical literature data, evaluation of the exposure to multiple risk factors, prevention proposals in a professional field where the "culture of tanning" is still widespread.

[Role of ECG screening and cardiologic examinations in occupational health prevention program for construction workers; results of study in the Province of Bergamo]. / Utilità dell'elettrocardiogramma e degli approfondimenti cardiologici nella sorveglianza sanitaria di una popolazione di operatori edili della Provincia di Bergamo.

Aim of this study was to estimate prevalence of resting electrocardiogram (ECG) abnormalities in men with high physical work demand, like construction workers and the prevalence of secondary related cardiovascular examinations. Several guidelines for cardiovascular risk management recommend an ECG in patients with cardiovascular risk but there are no clear indications about the frequency of resting ECG during evaluation for fitness for work. The results of our study confirm the presence of age-related ECG abnormalities with a similar stratified prevalence distribution in all age-classes. Our fundings intend to contribute to further discussion in occupational health policies and periodical medical evaluations.

[Occupational injuries and lifestyle in construction working population workers: which interaction?]. / Fenomeno infortunistico e stili di vita di una popolazione di lavoratori edili: quale correlazione?

Many factors of organizational, technical, social and human are involved in determining occupational injury. The purpose of this study was to evaluate how the characteristics of the human factor can influence the accident phenomenon. From records of the construction firms involved in the project "Protection of health on construction sites" promoted by CPT Bergamo and Occupational Medicine of Bergamo Hospital were extracted data on lifestyle of workers involved in occupational injuries in the period 2007-2011. The indicators of lifestyles used were the smoking status, alcohol consumption and drugs, body mass index (BMI), physical activity.

[A peculiar lead poisoning: a concern of team achievement]. / Un caso di intossicazione anomala da piombo: l'importanza di un'intervento multidisciplinare.

We describe a case of lead poisoning in a worker after hand and forearm trauma with fracture of radius and multiple fractures of metacarpal bones and hand phalanges and tissue infiltration of lead oxide (PbO) paste. Orthopedic surgery was immediately performed. After 20 days the patient had abdominal colic pain episodes and severe stipsis and blood lead level (BLL) was 60 mcg/mL with urinary lead level (ULL) of 238 mcg/24 h. After mobilization test with calcium disodium edetate were observed a high increase of BLL (180 mcg/dL) and UBL (17,000 mcg/24h). An initial anemia was observed and became severe (Hb 7.6 g/dL). A NMR exam and echography showed forearm subcutaneous lead paste infiltration and the patient underwent to a second surgical debridement with local low temperature (5 degrees C) irrigation of saline and CaNa2EDTA made the removal of the hardened lead paste. The day after, oral succimer (DMSA) chelation treatment was started with recovery of lead poison.