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Musculoskeletal disorders (MSDs) are common among hospital workers. This cross-sectional study on 1744 hospital workers showed strong interaction between temperature complaints (OR 2.73), other environmental complaints (OR 3.12) and upper limbs disorders. A significant interaction between temperature and strain for upper limbs disorders (F = 9.52, p = 0.023) was also found. Environmental and psychosocial factors can interact increasing significantly the risk of MSDs. [ABSTRACT FROM AUTHOR]

The recent emergence of new democracies in North Africa results in a massive wave of immigration in Europe with thousands landing in recent months on the coast of southern Italy. This phenomenon has caused major problems of public order (PO), worsened by the presence of ever-increasing numbers of immigrants and multiculturalism, exposing the Special Forces of the Italian State Police in periods of intense work-related stress. Aims: To explore the relationship between work context (OP routine i.e. mass migration control vs. OP extraordinary i.e. the G8 summit) of special force policemen and psychological measures of job strain (demand-control, JCQ and effort-reward imbalance, ERI) related to objective measure (sickness absences). Conclusions: data showed that in special police forces routine work as migration control is significantly more stressful than a single special event that presents a very high risk for law enforcement, probably due to positive changes in psychosocial work environment among special police force. [ABSTRACT FROM AUTHOR]

Scopo: Il lavoro ha la finalità di valutare se lo stress lavoro-correlato (alto carico, basso controllo, basso sostegno sociale, strain e isostrain) sia associato con la presenza di disturbi cutanei nei lavoratori ospedalieri e se i problemi psicologici, come l'ansia e la depressione, intervengano in questa relazione. Metodo: 1744 lavoratori ospedalieri, nell'intervallo di attesa delle visite periodiche, sono stati invitati a rispondere a un questionario sui disturbi cutanei e sui fattori psicosociali (stress, ansia, depressione). Risultato: Il 25% dei lavoratori dichiarava di aver sofferto di disturbi cutanei alle mani nei 12 mesi precedenti. Le condizioni di elevato carico psicosociale sul lavoro (OR=1.09 CI95% 1.05-1.14), basso sostegno sociale (OR=0.90, CI95% 0.87-0.93), elevato strain (OR=1.54 CI95% 1.20-1.98) ed elevato iso-strain (1.66 CI95% 1.27-2.19) erano tutte associate con elevata prevalenza di disturbi cutanei alle mani. Anche la depressione (OR=2.50 CI95% 1.99-3.14) e l'ansia (OR=2.29 CI95% 1.81-2.89) si associavano ai disturbi cutanei. L'associazione tra stress e disturbi cutanei restava significativa anche dopo correzione per I problemi psicologici. Conclusioni: Lo stress da lavoro gioca un ruolo significativo nella comparsa dei disturbi cutanei nei lavoratori ospedalieri e tale rapporto non sembra essere mediato da problemi psicologici. La prevenzione delle dermatiti cosiddette "da guanti" deve tenere conto di questa significativa associazione. [ABSTRACT FROM AUTHOR]

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Summary: Background. Angelo Iannaccone is certainly one of the most important personalities in the field of occupational medicine of the last century. Aims. The fiftieth anniversary of the Post-graduate School of Occupational Medicine of the Catholic University of Rome gives us the opportunity to define this extraordinary figure of man and scientist, at over 35 years from his death. Results. Prof. Iannaccone was among the very first, if not the first to deal with chronobiology and occupational ergonomics in Italy, adopting the modern perspective of "upstream" prevention, since the design phase, which had to be based on the adaptation of work to man and not vice versa. He carried out important and pioneering studies on the effects of benzene on the hematopoietic apparatus and of various industrial toxicants on the neuroendocrine system. In establishing the formative principles for the occupational physician, he devoted a significant space to industrial hygiene, in the interdisciplinary perspective of prevention sciences. He gave a significant contribution to the scientific society of occupational medicine, first as a member of the board, then as the president of the Italian Society of Occupational Medicine and Industrial Hygiene. He realized the Institute of Occupational Medicine of the Catholic University of Rome and founded the post-graduate school. Conclusions. Prof. Iannaccone's contribution to occupational health and industrial hygiene emphasized applied research and prevention in the workplace., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by GIMLE.)

Summary: Introduction. Burnout syndrome (BOS) can be defined as a chronic work strain characterized by three dimensions: emotional exhaustion, depersonalization (or cynicism), reduced professional effectiveness. BOS typically strikes the helping professions like the teachers. Objective. The aims of this study are: 1) clarify the concept of BOS, as currently configured in the international scientific literature; 2) analyze the psychosocial risk factors in teachers; 3) develop a methodology for the assessment and prevention of the risk of BOS in the teachers. Methods. The literature review followed some of the PRISMA guidelines criteria. Results and discussion. The results of the study highlight BOS as a risk factor specific and distinct from labor-related stress. A strategy called VA.RI.B.O is proposed (Burn-Out Recognition) for teachers., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by Aracne Editrice, Roma, Italy.)

Unlabelled: The recent emergence of new democracies in North Africa results in a massive wave of immigration in Europe with thousands landing in recent months on the coast of southern Italy. This phenomenon has caused major problems of public order (PO), worsened by the presence of ever-increasing numbers of immigrants and multiculturalism, exposing the Special Forces of the Italian State Police in periods of intense work-related stress., Aims: To explore the relationship between work context (OP routine i.e. mass migration control vs. OP extraordinary i.e. the G8 summit) of special force policemen and psychological measures of job strain (demand-control, JCQ and effort-reward imbalance, ERI) related to objective measure (sickness absences)., Conclusions: data showed that in special police forces routine work as migration control is significantly more stressful than a single special event that presents a very high risk for law enforcement, probably due to positive changes in psychosocial work environment among special police force.

Musculoskeletal disorders (MSDs) are common among hospital workers. This cross-sectional study on 1744 hospital workers showed strong interaction between temperature complaints (OR 2.73), other environmental complaints (OR 3.12) and upper limbs disorders. A significant interaction between temperature and strain for upper limbs disorders (F = 9.52, p = 0.023) was also found. Environmental and psychosocial factors can interact increasing significantly the risk of MSDs.

Physical and moral violence against the workers of a local public health unit is perspectively studied in the period 2005-2011. Data were collected during periodic medical surveillance of all workers exposed to risk and with more than one year of seniority. The prevalence of the phenomenon is constant in the period under review. On average, each year a worker in ten is physically assaulted, and one in five is subjected to verbal abuse. The professional groups most exposed to violence are nurses (OR 2.67 IC95% 1.63-4.39) and doctors (OR 2.44 IC95% 1.34-4.46). The areas at greatest risk are the psychiatric care (OR 25.7, IC95% 11.1-59.6) and emergency and first aid (OR 8.8, CI95% 3.8-20.5). The workplace violence against health workers requires urgent preventive interventions.

Background: The periodic medical examination at the workplace should be an opportunity to monitor the health of workers. Psychological well-being and work-related stress are part of health, and therefore the occupational physician is required to control these parameters during his examinations., Methods: 29 companies with a total of 4069 workers were monitored by the Italian version of the questionnaire on air quality MMO40/IAQ, which contains a section on work-related stress based on the demand/control/support model of Karasek, and by Goldberg's scales of anxiety and depression., Result: Work-related stress was significantly correlated with the number of symptoms reported by workers (p < 0.001) and with levels of anxiety and depression (p < 0.001)., Conclusion: Despite its extreme simplicity, the scale of stress included in the questionnaire allows effective monitoring of the work-related stress.

Introduction: Tuberculosis (TB) is still a threat for healthcare workers (HCW), due to the non decreasing incidence, the spread of drug-resistance, the introduction of new tests for the screening, the relevant costs of surveillance of exposed subjects. These issues implicate a revision of activities to prevent TB in health-care settings., Methods: A multidisciplinary working group, led by occupational physicians, examined the activities to prevent TB performed in 9 Italian hospitals and reviewed the literature, with the aim to formulate evidence-based procedures., Results: In the considered hospitals, 23.000 HCW are classified as exposed to TB, out of 32.000 HCW exposed to biological risks; yearly, about 6000 subjects are screened for preventive, periodical or post-exposure surveillance and 110-130 chemoprophylaxis are prescribed. A high proportion of HCW (54-75%) refused or interrupt to assume the drugs. In the period 2004-2008, 14 occupational TB were diagnosed (9/100.000 HCW exposed to biological risks)., Discussion: Critical issues are the availability of a specific, written TB control plan, including risk assessment, protocols for identifying, evaluating, managing infectious TB patients, health surveillance, education programs, specifically addressed to increase Standard Precaution adoption and compliance to the screening and to adequate risk perception. Risk assessment identify HCW to be included in TB testing (characterized by low positive predictive value), unrecognized TB and environmental control needed; TB risk classification should include no more than 3 or 4 classes and performed by assessing the issues suggested in the Italian guideline. Tubercolin skin test should be used for HCW screening, adding in vitro test in specific circumstances (for example, skin test positivity in BCG vaccinated HCW); the frequency of the screening should not exceed 2 years. Periodical revision of preventive activities should follow up to date scientific literature and need appropriate data computing.

Transmission of infections from healthcare workers to patients during clinical activities has been an issue for at least twenty years. Studies and general considerations on this topic have brought to consensus documents, guidelines and public health policies, that were sometimes different depending on which social and cultural backgrounds they referred to. Though crucial, this issue remains nowadays not completely resolved, especially if we consider that no agreement has been found on how to face the problem. In this complex framework a question arises about the potential role of the occupational physician. We are talking in fact about a risk that, though present in the working environment, does not directly involve the workers themselves, but rather the people the healthcare workers get in contact with. We may say it is not only a problem of occupational medicine, but rather an issue involving medicine in working environment. This is a real challenge for those who deal with job healthcare and security, even if it is fundamental to fully understand how to face it. After a synthesis of the problem in its conceptual and quantitative dimensions, we now offer some new food for thought and outline some operating clues for the occupational physician too, as a contribution for a common and effective solution.

Introduction: The influenza illness is a concern for health care workers (HCW) due to the potential nosocomial transmission and sickness absenteeism. Immunization and Isolation Precautions might be effective preventive measures., Aims: To formulate recommendations on vaccination in healthcare settings., Methods: A multidisciplinary working group, led by occupational physicians (OP), examined the information on seasonal influenza immunisation campaign in 9 Italian hospitals in the period 2005-2009 and reviewed scientific evidence., Results: Many health organizations recommend vaccination of HCW. The literature shows that seasonal influenza vaccination of healthy adult have a modest effect in reducing work day lost; there is no evidence that it affects transmission or it prevents the disease in elderly residents. These observations might be conditioned by methodological limitations. Further studies are required to avoid the risk of bias and in pediatric settings. The rate of flu vaccination among HCW is widely variable and it depends on individual risk perception and information about efficacy and side effects. In the considered hospitals, in the five-years period the vaccination rate ranged between 0 and 29%: the median value was 16-17% in 2005, 2008 and 2009 (only against H1N1 influence), 11% and 13% in 2007 and 2006 respectively. OP participation in the vaccination campaign seems to increase the immunization rate., Discussion: Seasonal influenza immunization of HCW might be effective. We recommend to formalize written procedures in health care settings, to perform data computing and to periodically revise immunization activities and promotion and scientific literature, with the aim to appropriately address resources.

The biological risk from exposure to bloodborne pathogens in health care environments represents a frequent and widespread risk, involving a large number of exposed workers. On the basis of the available scientific innovations, the recent legislation regarding health and safety of workers and the experiences of SIMLII guidelines on health surveillance (HS) workers exposed to biological risk, a multicenter study was carried out, involving nine relevant hospitals and about 32 000 healthcare workers (HCW). A review of the literature was performed, with particular reference to the last 10 years. For each hospital, protocols of HS have been examined according to tasks and biological risk from bloodborne viruses (HBV, HDV, HCV, HIV) as well as management of HCW infected with this pathogens. Differences of risk management in the hospitals, in relationship also with recommendations of the literature have been evaluated. The literature supplies important indications for HS management of HCW exposed to bloodborne pathogens, with relevant information also for patient safety. Preventive examinations are in line with the recommendations of literature and similar across the hospitals for HCV and HIV, while they are different for HBV. Periodic surveillance was different for the frequency, among the hospitals and also as compared to national SIMLII guidelines. As for management, no differentiation among the hospitals was detected as referred to different risk of exposure, while differences were observed around definitions of restrictions. Finally, good medical practices to support occupational physicians in the prevention and management of HCWs' exposed to biological risks are suggested.

Organizational justice is a construct defining the quality of social interaction at work. Organizational justice can be divided into three categories: procedural justice (fairness of the decision-making procedures), distributive justice (fairness of outcomes) and relational justice (equity and fairness in the interpersonal treatment of employees by their supervisors). Organizational justice is related to employees' health and well-being. Low perceived justice has been shown to be associated with experienced stress reactions and related physiological and behavioral reactions, such as inflammation, sleeping problems, cardiovascular regulation and cognitive impairments, and with a high rate of work absenteeism. This paper is a review of the literature on organizational justice and its impact on workers' health.

The hospital risk assessment (VdR) is certainly a relevant issue concerning the activities of prevention for the health of healthcare workers in relation to biological risk. The aim of this paper is to provide an up-date of the issue, based on the suggestions of recent literature about the rules ratified by the new legislative decree and data supplied by the Group of 10 Hospitals participated in this multicenter study. From the analysis of data on healthcare settings (HCS) participating in the project the following considerations can be formulated: i) All HCS considered VdR from biological agents. The method recommended in the Guidelines SIMLII 2005 is the most followed ii) To grading the risk, the use of invasive procedures for carrying out the analysis results is a necessary element iii) the operators classified as exposed to biological risk, and therefore subject to health surveillance, represent almost all of workforce in 7 out of 10 HCS. The subgroup believes that VdR must be conducted in close collaboration with the occupational physician and should represent a worthwhile investment with spin-off character on prevention, decision making, empowering. The presence of environmental requirements and organizational procedures should be considered, so that HCS is enabled for an effective risk management, without which risk assessments cannot be performed. The method of VdR mentioned in the guidelines MLIS 2005, besides being the most widely used by the company participating in the study, still has practical reasons and opportunities to justify its use. The HCS group felt the need to propose an implementation of the definition of invasive procedures and EPP, together with individual assessment. Flexibility was suggested in identifying different levels of risk with the involvement of occupational physicians, especially in the presence of EPP, also in order to plan content and frequency of health surveillance.

Background: Nosocomial transmission of varicella-zoster virus, certain paramixovirus and rubivirus might pose a risk of morbidity for varicella (V), rubella (R), mumps (Mu) and measles (Me) in health care workers (HCW), patients and coworkers. International literature and European legislation recommend preventive interventions to minimize the risk., Methods: A literature review and a seroprevalence study were carried out in 9 hospitals located in north and central Italy, in order to evaluate risk assessment, health surveillance and fitness for work of HCW exposed to V, R, Mu and Me. Antibodies (Ab) against V, R, Mu and Me were determined. For a subgroup of 4 hospitals; sociodemographic, occupational data and sera were collected and analyzed., Results: About 36000 tests on about 9000 HCW were analyzed. Differences in seroprevalence ratios (V 85.7-95.1%, R 47-96.8%, Me 71.4-97.8%, Mu 52.5-87.6%) were detected. In a subgroup, a relevant number of non immune HCW was also found among women infertile age and areas at higher risk. Statistically significant differences were detected only for selected variables and viruses., Discussion and Conclusions: Data of multicenter study confirm literature evidences and allow to define good medical practices for manage and minimize the risk of nosocomial transmission of V, R, Me and Mu. Recommendation are issued about serologic screening on HCW exposed to all 4 viruses thorough the modern analytical techniques, in order to assess risk on individual a group basis and to select priorities for intervention. Vaccination should be prescribed for those HCW non immune, selecting areas and HCW according to priorities.

Background: This study explored the relationship between individual characteristics, physical and psychosocial work-related risk factors and the musculoskeletal pain among non-specialized personnel working in different kinds of social care., Methods: The study population consists of 342 employees of a cooperative for in-house, outpatient and scholar social care. The study was conducted using a cross-sectional survey design. Data were collected by means of questionnaires, including questions about having or having had musculoskeletal symptoms (12 months prevalence), the perception of social support from co-workers and superiors, the perception of job strain according to the Karasek's demand/control model, and anxiety and depression according to the Goldberg's 9-items scales., Results: In all groups prevalence rates of musculoskeletal complaints were high. A forward stepwise binary logistic regression analysis showed that symptoms from the low back were significantly related to psychological demands, and depression score; symptoms from the upper back were related to age, anxiety and depression; symptoms from the neck were related to psychological demands, authority over decisions, gender and anxiety., Conclusions: The results of the present study indicate that both low and upper back complaints and neck complaints are major health problems in social care workers. Musculoskeletal disorders seemed to be related both to job strain and to individual and emotional factors. The professional groups under study all are target for preventive interventions; these interventions need to be specified for each of the professional groups, and to include educational, organizational, and ergonomic measures.

The aim of this review is to describe the state of the art of the assessment of psychosocial risk at work in Italy. Questionnaires for such assessment can be divided into four broad categories: a) those aimed at identifying work-related stress factors and assessing work organization; b) those that investigate the individual's perception of stress; c) those assessing mediating factors; and d) those that measure the effects of stress. For a complete picture of psychosocial risk at work, all these factors should be taken into account. However, lack of time and resources available for the practice of occupational medicine imposes the choice of simple questionnaires that are quick and easy to administer. A vast range of options is available in the literature. This gives rise to the need for multicenter trials to be set up and for research methods to be standardized. It is strongly recommended to use questionnaires published in the international literature which have a validated Italian version with adequate psychometric validity index and standardized methods of administration.

Hazardous workers (HWs) are they who, depending upon their pathologic conditions, ageing or addictive behaviour, may pose at risk the safety and health of their colleagues, customers, and other people. Physicians charged of the medical surveillance of workers (Competent Physicians, CPs) are called to assess fitting for work of HWs. The aim of this paper was to analyze the frequency of debate about HWs in the online forums of the Italian CPs' website. Results show that there is growing attention on the HWs issue. Different stakeholders are involved, and some ethic dilemma are posed. A systematic approach to the problem, and the formulation of guidelines for CPs, is highly desirable.

Workplace assessment is a critical issue in small firms, and even in bigger ones if workers are scattered in large working areas. The traditional "top-down" approach, based on centralized risk assessment and hardly understandable documents, may have limited impact on workers' safety behaviour. The Local Sanitary Unit RMF tried to improve workers' participation to risk assessment, through auditing techniques. Waste workers signalled occupational condition of biological and chemical risk, which had not been taken into account in the Corporate Risk Assessment Document. The participatory approach to workplace risk assessment proved to be an easy and not expensive method to increase workers' awareness of risk and compliance to hygienic measures.

A 39 year male pharmaceutical worker employed in a clean-room developed in 2003 acute dysphonia after environmental disinfection with glutaric aldehyde and isopropyl alcohol. Laryngoscopic examination showed glottis edema; the syndrome healed after a cycle of cortisone. In subsequent years, withdrawal from exposure to irritating chemicals was observed. The worker, however, complained for recurrent episodes of dysphonia, in the absence of abnormalities of the larynx, and gradually developed intolerance for perfume, solvents, and other smelling substances. He came to our observation in 2007, showing strong conviction that occupational exposure had a causative effect in his complaints. He was working in an office open to public, and fragrance exposure appeared to be the main cause of dysphonic episodes. We rejected the hypothesis of association between complaint and job exposure, and advised him to work in a well defined working situation, such as in a clean room, where chemical contamination may be effectively controlled over time.

The potential risk factors for sick building syndrome (SBS) are not yet well elucidated. A questionnaire was administered concerning environmental conditions at the work place and complaints before and after the take-over of one company from another corporation. Workers had to move into new company, but were still working in old office building. Before the change, environmental objective and subjective conditions and workers' wellbeing were within normal range. The change did not involved air quality, however results of the questionnaire demonstrated an increased irritation of the mucous membranes and a reduction of well-being. The level and severity of symptoms appeared to be related to perceived indoor environment quality, and depression score. High stress related to work changes was found to be significantly associated with SBS symptoms. The psychosocial work environment can be an important predictor of SBS symptoms.

Job satisfaction is an important determinant of wellbeing and a moderator of stress at work. The Warr's Job Satisfaction Scale (JSS) is probably the most used questionnaire to assess job satisfaction. The aim of this paper is to evaluate the Italian version of the JSS. The questionnaire has been distributed to 632 health care workers. Results show that the Italian version of JSS has good reliability (Cronbach's alpha = 0.94). Principal component analysis revealed that a significant percentage of the variance (52%) was explained by a single factor which included all the 16 items. Varimax orthogonal rotation yielded the same two factors observed in the original questionnaire: intrinsic and extrinsic job satisfaction. The JSS may be an useful tool in the assessment of psychosocial risk at work.

The Italian version of a short anxiety and depression questionnaire developed by Goldberg et al. (1988) was applied to 1918 health care workers during periodical medical surveillance at work. Internal consistency reliability coefficient (Cronbach's alpha) value was 0.82 for anxiety scale (A), and 0.78 for depression scale (D); both scales can be retained "good". The factor structure of the two scales was examined through use of the factor analysis technique. The anxiety scale showed an homogenous pattern: a significant percentage of the variance (41.5%) was explained by a single summative factor which included all the items. Varimax orthogonal rotation of the D-scale variables yielded two factors, both typical of depression: reduced activity (6 items, 28% of variance), and poor self-image (3 items, 22% of variance). The scales would be used by occupational health physicians in medical surveillance as indicators of stress levels.

Complaints and symptoms related to the indoor environment experienced by 3380 workers were collected from 26 workplaces by using the Italian modified version of the Swedish questionnaire MM-040 and the Finnish IAQ-Indoor Air Quality questionnaire. Complaints related to environmental factors, and air related symptoms, were common in indoor workers. Women reported work related symptoms more often than men, the difference being significant. The Indoor Air Quality questionnaire is a suitable tool for the occupational health physician in investigating indoor air problems. In the Italian version six general symptoms were added to the symptom scale, in order to make the questionnaire feasible for analysis of general health, during medical surveillance at work.

The Work Organisation Assessment questionnaire (WOAq) has been translated into Italian, back-translated, and modified. Data were collected from 160 health care workers and 50 white-collar bank employees. Employee wellbeing was assessed by the General Health Questionnaire (GHQ12), while work stress was assessed by the Karasek's Job Content Questionnaire (JCQ). Reliability, as measured by Cronbach's alpha, was very good (0.95). Principal component analysis revealed that a significant percentage of the variance (41.8%) was explained by a single summative factor which included 25 of the 28 items. Varimax orthogonal rotation yielded the same five factors observed in the original questionnaire (reward and recognition, quality of relationship with management, quality of physical environment, quality of relationship with colleagues, workload). The WOAQ sum score was positively related to social support, as measured by the Karasek's JCQ (Spearman's rho = 0.523; p < 0.001). It was negatively related both to job strain (Spearman's rho = -0.516; p < 0.001) and psychological distress GHQ (Spearman's rho = -0.365; p < 0.001). In conclusion, the Italian version of WOA maintains the original characteristics. The questionnaire has strong association with job stress and employee wellbeing, and it may be useful in risk assessment procedures.

A descriptive exploratory survey was used to investigate the occurrence of physical workplace violence among health care workers as well as the complaints and responses to such violence. The questionnaire was used for collecting data from a sample of 355 workers. Results showed that 25.6% of hospital workers reported physical aggression at any time of the working life, 8.5% in the last year. Injured workers showed significantly higher environmental complaint score than other workers. The results of the study indicated the importance of adopting hospital policies for dealing with incidents of violence.

Health care workers are exposed to a wide range of musculo-skeletal hazards: manual loading (nurses, ancillary personnel, blue-collars), body posture (technicians, physicians, nurses, blue-collars), repetitive motions (clerks, blue-collars, technicians). An integrated management approach to tackle musculoskeletal disorders (MSDs) was proposed in three health care organizations. An action programme, including participatory modification of tasks and jobs, and early identification and treatment of MSDs cases has been implemented, following a proper assessment of the hazards and risks. Participatory ergonomics programs proved to be effective in reducing absence rate and prevalence of workers with reduced work capacity, and in increasing workers' job satisfaction.

Stalking is a form of interpersonal victimization that can have irrevocable effects on the lives of victims but is frequently misunderstood and minimized. This article presents a case study of a woman who was stalked in the workplace by a 39-year-old male colleague, and offers recommendations for occupational health clinicians charged of medical surveillance of workers (so-called "Competent Physicians") who have to cope with stalking at the workplace. The prevalence of stalking provides many opportunities for Competent Physicians to intervene, but first they must recognize and understand the problem. The study underlines the inadequacy of the current legal and medical responses to the needs of these victims.

The occupational health physician charged of medical surveillance of hospital workers is often mandated to manage impaired physicians. Some "red flags" may be observed during medical surveillance of workers, and this should elicit the suspect that the colleague is impaired by chemical, psychiatric, or neurological disease. Three emblematic cases are discussed. While English-speaking countries have faced the problem since the 70's, Italy currently lacks policy to deal with impaired physicians.

Participatory techniques have been adopted in vigilance of Civitavecchia's port activities, in order to control and remove injury causes. Injuries were studied by small participatory groups of port workers. As an example, seafastening operations were analyzed. The project team encouraged the workers to design ergonomic measures, or to modify work organization. Workers made suggestions and presented their points of view, that were reported to management for implementation.

Objectives: A program to promote occupational health among wood dust workers in the district of Civitavecchia., Methods: In recent years, occupational health physicians charged of medical surveillance of wood workers (Competent Physicians, CPs) had been invited to perform a peer-review of their methods and activities. In the present phase, CPs have been invited to show the result of their medical surveillance., Results: One hundred forty seven wood workers were submitted to rhinoscopic examination. The prevalence of woodwork-related rhinitis and other pathologic signs, including nasal adenocarcinoma (one case), was 32.7%. The prevalence of rhinitis in woodworkers increased with years of working as a woodworker., Conclusion: Wood dust and chemical exposures in wood workers represent a serious risk of disease for the nasal cavity and paranasal sinuses.

Occupational stress is currently studied by the Job Demand/Control model of Karasek, and the Effort/Reward Imbalance model of Siegrist. In this study we have translated into Italian and validated the short form of the Job Content Questionnaire (JCQ) and of the Effort Reward Imbalance Questionnaire (ERI). The questionnaires were applied to 531 health care workers during periodical medical examinations. Estimations of internal consistency, based on the correlation among the variables comprising the set (Cronbach's alpha), in each case were satisfactory (alpha ranging from 0.76 to 0.89), with the exception of the control" scale of JCQ (alpha = 0.57). Exploratory factor analysis showed that "control" scale of JCQ, and "reward" scale of ERI could be divided into two and, respectively, three sub-scales. The Karasek's and Siegrist's models made distinct contributions to explaining perceived work stress. Both JCQ and ERI questionnaire may be useful in occupational health.

The etiology of systemic sclerosis, probably multifactorial, is not yet well defined. Among the many endogenous and exogenous factors probably involved, occupational elements may play an essential role. Here we report a cluster of local scleroderma and systemic sclerosis, which occurred in a small group of typography workers exposed to polyvinyl-acetate glues, containing up to 1% of vinyl-acetate. Vinyl acetate exposure has been associated with acidification of the intracellular environment, which is thought to produce cytotoxic and/or mitogenic responses that are the sentinel pharmacodynamic steps toward cancer. Autoantibody production in systemic sclerosis depends upon intracellular acidification. More studies are needed to clarify the relationship between vinyl acetate exposure and scleroderma.

Stressors at work are classified, according to Kalimo (1980) and Cooper (1976) in six broad categories: role within organisation, intrinsic stressors, interpersonal problems, work climate, career, social context. The 40-item Factors of Stress Questionnaire has been proposed as a screening instrument for causes of stress at work. The factor structure of the questionnaire was evaluated in 371 health care workers. Internal reliability analysis was also conducted. The Factor Analysis, according to the Kaiser rule to drop all components with eigenvalues under 1.0, gave nine principal components, with a 58% cumulative variance explained. However, most of these components had poor comprehensibility. The first component was significantly related to most of the items. The questionnaire showed good reliability (Cronbach's alpha = 0.93).

Workers with handicap or psychological impairment are frequently submitted to mobbing. If causative factors of psychological disorders are not recognized, the physician charged of medical surveillance of workers may himself become a prosecutor and enhance the mobbing actions to the extent that the mobbed worker is discharged. In order to avoid this undue effect, the physician should strictly adhere to the body of legislation and to good occupational medicine practices. Health surveillance for occupationally exposed groups of workers is required under specific health and safety legislation. Workers unexposed to hazard in the workplace cannot be included in health surveillance programme, and declaring these workers unfit for their job is a patent violation of Workers' Statute Law. Psychological disorders should be carefully evaluated in order to clarify their relationship with work. The case of a worker affected with schizophrenia, already reported in the literature, is here re-analysed in order to emphasize these concepts.

Background: Working in health care increases the probability that an impaired worker be hazardous for third persons., Methods: A literature review concerning identification, intervention, and treatment of hazardous health care workers is here reported., Results: Published reports of health care worker-to-patient transmission of bloodborne infections, and papers concerning the so-called "impaired physician", have been reviewed., Discussion: According to European directives on workers' health and safety, the occupational health physician charged of medical surveillance of hospital workers is often mandated to manage impaired professionals., Conclusions: Strategies for early identification, treatment and rehabilitation of impaired physicians are reviewed and suggestions for preventive action are given.

Violence and aggression in health care settings is an ill-defined and under-reported problem. Early risk assessment, adequate training and information of health care workers, and specific monitoring tools (such as the Violent Incident Form, VIF) are necessary for risk management.

The ASIA model (assessment, surveillance, information audit) has been applied in wood work. The physicians charged of medical surveillance of workers were enrolled in a specialistic audit, concerning the main aspects of their preventive activity. Doctors significantly improved the quality of their surveillance programs, so identifying two cases of work-related illnesses (nasal cancer and poliposis). Even quality of risk assessment, and information of workers, were significantly improved after the audit. The ASIA model proved to be feasible and useful in wood risk prevention.

Risk management of occupational exposure in hospital personnel involved in the preparation and administration of antineoplastic drugs was performed using the A.S.I.A. model. The first step was auditing of compliance. Training of workers specifically addressed the areas of deviation from guidelines. Medical surveillance, and risk assessment, were oriented toward observed deviations.