[Association between relational and organizational factors and occurrence of musculoskeletal disease in health personnel]. / Associazione fra fattori relazionali e organizzativi e insorgenza di patologia muscolo-scheletrica negli operatori sanitari.

INTRODUCTION AND OBJECTIVES: Even if work musculo-skeletal disorders represent a serious and commonly observed health problem among health care workers, few data are available about physical therapists. This study aims to compare the musculoskeletal disorders prevalence over two different health care populations and MATERIALS AND METHODS: Two populations have been studied: (i) 100 nurses working in the teaching hospital Azienda Policlinico di Modena and (ii) 100 physical therapists working in different hospitals in Modena and Reggio Emilia. The ergonomic risk assessment has been made according to the Ergo Web questionnaire. A self-reported questionnaire [partly built according to Outil de Repérage et d'Evaluation des Gestes (OREGE) method] has been used to collect data about physiological factors, musculo-skeletal symptoms of the upper limb and spine, stress indexes and psychosocial indexes. RESULTS: The two populations are comparable as far as the data of physiological and working anamnesis. The physical therapists have an higher prevalence of neck pain (p<0.01), whereas the nurses have an higher prevalence of low back pain (p<0.01). Furthermore, the physical therapists have an higher index of pain (involving prevalence, number of occurrences and intensity of the disorder) of right upper limb too. The nurses have higher working strain (p=0.00), attention need at work (p=0.00), poor autonomy (p<0.01) indexes than physical therapists. The indexes' analysis shows that musculo-skeletal disorders are associated to stress and psychosocial factors in both populations.

Cost of umbilical cord blood units released for transplantation.

BACKGROUND: A large number of institutions have started programs banking umbilical cord blood (UCB) for allogeneic unrelated-donor and related-donor transplantation. However, limited information is available on the financial issues surrounding these activities. STUDY DESIGN AND METHODS: The aim of this study was to determine the fee per UCB unit released for transplantation that would allow cost recovery after 10 years. Three organizational models were considered suitable to provide units for five UCB transplants per 1 million population per year, a figure that would translate into an annual need for 280 units in Italy. Models A, B, and C included, respectively, seven networked banks, each with an inventory of 1,500 units; two networked banks, each with an inventory of 5,000 units; and one bank with an inventory of 10,000 units. It was estimated that it would take 3 years to develop the cryopreserved inventory and that approximately 3 percent of the inventory could be released and replaced each year during the 7-year interval between the fourth and tenth years of activity. The data on the costs of labor, reagents and diagnostics, disposables, depreciation and maintenance, laboratory tests, and overhead, as well as the operational data used in the analysis were collected at the Milano Cord Blood Bank in 1996. RESULTS: Fees of US $15,061, $12,666, and $11,602 per unit released during the fourth through the tenth years of activity allow full cost recovery (principle and interest) under Models A, B, and C, respectively. CONCLUSION: Although UCB procurement costs compare favorably with those of other hematopoietic cell sources, these results and the current fee of US $15,300 used in some institutions show that UCB is an expensive resource. Therefore, judicious planning of banking programs with high quality standards is necessary to prevent economic losses. The advantages of lower fees associated with the centralized banking approach of Model C should be balanced with the more flexible collection offered by Model A.