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The economic crisis that started in 2008 in many countries of the world, has resulted in the reduction of many jobs in all the regions of Italy, most especially in the Southern part of the Country. The employment difficulties experienced by both the unemployed and employed workers, experiencing increasingly precarious conditions, will inevitably result in a worsening of psycho-physical conditions of the population; especially as an increase in stress-related diseases. Aims: The aim of this study is to point-out the possible effects of the economic crisis on the health status of the population resident in Italy and Sicily, evaluating data from years preceding and following the year 2008. Methods: We have selected two populations: the first comprising the inhabitants of the Italian territory, the second comprising the inhabitants in the Sicilian territory. We evaluated official statistical data regarding demographics, information about lifestyles that can cause cardiovascular diseases, and also statistical data about job accidents and occupational diseases. We also investigated the use of antidepressant drugs, as indicators of psychological distress and metabolic diseases in the two populations. Results: Data analysis shows an overall increase of people migrating to foreign countries, increased unemployment for all age groups, with dramatic spikes in Sicily, and degenerating lifestyles associated with increasing numbers of subjects suffering from depression, diabetes and ischemic heart disease, although treatments and prognosis have improved. Work-related accidents only have been significantly reduced, while at the same time reports of occupational diseases increase. Conclusions: It is necessary to change economic policies and development throughout the country; especially in the Southern regions, in order to substantially improve the mental and physical health of the population.

Background: Leishmaniasis is a widespread infectious disease, but there is not much information about its prevalence in high risk occupational categories. Objectives: Te aim of this study is to assess the prevalence of Leishmania immunological positivity in human skin tissues collected from subjects living in Western Sicily, with suspected cutaneous Leishmania infection, in order to explore the risk possibly related to occupation. Methods: 318 consecutive subjects (M/F ratio=1.0, mean age=40±25.4 years), attending the Dermatology Department of the University of Palermo Hospital from 2013 to 2015, without any previous history of Leishmania infection and performing various occupations, were included. Parasite isolation and PCR-RT test on skin scrapings were performed to evaluate the immunological status; all data were analyzed by the chi square test, comparing all positive results from the different provinces. Results: 81 (50.9%) out of 159 females and 79 (49.7%) out of 159 males were found PCR-RT positive to Leishmania infantum, with a higher risk in the Agrigento district (p

Introduction and objective: Italy is a country with a low incidence of tuberculosis and in the last fifty years the annual number of TB cases decreased from 12,247 to 4,418, showing a reduction of approximately 64% in the number of cases and 71% in incidence. Despite of this encouraging trend, in the last years the epidemiology of tuberculosis changed and today it is a re-emerging infectious. The aim of this study is to measure the prevalence of positivity to tuberculosis infection (latent TB) in students, without any obvious manifestation of disease, attending degree courses of the health care professions and postgraduate medical courses of the School of Medicine of the University of Palermo, Italy. Materials and methods: A cross-sectional observational study in students of nursing, midwifery, dentistry degree courses and in resident physicians of postgraduate medical schools was carried out from January 2012 to July 2016. Mantoux test was performed and all positive cases were tested with Interferon-Gamma Release Assay (IGRA). Results: Of the 1,351 subjects evaluated, 25 (1.8%) resulted positive to Mantoux test; in 17 students (1.2%) the diagnosis was confirmed with IGRA. Positive cases were significantly more frequent among students attending Postgraduated Medical School Courses (p

Introduction and objective. Little is known about the development of chronic Q fever caused by Coxiella burnetii in occupational risk groups and in the general population in Italy, as well as in many countries in the world. The aim of this study was to highlight the presence of the infection in a sample of workers operating outdoors (but not directly in contact with animals), in three provinces of western Sicily, in order to detect the human seroprevalence and compare the obtained data with those found in animals raised in the same territory. Materials and methods. The study included 126 generic seasonal agricultural workers (labourers), 84 male and 42 female; none of whom were aware of any previous contact with Coxiella burnetii. Their immunologic status against Coxiella burnetii was tested through research and titration of both phases I and II specific antibodies (IgG) with an indirect immunofluorescence assay, using anti-antibodies labeled with fluorescein isothiocyanate. All data were statistically analyzed, comparing all positive results from the three provinces through variance analysis, and then comparing human results with those obtained from animals raised in the considered areas, specifically, 1,511 cows, 46 of which were found positive (3.04%), and 3,391 sheep, 548 of which were found positive (16.16%). Results. Anti-Coxiella antibodies were found in nine of 42 females sampled (21.4%; 95%CI=[9.0–33.8]) and 21 of 84 males sampled (25.0%; 95%CI=[15.7–34.3]). 60% (18 of 30; 95%CI=[42.5–77.5]) of seropositive samples were positive either for Phase I antigen or for both Phase I and II antigens, representing cases of chronic infection. Applying Spearman’s rank correlation, the percentage of seropositive humans was significantly correlated with that observed for sheep (r=1.00; p

INTRODUCTION: The work of housewives, in many ways, still lacks professional respect; particularly with respect to the neglect of exposure to risk factors such as: chemical, physical, biological, psychological and accidents. The purpose of this study is to analyze the possible impact of environmental risk factors on the physical and mental health of a group of Sicilian housewives. METHODS: We enrolled housewives living in Palermo and Catania and administered an anonymous questionnaire to obtain knowledge of three factors: (1) the habits of the respondents, (2) the type of house in which they lived and worked, (3) the diseases they suffered. We also administered them a hospital anxiety and depression scale questionnaire. A statistical analysis was performed calculating the p value and a Yates chi square test to compare the percentages of diseases that emerged in three different groups: (1) the sample, (2) an ISTAT report on women of the same average age performing various work tasks ‘other than housework’ and (3) an ISTAT nationwide report on the housewives of the same average age. Finally, we evaluated the average questionnaire scores measuring anxiety and depression, and correlated those scores with age. RESULTS: The sample group consisting of 468 housewives showed high percentage of allergic disorders (35.6%), which is statistically significant when compared to the ISTAT national data on women generally and housewives particularly of the same average age. The evaluation of data on anxiety and depression showed an average score indicating borderline pathology for both (anxiety and depression) and increasing proportionally with increasing age. DISCUSSION: It is considered appropriate to inform society and the scientific community about the issues concerning these housewife workers, who must be regarded as and recognized as workers.

Il lavoro domestico presenta numerose peculiarità che ne rendono complesso l’inquadramento dal punto di vista della salute e della sicurezza dei lavoratori. In primo luogo il soggetto casalingo trascorre molto tempo all’interno delle mura domestiche, con tempi di esposizione alle diverse noxae lesive lunghi e difficilmente quantificabili; in secondo luogo è estremamente difficile promuovere in modo capillare le attività tipicamente svolte negli altri ambiti lavorativi, quali l’attuazione delle misure di prevenzione e protezione del lavoratore, la valutazione dei rischi, l’informazione e la formazione o la sorveglianza sanitaria. I vari fattori di rischio, sia per la sicurezza sia per la salute dei lavoratori, sono pertanto causa di un elevato numero di infortuni domestici in Italia, le cui cause prevalenti sono la disattenzione, i comportamenti imprudenti e i malesseri improvvisi, nonché di frequenti e spesso misconosciute patologie professionali e lavoro-correlate, causate da agenti fisici, chimici, biologici, nonché legati all’organizzazione del lavoro, fra le quali più frequenti risultano le allergopatie, i disturbi muscolo-scheletrici ed inoltre le patologie della sfera psico-affettiva (disturbi ansioso-depressivi e da stress).

Background: the entrance of women in the workforce, due to a their growing cultural and, accordingly, social commitment, changed many aspects of their lives; the research or the maintenance of a job, especially during periods of severe economic crisis, leads to a delay of many physiological stage, maternity at first. The aim of this study is to verify and, if it really happened, to quantify an increasing age of first-time mothers in a sample of mothers in the province of Agrigento in the last 20 years, correlating any positive response to the work task performed. Material and Methods: we have enrolled all primiparous women who gave birth in a hospital in the province of Agrigento, from January 1993 to December 2012; through retrospective analysis of medical records, prepared during hospitalization, we have assessed the following parameters: a history (family, physiological, pathological remote and proximate, pharmacological and work), nationality, age at first birth, the task being performed, mode of delivery, days of hospitalization and possible fetal pathologies occuring in newborns. Then we have processed statistically data calculating mean, median, range and standard deviation. To assess statistical significance of the difference in the average age of the first pregnancy by professional category and decade, it was used the two-way anova test. Results: the results show an overall increase in age of first-time mothers, especially in women workers with high profile professional tasks. Discussion: the increase in the age at first pregnancy can’t be considered a positive event, because of the increasing risk of complications and maternal-fetal pathologies that is directly proportional to aging.

Il rischio biologico in ambito lavorativo rappresenta un fattore di grande attualità e in continua evoluzione, anche in relazione alla crescente attenzione verso agenti patogeni resistenti alle comuni terapie, alla identificazione di patologie emergenti (influenza aviaria, SARS, West Nile) e all’ubiquitarietà del rischio. L’attenzione del medico del lavoro deve rivolgersi a varie categorie lavorative esposte, oltre quelle inerenti l’ambito sanitario la cui trattazione sarà affrontata in altro capitolo; fra queste ricordiamo, in un elenco non esaustivo, tutte le professioni veterinarie, quelle attive nel settore primario, nonché gli addetti alla rimozione e trattamento dei rifiuti, al trattamento delle acque reflue e degli impianti fognari, alla manipolazione degli alimenti e dei derivati animali, gli operatori dei centri di estetica, gli addetti ai servizi cimiteriali, i lavoratori che necessitano per ragioni di servizio di recarsi e soggiornare all’estero in Paesi ad elevata endemia di malattie infettive particolari, i lavoratori di ambienti indoor. Fra le malattie infettive di maggiore risalto in ambito occupazionale si ricordano le zoonosi, quali la brucellosi, le rickettsiosi, la leishmaniosi, l’echinococcosi, particolarmente endemiche nelle regioni centro-meridionali italiane, ed altre meno diffuse, ma non trascurabili, quali la borreliosi di Lyme, frequente nelle regioni settentrionali, la febbre Q, la leptospirosi, la tubercolosi da Mycobacterium tuberculosis Avium e Bovis, l’afta epizootica. Un cenno a parte merita il tetano, per le strategie di profilassi che il medico del lavoro deve adottare nelle categorie lavorative esposte. Fra le patologie ad etiologia virale grande rilievo deve essere dato alle epatiti virali a trasmissione parenterale anche inapparente, interessanti principalmente il settore sanitario, ma anche quello della rimozione e trattamento dei rifiuti e i centri di estetica; in altri ambiti come per esempio quello del trattamento delle acque reflue, della manipolazione degli alimenti, nonché degli istituti di istruzione primaria e nelle comunità chiuse (caserme, carceri ecc.), l’attenzione dovrà essere rivolta alle epatiti a trasmissione fecale-orale (epatite A, epatite E). Non di minore importanza per le comunità chiuse è il rischio di contrarre l’influenza, per la notevole diffusione della stessa nella stagione invernale, con importanti ripercussioni economiche aziendali e sociali. Esistono anche malattie micotiche non trascurabili in alcuni settori lavorativi, soprattutto in quello primario e nel terziario, fra cui l’aspergillosi, l’istoplasmosi e la criptococcosi; in questo caso il medico del lavoro, in occasione delle sorveglianza sanitaria, deve, quanto più possibile, evitare l’esposizione al rischio di coloro che per motivi vari possono essere considerati ipersuscettibili (ad esempio soggetti immunodepressi). Infine, nei confronti dei lavoratori che devono recarsi all’estero, soprattutto in aree tropicali, è necessario adempiere alla prescrizione di misure di prevenzione e protezione nei confronti di alcune patologie endemiche, quali l’amebiasi e la malaria. Molte patologie infettive sono soggette a notifica obbligatoria ai sensi del D.M. dell’11/12/1990 e a denuncia obbligatoria ai sensi dell’art. 139 del D.P.R. 1124/65. Un ruolo attivo in questo senso è rappresentato dal medico del lavoro che pone diagnosi in ambito occupazionale e che rappresenta un importante punto di riferimento nell’attuazione delle corrette misure di prevenzione e protezione per la gestione del rischio biologico.

Background: Attention to vocal pathologies in occupational categories that provide for a continuous use and often abuse of phonation has grown in recent decades. Objectives: Aim of this study was to evaluate presence of laryngopathies by vocal abuse in subjects occupationally exposed, namely teachers and singers, compared with non-exercising jobs at risk, also checking if self-assessment tests and spectrographic signals could be predictive of disease observed with endoscopy. Methods: We therefore proceeded to enroll on a voluntary basis, after information campaign, subjects, which in addition to an ananmnestic framework, underwent a multidisciplinary evaluation, which included, besides a fiber optic laryngoscopic examination, the preventive administration of self report test on perception the quality of their voice, or the voice Handicap Index for professional speaking voice and not exposed to risk, and the Singing Handicap Index for the singers, and also the spectrographic analysis of voice output (spoken or sung). Results: The results, in addition to confirming the guessed higher prevalence of disease in voice professionals, provide the opportunity to integrate the common medical diagnostic investigations, such as fiber optic laryngoscopy, with self report test and spectrographic survey, which showed a significant relationship with endoscopic data. In fact, the results confirmed that the VHI and the MSHI, integrated with the spectrographic test can be a valuable tool to assess the implications of bio-psycho-social aspects of professional and non-voice disorders, contributing significantly to validate the provisional diagnosis of diseas. Conclusions: This study recommends not only the implementation of vocal education during the training of teacher to prepare the vocal professional user, but also a multidisciplinary approach to voice disorders in occupational exposure population.

In accordo con l’OMS, il D.Lgs. 81/08 ha introdotto l’obbligo di valutare in tutte le realtà lavorative il rischio stress, secondo i contenuti dell’Accordo Europeo dell’8 ottobre 2004. Sulla base del nuovo obbligo di legge, la Commissione Consultiva ha fornito nel novembre 2010 le indicazioni metodologiche. Il settore occupazionale prescelto per l’analisi è stato una azienda ospedaliera di una provincia siciliana ai cui lavoratori, distinti per partizioni organizzative e mansioni omogenee, è stato somministrato il Questionario Indicatore modello ISPESL-HSE. Dal presente studio è emersa una percentuale di rischio alta per tutti i reparti afferenti al Dipartimento di Emergenza e per l’U.O.C. di Ortopedia e Traumatologia, media per i restanti dipartimenti. Le prime applicazioni pratiche delle suddette indicazioni hanno evidenziato diverse criticità per quanto attiene l’individuazione e soprattutto la realizzazione dei correttivi.

Environmental pollution constantly threatens the health of urban populations. This problem of environmental hygiene takes a particular interest in Occupational Medicine, whereas some tasks take place mostly outdoors, so the airborne pollutants and noise can be considered as occupational hazards. The subject of this study is to evaluate the health of a group of newsagents in the city of Palermo, in relation to the level of urban pollution and noise monitored in ten years (2000-2010). It was assessed lung function, hearing, kidney, liver and cardiovascular systems, with particular reference to endothelial structures. Analysis of the results show the high prevalence of damage to the carotid district, for which we can not exclude a role simultaneously, contribute to various airborne pollutants.