Work resumption after invasive heart procedures, rehabilitation and ergonomic evaluation: from the hospital to the workplace.

Our Institute adopts a multidisciplinary protocol named "CardioWork" for work resumption after invasive cardiac procedures and subsequent rehabilitation: after evaluation of the cardiac functional profile, the occupational physician analyses the work activity prior to the cardiopathological event, identifies the presumed task energy requirement (from specific, published tables), and compares it with the exercise test results. Indications regarding timing and modality of returning to work are formulated accordingly. To verify the reliability of the indications thus provided, we carried out a clinical-functional follow-up study in the workplace, with Holter ECG and Armband measurement of actual energy expenditure. Over the course of two years, we enrolled 36 patients (mostly males, aged between 30 and 70 years), hospitalized after coronary revascularization, valve replacement or cardiac defibrillator implant. After rehabilitation, instrumental diagnostics (Holter ECG, echocardiography, exercise test) showed discrete functional conditions, with better values with regard to cardiac function than exercise capacity and effort tolerance. All subjects were judged fit for the job, in most cases with limitations concerning ergonomic factors, working timetable and/or stress. They returned to work quickly, with good adherence to the indications provided. Workplace Holter ECG did not show appreciable differences compared to the hospital evaluation. In one case, the average energy expenditure measured while working was higher than that inferred from the tables; in the remaining subjects, the actual expenditure coincided with what was expected or was lower. In a minority of cases (39%), the measured average expenditure slightly exceeded the optimal value (35% of the maximal value at the exercise test) recommended at the time of hospital discharge. At the end of the workplace evaluation, it was not necessary to formulate new indications. The study provides further evidence of the effectiveness of the CardioWork protocol in promoting return to work after invasive heart procedures. Though they need continuous updating, the published estimates of presumed task energy requirement remain reliable. In particularly complex cases, it is however advisable to carry out a field check of the ergometric assessments performed at the end of rehabilitation.

[Manual handling, job fitness, and musculoskeletal disorders in the Sondrio hospital (Italy) healthcare workers.] / Movimentazione manuale, idoneità alla mansione e disturbi muscolo-scheletrici negli operatori sanitari dell'Ospedale di Sondrio.

OBJECTIVES: Musculo-skeletal disorders (MSD) are a large group of locomotor system pathologies with multifactorial etiology. Healthcare professionals are often exposed to biomechanical overload of the spine and upper limb, for example during patient handling, and represent a working population at risk. METHODS: In order to acquire further knowledge on this subject, we conducted a cross-sectional study (year 2016) among healthcare workers (excluding physicians) of the Sondrio Hospital (Italy), investigating the correlations between manual handling, MDS and job fitness. RESULTS: The sample examined included 667 subjects (74 males and 593 females, mean age: 50 years): 557 (83.5%) certified fully "fit for the job", 109 (16.3%) "partially fit" (with limitations and/or prescriptions), and one "not fit" female worker. Eighty-seven of the 109 partial fitnesses (79.8%) were related to manual handling. In turn, 76 of the 87 limitations/prescriptions for manual handling (87.4%) were due to the presence of musculo-skeletal disorders (accompanied by instrumental diagnosis, and often associated with each other), especially of the lumbo-sacral tract, to a lesser extent of the cervical spine, shoulder or other body districts. Associations between partial job fitness and worker operative units have not been observed. CONCLUSIONS: The data indicate that, among healthcare workers, the biomechanical overload of the limbs and the spine, and the related MSD, are the health problems that most often come to the attention of the occupational physician, posing delicate problems for the "fitness to job" certification. The observed lack of correlation with the operative unit is an expression of the tendency to relocate staff with MSD in tasks at lower biomechanical risk.

[Professional outcomes and psychological health after workplace bullying: an exploratory follow-up study]. / Esiti professionali e salute psicologica a seguito di vessazioni sul luogo di lavoro: uno studio esplorativo di follow-up.

BACKGROUND: The literature shows that workplace bullying can lead to negative consequences for both individuals' health and professional outcomes. Most of these studies used cross-sectional designs and self-report questionnaires and further research is needed in order to explore long-term effects of workplace bullying. OBJECTIVES: This follow-up study aimed to explore professional and psychological outcomes in a sample of subjects who required a specialized and multidisciplinary assessment for psychological problems related, in their opinion, to workplace bullying. METHODS: The sample includes 71 patients with a baseline diagnosis of work-related psychological disorder who were assessed at follow-up by means of a structured telephone interview. The interview included structured questions about professional career developments and psycho-somatic health, and administration of the General Health Questionnaire-12. RESULTS: 62.0% of the participants were currently working and, of these, 59.1% had changed workplace after experiencing mobbing. Patients who changed workplace scored significantly higher on job satisfaction levels (p<0.01) and showed lower levels of social dysfunction (p<0.01) compared to those who did not change their job. Patients with a baseline diagnosis of Adjustment disorder/Post-Traumatic Stress disorder had higher levels of general dysphoria (p<0.04) and social dysfunction (p<0.01) at follow-up than other patients. CONCLUSIONS: These findings  stress the importance of an accurate diagnostic assessment of mobbing-related psychopathological disorder. Victims of workplace bullying require early and continuous psychological support in order to promote their psychological well-being and work reinstatement.

[Occupational risk factors and medical prevention in corrections officers]. / Fattori di Rischio Lavorativo e Prevenzione Medica nella Polizia Penitenziaria.

In Italy, the Law n. 395/1990 defines the tasks and attributions of prison officers. According to the article 25 of the Legislative Decree n. 81/2008, the occupational physician should participate to risk assessment, and carry out the sanitary surveillance. This report analyzes the various tasks of prison staff, identifies the risk factors, and discusses the preventive strategies, including workers formation and education. Biological agents and work-related stress are the main risk factors, as a consequence of prison overcrowding, personnel shortage and work organization complexity. In his preventive action, and particularly in formulating the judgment on work fitness, the occupational physician often clashes with inadequate ministerial funding.

[Role of occupational rehabilitation therapy in returning to work: experimental experience]. / Ruolo della terapia riabilitativa occupazionale nel reinserimento al lavoro: esperienze sperimentali.

The experimental experience is the result of combining cultural, clinical and scientific interest in rehabilitative, occupational and forensic mnedicine and in ergonomics. It deals with the rehabilitation and return at work of patients with physical disabilities caused by occupational trauma or disease. The programme described starts with a selection by INAIL and involves with an outpatient surgery inclusion. It is composed of: preliminary physical examination, functional assessment, the formulation of a rehabilitation plan and its successive implementation. At the end of the evaluation plan, there is a final assessment to identify outcome indicators and residual functional and work capacity.

Carbon Monoxide Poisoning: From Occupational Health to Emergency Medicine.

Carbon monoxide poisoning remains a leading cause of accidental poisoning worldwide (both at home and at work), and it is also a cause of suicidal poisoning. Such poisoning can arise following prolonged exposure to low levels of CO or following brief exposure to high concentrations of the gas. In fact, despite exposure limits, high safety standards, and the availability of CO alarms, nearly 50,000 people in the United States visit the emergency department each year due to poisoning. Additionally, CO poisoning in the United States causes up to 500 deaths each year. Despite the widespread nature of this form of poisoning, known about for centuries and whose damage mechanisms have been recognized (or rather hypothesized about) since the 1800s, early recognition, especially of late complications, and treatment remain a medical challenge. A well-designed therapeutic diagnostic process is necessary so that indication for hyperbaric or normobaric therapy is correctly made and so that patients are followed up even after acute exposure to diagnose late complications early. Furthermore, it is necessary to consider that in the setting of emergency medicine, CO poisoning can be part of a differential diagnosis along with other more frequent conditions, making its recognition difficult. The last thirty years have been marked by a significant increase in knowledge regarding the toxicity of CO, as well as its functioning and its importance at physiological concentrations in mammalian systems. This review, taking into account the significant progress made in recent years, aims to reconsider the pathogenicity of CO, which is not trivially just poisonous to tissues. A revision of the paradigm, especially as regards treatment and sequelae, appears necessary, and new studies should focus on this new point of view.

Does job satisfaction predict early return to work after coronary angioplasty or cardiac surgery?

PURPOSE: Few studies have analyzed the relationship between job satisfaction and return to work (RTW) in cardiac patients. The aim of this paper was to investigate whether job satisfaction predicted early RTW in patients sick listed after cardiac invasive procedures. METHODS: A 6-month prospective study was carried out in a sample of 83 patients in working age who had recently been treated with angioplasty or cardiac surgery. Job satisfaction was measured using the scale from the Occupational Stress Indicator during cardiac rehabilitation. Time to RTW was assessed at the 6-month occupational physician examination. Logistic regression analyses were used to study the association between job satisfaction at baseline and early RTW at follow-up, adjusted for socio-demographic, medical (type of cardiac intervention, ejection fraction) and psychological (depression, locus of control, illness perception) factors. RESULTS: Participants with high job satisfaction were more likely to return early to work, with an odds ratio (OR) of 5.92 (95 % CI, 1.69-20.73) in the most-adjusted model, compared to participants with low job satisfaction. Satisfaction with organizational processes was the job satisfaction component most strongly associated with early RTW (OR, 4.30; 95 % CI, 1.21-15.03). CONCLUSIONS: To the best of our knowledge, this is the first prospective study that investigated whether job satisfaction predicts time to RTW after cardiac interventions. The results suggested that when patients are satisfied with their job and positively perceived their work environment, they will be more likely to early RTW, independently of socio-demographic, medical and psychological factors.

Brugada syndrome and job fitness: report of three cases.

Brugada syndrome (BrS) is an inherited arrhythmogenic disorder predisposing patients to a high risk of sudden cardiac death. Specific guidelines on the health surveillance of BrS workers are lacking. We report here three cases requiring assessment of specific job capacity, investigated with an interdisciplinary protocol including 24-h Holter electrocardiography with modified precordial leads, pharmacological test with ajmaline, molecular genetic analysis, electrophysiological study with ventricular stimulation, risk stratification, and occupational medicine evaluation: (1) a female 42-yr-old company manager with positive ajmaline test and CACNA1C gene mutation (judged fit for the job with limitations regarding work-related stress); (2) a male 44-yr-old welder with positive ajmaline test, SCN5A gene mutation, and associated OSAS (obstructive sleep apnea syndrome), who was advised to refrain from night shifts and driving company vehicles; (3) a male 45-yr-old electrical technician with inducible ventricular tachyarrhythmia, who was implanted with a biventricular cardioverter defibrillator, and therefore recommended to avoid exposure to electromagnetic fields and working at heights. We conclude that the collaboration between the cardiologist and the occupational physician allows defining the functional capabilities and the arrhythmogenic risk of BrS workers, to optimize job fitness assessment.

[Occupational toxic neuropathies: morphology in peripheral nerve biopsies]. / Neuropatie tossiche occupazionali: quadri morfologici in biopsie del nervo periferico.

Many peripheral neuropathies are caused by the (acute or chronic) toxic action of metals, solvents, pesticides, and other occupational and environmental contaminants. These agents often reproduce the anatomoclinical pictures of hereditary (e.g., Charcot-Marie-Tooth disease), autoimmune (Guillain-Barrè syndrome), or dysmetabolic (thiamine deficiency, diabetic neuropathy) forms. Toxic peripheral neuropathies can be classified on the basis of etiology, clinical features (sensitive, motor, sensitive-motor), or histopathology: neuronopathies (uncommon, mostly secondary to retrograde axonal degeneration; e.g., arsenic, thallium), axonopathies (acrylamide, esacarbons, CS2, organophosphate-induced delayed neuropathy), myelinopathies (trichloroethylene), mixed forms (axonal and demyelinating: lead). For many substances, experimental research has led to the identification of the molecular and cellular targets of neurotoxicity. Several compounds are active by biotransformation (e.g., the esacarbons n-hexane and MnBK are neurotoxic since they are metabolized to 2,5-hexanedione), Genetic, physiological and environmental factors determine the individual metabolic set-up, and they may give origin to differences in the workers' sensitivity. Cessation of exposure is often followed by (microscopically observable) regenerative phenomena and clinical improvement. The morphology of neuropathies can be studied through peripheral nerve biopsy. Samples of sural nerve (or other nervous trunks of the limbs), adequately fixed, sectioned, and stained, allow the observation of alterations in axonal fibres (e.g., giant-axonal neuropathy, dying back neuropathy), myelin (demyelination), Schwann cells, interstitium, and blood vessels; possible inflammatory infiltrates; fibre density; regenerative phenomena (growth cone, remyelination). In occupational medicine, biopsy is indicated when the anamnestic-clinical picture, laboratory tests, and instrumental exams leave doubts about the nature, type, and entity of the neurological damage. In such cases, current optical and electron microscopy techniques can be very useful for injury evaluation, prognosis, and follow-up.

[Work-related stress and mobbing: case series and gender differences]. / Stress lavoro-correlato e mobbing: casistica clinica e differenze di genere.

The attention of international agencies and scientific community on mobbing (bullying) and work-related stress is increasing. However, research on gender differences and etiologic agents is still limited. This study describes the gender differences found in victims of mobbing and work-related stress in an Italian case series. Between 2001 and 2009, at the Occupational Medicine Unit of our Institution we examined 345 outpatients (197 women and 148 men) for suspected psychopathological work-related problems. After interdisciplinary diagnostic evaluation, the diagnosis of "mobbing syndrome" was formulated, according to international criteria (ICD-I0 and DSM-IV), in a minority of cases: 35 subjects. In the other workers, we found pre-existing psychiatric conditions (not related to work), or altered relationships dynamics with the colleagues. Significant gender differences emerged among people with "mobbing syndrome": there was a high prevalence of women (65%), with medium to high level of education; the most affected age group was between 34 and 45 years; several occupations were involved, with a clear preponderance of office workers. Women are mostly harassed for personal aspects related to emotional and relational factors; men for the content of their work. The knowledge of the phenomenon is an essential prerogative to contrast mobbing; this can be realized, at a preventive level, only through effective information and training for workers and employers, who have the legal obligation to preserve the integrity of the mental and physical status of their employees during the work.

[Stress risk evaluation in health personnel: framework and applicative experiences]. / La valutazione del rischio stress negli operatori sanitari: inquadramento del problema ed esperienze applicative.

The Italian legislative decree 81/08 requires stress risk evaluation for all the workers, including health personnel. The present paper compares two different occupational stress evaluation procedures, tested in two North Italy sanitary structures: a) the first through subjective methods, based on self report questionnaires and focus groups; b) the second through an objective approach, utilizing the OSFA (Objective Stress Factors Analysis) method. The comparison of the two experiences indicates that the subjective approach may present several limitations, since it gives a measure of the "felt" stress, not directly related to the nature of the job. On the other hand, the objective approach, and particularly the OSFA method, allows an analysis of the work conditions and the identification of single and specific aspects that can be ameliorated in order to eliminate or reduce the occupational stress sources.

Work-related post-traumatic stress disorder: report of five cases.

Post-traumatic stress disorder (PTSD) may arise after events involving a risk to physical integrity or to life, one's own or that of others. It is characterized by intrusive symptoms, avoidance behaviors, and hyper-excitability. Outside certain categories (e.g., military and police), the syndrome is rarely described in the occupational setting. We report here five unusual cases of work-related PTSD, diagnosed with an interdisciplinary protocol (occupational health visit, psychiatric interview, psychological counselling and testing): (1) a 51-yr-old woman who had undergone three armed robbery attempts while working in a peripheral post office; (2) a 53-yr-old maintenance workman who had suffered serious burns on the job; (3) a 33-yr-old beauty center receptionist after sexual harassment and stalking by her male employer; (4) a 57-yr-old male psychiatrist assaulted by a psychotic outpatient; (5) a 40-yr-old woman, sales manager in a shoe store, after physical aggression by a thief. All patients required psychiatric help and pharmacological treatment, with difficulty of varying degrees in resuming work. We conclude that PTSD can develop even in professional categories generally considered to be at low risk. In such cases, a correct interdisciplinary diagnostic approach is fundamental for addressing therapy and for medico-legal actions.

Adenosine A1 and A3 receptor agonists inhibit nonadrenergic, noncholinergic relaxations in the guinea pig isolated trachea.

BACKGROUND: Adenosine affects the tone and reactivity of airways by activating specific membrane receptors, named A(1), A(2a), A(2b) and A(3). It affects cellular activities either directly by regulating membrane ion exchanges and polarization, or indirectly by modifying neurotransmitter release. OBJECTIVES: We assessed the effect of A(1) and A(3) receptor activation on electrically induced nonadrenergic, noncholinergic (NANC) relaxations in the guinea pig isolated trachea and the localization of A(1) and A(3) receptors in tracheal inhibitory neurons. METHODS: NANC responses at 3 Hz were evaluated in the presence of 2-chloro-N(6)-cyclopentyladenosine (CCPA), a selective A(1) agonist, and 2-chloro-N(6)-(3-iodobenzyl)-adenosine-5'-N-methyluronamide (Cl-IB-MECA), a selective A(3) agonist, before and after the administration of 8-cyclopentyl-1,3-dipropylxanthine (DPCPX), a selective A(1) antagonist, or 9-chloro-2-(2-furanyl)-5-((phenylacetyl)amino[1,2,4]triazolo[1,5-c])quinazoline (MRS 1220), a selective A(3) antagonist, respectively. For immunohistochemistry, tissues were exposed to antibodies to HuC/D, a general neuronal marker, neuronal nitric oxide synthase (nNOS), and A(1) or A(3) adenosine receptors and processed by indirect immunofluorescence. RESULTS: CCPA (10 nM-3 microM) inhibited NANC relaxations. DPCPX (10 nM) failed to antagonize the effect of CCPA, but inhibited per se NANC relaxations (range 0.1-100 nM). CCPA (10 nM-10 microM) contracted unstimulated tracheal preparations, an effect antagonized by 10 nM DPCPX, with a pK(B) value of 8.43. Cl-IB-MECA (10 nM-3 microM) inhibited NANC relaxations through a mechanism antagonized by MRS 1220 (100 nM). A(1)- and A(3)-positive neurons containing nNOS were detected in tracheal sections. CONCLUSIONS: Enogenous adenosine may induce airway hyperresponsiveness by inhibiting NANC relaxations via A(1) and A(3) receptors.

Irritant vocal cord dysfunction and occupational bronchial asthma: differential diagnosis in a health care worker.

OBJECTIVES: Vocal cord dysfunction (VCD) is an uncommon respiratory disease characterized by the paradoxical adduction of vocal cords during inspiration, that may mimic bronchial asthma. The pathogenesis of VCD has not been clearly defined but it is possible to recognize non-psychologic and psychologic causes. The majority of patients are female but, interestingly, a high incidence of VCD has been documented in health care workers. A misdiagnosis with asthma leads to hospitalisation, unnecessary use of systemic steroids with related adverse effects, and sometimes tracheostomy and intubation. In a subset of VCD patients, the disease can be attributed to occupational or environmental exposure to inhaled irritants. MATERIALS AND METHODS: We report the case of a 45-year-old woman, working as a nurse, who complained of wheezing, cough, dyspnoea related to inhalation of irritating agents (isopropylic alcohol, formaldehyde, peracetic acid). She underwent chest radiography, pulmonary function assessment both in the presence and in the absence of symptoms, bronchial provocation with methacholine and bronchodilation test with salbutamol to recognize asthma's features, allergy evaluation by skin prick tests and patch tests and video-laryngoscopy. RESULTS: VCD diagnosis was made on the basis of video-laryngoscopy, that visualized the paradoxical motion of the vocal cords during symptoms, in the absence of other pathologic processes. CONCLUSIONS: This case fulfils the proposed criteria for the diagnosis of irritant VCD (IVCD). This is the first report of VCD onset following exposure to several irritants: formaldehyde, glutaraldehyde, sopropylic alcohol, peracetic acid-hydrogen peroxide mixture. These substances are used as cleaning and antiseptic agents in healthcare settings and some ones can also be found in many indoor environments. A correct diagnosis is important both to give the appropriate treatment and for medical legal implications.

Malignant mesothelioma of the tunica vaginalis testis in a petrochemical worker exposed to asbestos.

Malignant mesothelioma of the tunica vaginalis testis is a rare and aggressive asbestos-related malignancy that may pose difficult diagnostic problems. After 16 years of asbestos exposure, a 38-year-old petrochemical worker came to our notice with acute right testicular pain and swelling, simulating torsion of the spermatic cord. Histopathology of surgical samples of the tunica vaginalis revealed tubulopapillary, epithelioid neoplastic proliferation. Immunohistochemical staining for the epithelial glycoprotein Ber-EP4 was negative, whereas results were positive for mesothelial markers, thus leading to the diagnosis of epithelial mesothelioma. The tumour infiltrated the testicular surface and the epididymis, but no distant metastases were found. The patient was treated with radical inguinal orchidectomy without adjuvant therapy and is free from disease 15 months after diagnosis. Tunical mesothelioma may simulate metastatic carcinoma at routine histopathological examination. Immunohistochemistry and occupational anamnesis are helpful for the correct diagnosis, which, in turn, is important for prognosis and treatment, and in relation to legal issues when asbestos is involved in the causation of the disease.

Anaemia and abdominal pain due to occupational lead poisoning.

We describe a 47-year-old patient with chronic anaemia with basophilic stippling of erythrocytes, recurrent abdominal colics, discoloration of gums, sensitive polyneuropathy to the four limbs, hyperuricaemia, hepatosteatosis with raised transaminases, and a long ignored history of lead exposure in a battery recycling plant. The diagnosis of poisoning was confirmed by high lead levels in the blood and urine, decreased erythrocyte delta-aminolevulinic acid dehydratase (ALA-D), raised erythrocyte zinc protoporphyrin (ZP), and elevated urinary excretion of porphyrins. Chelation with EDTA resulted in increased urinary lead excretion, gradual improvement of the clinical picture, and progressive normalization of lead biomarkers. The case highlights the importance of occupational anamnesis for the diagnosis of lead poisoning, an uncommon condition which may mimic a variety of internal and surgical diseases. Since antiquity, lead has been extensively mined, produced, and utilized in a variety of industrial settings, such as metallurgy, construction, production of plastics, ceramics, paints and pigments. Lead and its compounds are systemic toxicants, and a wide range of adverse health effects (including haematological, gastrointestinal, neuropsychiatric, cardiovascular, renal, endocrine, and reproductive disorders) has been observed in exposed workers. The general population (particularly children) may also be exposed to toxic lead levels due to air, soil, food and water contamination. Thanks to the improvement of workplace hygienic conditions, the pathological picture of occupational lead poisoning (plumbism, saturnism) has gradually become less serious, at least in the most industrialized countries, and has progressively changed into aspecific, subclinical manifestations. We describe here an unusual case (nowadays) of anaemia and recurrent abdominal pain due to lead poisoning from battery recycling.

Seven years of workplace drug testing in Italy: A systematic review and meta-analysis.

In Italy, Workplace Drug Testing (WDT) has been compulsory by law for specific categories of workers since 2008, offering the opportunity to compare studies conducted within a single regulatory framework. The aims of this paper are to estimate the overall prevalence of WDT positivity (at screening survey) among Italian workers and evaluate the percentage of true and false positives at confirmation analysis. A systematic review and meta-analysis of the scientific literature on WDT in Italy from January 2008 to March 2015 was carried out, according to the MOOSE guidelines. A random effects model was utilized to calculate pooled prevalence. Potential sources of heterogeneity were explored using sensitivity test and subgroup analysis. The overall meta-analytical prevalence of positivity at WDT among Italian workers was 1.4% [95% confidence interval (CI) = 1.1-1.7%]. It was significantly lower among workers screened with an on-site test (1%; 95% CI = 0.5-1.5%), compared with a bench-top test (1.7%; 95% CI = 1.3-2.1%). Nine studies provided data on false positives at the screening test, with a combined prevalence estimate - calculated on positive cases - of 30% (95% CI = 16-44%). In Italy, the number of true positives at first-level workplace drug testing is low, while the frequency of false positives is relatively high. A revision of the Italian legislation on the subject seems advisable. Copyright © 2017 John Wiley & Sons, Ltd.

Poor weight control, alcoholic beverage consumption and sudden sleep onset at the wheel among Italian truck drivers: A preliminary pilot study.

OBJECTIVES: The aim of this study was to investigate the prevalence of obesity, alcoholic beverage consumption, unhealthy alcohol use and sudden sleep onset at the wheel among Italian truck drivers. In addition to prevalence rates, this study also aimed at investigating potential predictors for sudden-onset sleepiness and obesity. MATERIAL AND METHODS: A sample of truck drivers was extracted from the database of the High Risk Professional Driver Study. Data concerning demographics, anthropometry, medical information and working conditions were collected using anonymous questionnaires. Logistic regression analyses were performed to assess the association of the reported body mass index (BMI), alcohol consumption and sudden sleep onset with working conditions and general lifestyle factors. RESULTS: Three hundred and thirty-five questionnaires were collected. According to their BMI, 45% of the participants were overweight and 21.4% of them were obese. Twenty-four point two percent declared they drank alcoholic beverages during working hours or work breaks and 21.3% of the drivers had an Alcohol Use Disorders Identification Test Consumption (AUDIT C) score ≥ 5 (the threshold value for unhealthy alcohol use). Forty-one point six percent of the interviewees experienced one episode of sudden sleep onset at the wheel per month (5.5% per week and 0.9% daily). Predictive factors for obesity were: length of service (odds ratio (OR) = 1.09, confidence interval (95% CI): 1.04-1.15, p < 0.001) and the AUDIT C total score (OR = 1.34, 95% CI: 1.08-1.66, p = 0.008). Predictive factors for sudden-onset sleepiness at the wheel were: age > 55 years old (OR = 5.22, 95% CI: 1.29-21.1, p = 0.020), driving more than 50 000 km per year (OR = 2.89, 95% CI: 1.37-6.11, p = 0.006) and the Chalder Fatigue Questionnaire (CFQ) score > 11 (adjusted OR = 2.97, 95% CI: 1.22-7.21, p = 0.016). CONCLUSIONS: This study strongly emphasizes the need for intervention in order to reduce and prevent important risk factors for the sake of road safety and truck drivers' health.

Return to work after coronary revascularization procedures and a patient's job satisfaction: A prospective study.

INTRODUCTION: Research into work reintegration following invasive cardiac procedures is limited. The aim of this prospective study was to explore predictors of job satisfaction among cardiac patients who have returned to work after cardiac rehabilitation (CR). MATERIAL AND METHODS: The study population consisted of 90 cardiac patients who have recently been treated with coronary angioplasty or heart surgery. They were evaluated during their CR and 12 months after the discharge using validated self-report questionnaires measuring job satisfaction, work stress-related factors, emotional distress and illness perception. Information on socio-demographic, medical and occupational factors has also been collected. RESULTS: After adjusting for demographic, occupational and medical variables, baseline job satisfaction (p < 0.001), depression (p < 0.01) and ambition (p < 0.05) turned out to be independent, significant predictors of job satisfaction following return to work (RTW). Patients who had a partial RTW were more satisfied with their job than those who had a full RTW, controlling for baseline job satisfaction. CONCLUSIONS: These findings recommend an early assessment of patients' psychosocial work environment and emotional distress, with particular emphasis on job satisfaction and depressive symptoms, in order to promote satisfying and healthy RTW after cardiac interventions.

Psychological and Work Stress Assessment of Patients following Angioplasty or Heart Surgery: Results of 1-year Follow-up Study.

The aim of this study was to explore changes in subjective psychological health and perceived work stress among patients who returned to work (RTW) after a multidisciplinary cardiac rehabilitation (CR) following cardiac interventions. A total of 108 patients were evaluated at the beginning of their CR, at 6 and 12 months after discharge. Self-report questionnaires were used to assess depression, anxiety, illness perception and work stress at each time stage. Results showed reports of depressive symptoms significantly decreased (p < 0.05) and subjective mental (p = 0.001) and physical health (p < 0.001) improved over time. Patients revealed a decrease in Type A behaviour pattern (p < 0.001) and in job satisfaction levels (p = 0.01), greater internal locus of control (p < 0.01) and increased use of the coping strategy 'Involvement' (p < 0.01). Major findings are that cardiac patients had an improvement in subjective psychological health and did not perceive increased work stress after their RTW. Patients' psychological health and work stress need to be assessed during the CR and should be also carefully monitored after the RTW in order to identify patients' psychological and work-related barriers and facilitate a safe and successful work reintegration.