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The occurrence of contagious diseases such as measles, varicella, mumps and rubella in the hospital open creates situations of alarm, due to the potential involvement of workers, but most importantly for the oftentimes harmful consequences for critical patients, such as pregnant women or immunocompromised individuals. In 2007 antibody titration was initiated in our hospital for four infectious diseases, also pursuant to the Lombardy Region Resolution N. VIII/1587 of 22-12-2005 "Decisions regarding vaccinations in children and adults in the Lombardy Region" which indicate the departments in which a priority exists: maternity-neonatal and infectious illnesses. In 2011 a vaccination campaign was launched for unprotected operators in the Health and Medical Management departments: after an interview with the competent physician of reference, the subjects voluntary submitted themselves to vaccination. The protective antibody data encountered over the years are similar to that reported in the literature, with coverage percentages greater than 93 % for varicella and rubella, over 89% for measles and over 85% for mumps. Approximately 80% of the operators are protected against all four diseases. However, the dramatic consequences of potential contagion lead us to strongly recommend vaccinations for non-protected subjects. At present 37 operators have been vaccinated with the trivalent MMR vaccine (Measles, Mumps and Rubella) and 14 for Varicella. The antibody response was verified in all cases. [ABSTRACT FROM AUTHOR]

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THE ROLE OF THE OCCUPATIONAL PHISICIAN IN DISABLED RETURN TO WORK. 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 partecipating 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. [ABSTRACT FROM AUTHOR]

Il D.Lgs 81/08, recepimento di direttive europee, prevede che nella valutazione dei rischi si tenga conto anche delle differenze di genere. L'intento del presente studio descrittivo è di evidenziare, attraverso l'analisi delle malattie professionali segnalate in un campione di 100 lavoratrici valutate presso la UOOML (Unità Operativa Ospedaliera di Medicina del Lavoro) di Bergamo nel triennio 2008-2010, gli aspetti nevralgici e le attuali carenze che, nella valutazione dei rischi, nella sorveglianza sanitaria, nei processi di diagnosi e di riconoscimento delle malattie professionali, derivano dalla inadeguata considerazione delle differenze di genere. Il campione osservato è costituito da 100 donne (6,4% di tutti i soggetti valutati a cui sono state riscontrate tecnopatie nel triennio), di età media 50 anni (dev std 12,5) e anzianità lavorativa totale media di 22 anni (dev std 7,8), giunte all'osservazione principalmente inviate dal Medico Curante per sospetta malattia professionale. Nel triennio sono state segnalate 125 malattie professionali, di cui la maggiorparte a carico dell'apparato osteomioarticolare (63%), seguite dalle dermopatie (14%) e dalle tecnopatie respiratorie (12%). I settori più colpiti sono quello della sanità (22%) e il tessile (17%). Tra le parrucchiere sono state segnalate circa il 12% delle tecnopatie, di cui la maggior parte patologie cutanee (44% delle dermopatie segnalate). Due casi di mobbing su cinque sono stati riscontrati in lavoratrici del comparto sanità. La maggiorparte delle donne colpite da tecnopatie sono coniugate e hanno almeno un figlio (41%). I dati emersi sottolineano l'importanza di arrivare a costituire modelli valutativi che tengano conto delle differenze biologiche di genere e delle variabili extraprofessionali, in particolare in quei settori lavorativi e per quegli apparati che nelle donne risultano essere particolarmente suscettibili al manifestarsi di patologie da lavoro. [ABSTRACT FROM AUTHOR]

Vengono descritte le caratteristiche di una popolazione di lavoratori afferiti alla UOOML di Bergamo per i quali è stata inoltrata segnalazione di ipoacusia professionale, in seguito all'istituzione di un archivio informatizzato che consente di analizzare istantaneamente età, comparto di appartenenza, anzianità lavorativa, committenza, e caratteristiche dell'ipoacusia. [ABSTRACT FROM AUTHOR]

Copyright of Giornale Italiano di Medicina del Lavoro ed Ergonomia is the property of Giornale Italiano di Medicina del Lavoro ed Ergonomia Editorial Board and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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.

In Bergamo there is a huge network of 46 "health promoting companies" following an accreditation system which requires the implementation of best practices on health promotion in the workplace. For some of these practices, Company Doctor are involved: management of smokers and workers with alcohol consumption; courses for employees about WHP, use of SMS and web-based systems. Local Public Health Authority has created an annual training which also provided tools to Doctors for their activities in the project. Nowadays 55 doctors have been trained. For Accreditation 2012 eight companies will declare as good practice the training of its CD about smoking and three companies their activities on alcohol abuse prevention and control.

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.

The occurrence contagious diseases such as measles, varicella, mumps and rubella in the hospital open creates situations of alarm, due to the potential involvement of workers, but most importantly for the oftentimes harmful consequences for critical patients, such as pregnant women or immunocompromised individuals. In 2007 antibody titration was initiated in our hospital for four infectious diseases, also pursuant to the Lombardy Region Resolution N. VIII/1587 of 22-12-2005 "Decisions regarding vaccinations in children and adults in the Lombardy Region" which indicate the departments in which a priority exists: maternity-neonatal and infectious illnesses. In 2011 a vaccination campaign was launched for unprotected operators in the Health and Medical Management departments: after an interview with the competent physician of reference, the subjects voluntary submitted themselves to vaccination. The protective antibody data encountered over the years are similar to that reported in the literature, with coverage percentages greater than 93% for varicella and rubella, over 89% for measles and over 85% for mumps. Approximately 80% of the operators are protected against all four diseases. However, the dramatic consequences of potential contagion lead us to strongly recommend vaccinations for non-protected subjects. At present 37 operators have been vaccinated with the trivalent MMR vaccine (Measles, Mumps and Rubella) and 14 for Varicella. The antibody response was verified in all cases.

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.

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.

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.

Based on definition of worker according to D.Lgs.626/94, art.2, c.1 also the University Students before to start their pratical training in Hospital must be submitted to sanitary surveillance by Occupational Health Physician. Aim of this paper is to report about the Job Fitness Management regarding no. 231 University School of Nursing's Students that in some cases has involved the formulation of limitations and/or prescription.

The aim of this paper is to report the case of a Physiotherapist working in a big hospital, affected by Chronic Fatigue Syndrome (CFS). After the diagnosis, made in an High Specialized Center, the Occupational Health Physician, with the cooperation of the Nursing Managing Direction, the Chief of the Department of Rehabilitation and the Physiotherapists Coordinator, had to cope with the job fitness management. Afterwards the patient, in accordance with the Physician of a Trade Union Medical Office and the Occupational Health Physician, tried to obtain the disability pension, that at the end was given by the Medical Commission of the ASL.

Lombardy Region, with the Deliberation NoVIII (22-12-2005), about vaccinations in childrens and adults, suggest to offer to the healthcare workers (HCW) of 'Infectious diseases' and of 'Obstetrics and 'Pediatrics' Department, the vaccines for varicella and measles, mumps and rubella (MMR). We performed in 120 HCW of our hospital the dosage of antibodies versus these infectious diseases, in order to protect both workers and critical patients. The study results show that more than 80% of the HCW was immune to all the four infectious diseases. The percentage of immunisation to measles, varicella and rubella exceeded the 90%, while 87.5% of HCW was immune to mumps. We are going to offer the vaccine to the operators that are not immune, but we are also thinking about offer it to the HCW working with critical patient.

Background: The production and the use of hard metal tools have becoming increasingly widespread since the second half of the last century also thanks to the great variety of applications that extends from DIY to the aeronautical industry. It has already been known for many years that occupational exposure to hard metals dusts (which occurs especially in people employed in production of the metals or in the sharpening of tools that contain them) can determine the onset of pulmonary fibrosis, bronchial asthma and contact dermatitis., Objectives: clinical evaluation of a peculiar case of hard metal disease. Descriptions of cases with single pathological pictures due to hard metals, are, in fact, common in the literature, neither are cases with two different clinical pictures (more frequently asthma and pulmonary fibrosis) rare. However, cases in which all the signs and symptoms appeared simultaneously have never been reported., Methods: a male worker aged 41 years, employed i a hard metal factory for seven years in sintering, and then in grinding. A year later he developed dry cough, wheeze, and eczematous patches. The diagnosis of hard metal disease was based on the work-related symptoms, clinical evaluation, spirometry, chest x-ray, HRCT and patch tests., Results: during the working period, ventilatory function decreased substantially, and then normalized one month after the patient stopped working. Patch tests confirmed sensitivity to cobalt, and skin lesions improved, as did ventilatory function. Chest x-ray and HRCT showed a pulmonary fibrosis that, at the last radiological examination, was still unchanged., Conclusions: The particular susceptibility to the development of the diseases, could, in our opinion, be in relationship with the race of the subject, many studies (particularly American) have shown that allergic diseases are more frequent, and often more serious, in African subjects, particularly in immigrants from Africa. In the case of occupational diseases attention also needs to be given to the fact that immigrants are often employed in duties that involve a greater exposure to harmful or sensitizing agents. The occurrence of a whole series of occupational allergic diseases among these workers is therefore to be expected.

The Occupational Health Department of Bergamo Ospedali Riuniti and Occupational Health Public Services set up a project in order to check the health surveillance quality in noise exposed workers. 887 hearing threshold tests, performed between 1998 and 2002, were examined; the audiograms concerned 304 workers exposed to industrial noise higher than 85dB(A), employed in 22 textile, mechanical, wood, stone, building and paper industries. After examining the 887 audiograms we noticed that the health surveillance of noise exposed workers up to now, 14 years after the issuing of the Legislative Decree 277/91, reveals many critical situations, showing an inadequate accuracy and possibility of interpretation of the audiometric tests.

Background: There are very few studies in the Italian and international literature concerning occupational diseases and their prevention in the building industry., Objectives: The aim of this study was risk assessment in the building industry., Methods: We analyzed the international literature and the results of our cross-sectional study, which involved more than 1000 workers., Results: The analysis of several studies and of our experience suggests a high occupational risk in this field and shows as main risk factors: noise, dusts, fibers, manual lifting, prolonged static positions, repetitive motions, hand-shoulder and whole-body vibrations, chemicals and weather conditions. In addition, non-occupational risk factors can influence health: e.g., habits and lifestyle, like hypercaloric diet, cigarette smoking and alcohol consumption., Conclusions: Preventive measures and training initiatives are urgently needed to improve the safety and the health among building workers.

In the Italian and international literature there are very few studies about work diseases and their prevention in the construction's compartment. The analysis of the most recent articles about this theme, however, suggests the presence of an high professional risk in the compartment and indicates as the most relevant risk factors noise, dusts, fibres, manual lifting, prolonged fixed postures, cumulative trauma disorders, vibrations, chemical substances and climatic conditions. The role that extra-lavorative risk factors can play on health is also relevant; those risks are due to the workers' peculiar life-style: hyper caloric diet, smoke and use of alcohol. Interventions of medical hygienic prevention, formation and information are therefore necessary. Lombardy Region, which from many years is careful to the problems about the prevention in building yards, has created a Working party who has elaborated the "Guide Lines for the sanitary surveillance in the building industry". The indications reported in the Guide Lines could represent, even for the occupational-doctors of the building contractors of the New Hospital, a good base for the working out of the workers' health care activity, in the respect of the dues of the law in force.

Unlike other apparatuses, the potential effects on the nervous system of occupational exposure to anaesthetic gases have not been exhaustively reviewed. Because of the relevance of these effects, their significance of the quality of life of the exposed subjects and of the increased risk inherent in their delicate work tasks, these themes deserve the greatest attention. This paper briefly examines the data from the international literature as well as the neurobehavioral methods employed, underlines the existing gaps of knowledge and eventually proposes strategies aimed at filling these gaps of knowledge.

The authors describe the results of a preliminary clinical survey of a group of 220 health workers, physicians and 151 nursing and auxiliary staff members of a large regional hospital in Lombardia, who are exposed to volatile anaesthetics. Contact dermatitis, varices of the legs and arthrosis, particularly that of the cervical and lumbar tract, are the most frequently reported disease in our population. In 75% of cases these disturbances arose after the beginning of the job working in the operating-theatres. When compared with a control group there was a statistically significant difference for contact dermatitis (p less than 0.01) and cervical tract arthrosis (p less than 0.02). The statistical comparison among the subjects exposed to the anaesthetics gases, who were stratified on the basis of the level of exposure and of seniority, confirms a higher prevalence of symptoms due to a reduction of alertness and of psychological and psychomotorial performances in the more exposed personnel. The comparison between female staff exposed and not-exposed to the gases did not show an increase of abortivity, while a statistically significant difference was evident between the female staff (either exposed or not-exposed) and the wives of male workers not exposed to the anaesthetics gases.

The aim of this work is to present a computerized program for an epidemiological evaluation of the data relevant to workers occupationally exposed to anesthetic gases and of the related occupational risks. The great handiness, the speed of execution, the possibility of carrying out researches by mean of multiple variables correlation and the prompt availability of the data, are the distinguishing features of this program.

We describe a case of acute hepatonephritis in a worker of a pharmaceutical factory, due to sporadic and short exposures to chloroform at levels even 70 times higher than its TLV.

The present report deal, a year after its beginning, with the results of a programme for health control regarding 592 ex-employees of Società Bergamasca Industrie Chimiche. Azo dyes were obtained from benzidine and beta-naphthylamine in this factory from 1947 to 1968. The report analyses the organizing difficulties and the troubles which caused a scarce performance of the programme at different levels: the subjects interested in the control, the Commission responsible for the district, the doctors in charge, the laboratories, the hospital division. In the end some proposals are advanced referring to the provision of the ministerial circular letter no 46, dated june 12, 1979, about the medical control of workers who leave the hazardous working job.