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Peila C, Spada E, Riboldi L, Capitanio M, Pellegrino F, Coscia A. Twinning as a risk factor for neonatal acute intestinal diseases: a case-control study. Front Pediatr 2023; 11:1308538. [PMID: 38161432 PMCID: PMC10755860 DOI: 10.3389/fped.2023.1308538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Acute intestinal diseases (AID), including necrotizing enterocolitis and spontaneous intestinal perforation, are a group of conditions that typically present in preterm infants, and are associated with an elevated mortality and morbidity rate. The risk factors for these diseases remain largely unknown. The aim of the study is to identify the correlation between twinning and the development of AID. Methods A single-center retrospective case-control study was conducted. We recruited all infants with a diagnosis of AID, confirmed by anatomopathology, recovered in NICU between 2010 and 2020. Considering the rarity of the outcome, 4 matched controls for each subject were randomly chosen from the overall population of newborns. Odds Ratio (OR) and 95% Confidence Interval (CI) were calculated using a conditional logistic regression model and a multivariate model by the creation of a Directed Acyclic Graph (www.dagitty.net). Results The study population resulted in 65 cases and 260 controls. The two groups present similar median gestational age and mean birthweight in grams. The cases have a higher frequency of neonatal pathology (defined as at least one of patent ductus arteriosus, early or late sepsis, severe respiratory distress) (84.6% vs. 51.9%), medically assisted procreation (33.8% vs. 18.8%) and periventricular leukomalacia (10.8% vs. 2.7%), and a lower frequency of steroids prophylaxis (67.7% vs. 86.9%). About 50% of cases needed surgery. The OR for the direct effect were difference from one using logistic regression booth without and with repeated measures statements: from 1.14 to 4.21 (p = .019) and from 1.16 to 4.29 (p = .016), respectively. Conclusions Our study suggests that twinning may be a risk factor for the development of AID. Due to the small number of cases observed, further studies on larger populations are needed.
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Affiliation(s)
- C. Peila
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - E. Spada
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Laboratorio Della Conoscenza Carlo Corchia—APS, Florence, Italy
| | - L. Riboldi
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - M. Capitanio
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - F. Pellegrino
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - A. Coscia
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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Peila C, Riboldi L, Spada E, Coscia A, Barbagallo I, Li Volti G, Galvano F, Gazzolo D. The Gestational Pathologies Effect on the Human Milk Redox Homeostasis: A First Step towards Its Definition. Nutrients 2023; 15:4546. [PMID: 37960198 PMCID: PMC10648900 DOI: 10.3390/nu15214546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Human Milk (HM) is a dynamic nourishment; its composition is influenced by several conditions such as gestational age, maternal diet and ethnicity. It appears important to evaluate the impact that gestational pathologies have on HM components and if their presence, as a source of oxidative stress in the mother, influence milk's redox homeostasis. To assess the effect of Preeclampsia (PE) and Gestational Diabetes Mellitus (GDM) on some aspects of human milk redox homeostasis, we chose to investigate both oxidative and antioxidant aspects, with, respectively, Lipid hydroperoxides (LOOHs) and Glutathione (GSH). METHODS Women with PE, GDM and who were healthy were recruited for this study. Colostrum, transitional and mature milk samples were collected. GSH and LOOHs levels were measured using a spectrophotometric test. To investigate the effect of pathology on redox homeostasis, a mixed linear model with unistructural covariance structure was performed. RESULTS A total of 120 mothers were recruited. The GSH concentration results were significantly lower in GDM women than in healthy women only in colostrum (p < 0.01). No other differences emerged. LOOHs was not detectable in almost all the samples. DISCUSSION Our study is the first to extensively evaluate these components in the HM of women with these gestational pathologies. The main observation is that GDM can alter the GSH level of HM, mainly in colostrum.
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Affiliation(s)
- Chiara Peila
- Neonatal Unit, Department of Public Health and Pediatrics, University of Turin, 10100 Turin, Italy
| | - Lorenzo Riboldi
- Neonatal Unit, Department of Public Health and Pediatrics, University of Turin, 10100 Turin, Italy
| | - Elena Spada
- Neonatal Unit, Department of Public Health and Pediatrics, University of Turin, 10100 Turin, Italy
| | - Alessandra Coscia
- Neonatal Unit, Department of Public Health and Pediatrics, University of Turin, 10100 Turin, Italy
| | - Ignazio Barbagallo
- Department of Biological Chemistry, Medical Chemistry and Molecular Biology, University of Catania, 95131 Catania, Italy
| | - Giovanni Li Volti
- Department of Biological Chemistry, Medical Chemistry and Molecular Biology, University of Catania, 95131 Catania, Italy
| | - Fabio Galvano
- Department of Biological Chemistry, Medical Chemistry and Molecular Biology, University of Catania, 95131 Catania, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, University of Chieti-Pescara, 66100 Chieti, Italy
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Coscia A, Riboldi L, Spada E, Bertino E, Sottemano S, Barbagallo I, Livolti G, Galvano F, Gazzolo D, Peila C. Preeclampsia and Its Impact on Human Milk Activin A Concentration. Nutrients 2023; 15:4296. [PMID: 37836580 PMCID: PMC10574093 DOI: 10.3390/nu15194296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/27/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND It is known that preeclampsia affects lactogenesis. However, data on the effects of this pathology on human milk neurobiomarker composition are not available. The aim of this study is to investigate the effects of this gestational pathology on activin A levels, a neurobiomarker known to play an important role in the development and protection of the central nervous system. METHODS The women recruited were divided in two different study groups: preeclamptic or normotensive women. All the human milk samples were collected using the same procedure. Activin A was quantified using an Enzyme-linked immunosorbent assay (ELISA) test. To investigate the effect of preeclampsia on the activin A concentration in the three lactation phases, a mixed linear model with a unistructural covariance structure, with the mother as the random effect, and fixed effects were performed. RESULTS Activin A was detected in all samples. There were no significant differences between preeclamptic and normotensive women. The only significant effect is related to the lactation phase: the difference between colostrum and mature milk (p < 0.01) was significant. In conclusion, these results allow us to affirm that breast milk's beneficial properties are maintained even if preeclampsia occurs.
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Affiliation(s)
- Alessandra Coscia
- Neonatal Unit, Department of Public Health and Pediatrics, University of Turin, 10124 Torino, Italy
| | - Lorenzo Riboldi
- Neonatal Unit, Department of Public Health and Pediatrics, University of Turin, 10124 Torino, Italy
| | - Elena Spada
- Neonatal Unit, Department of Public Health and Pediatrics, University of Turin, 10124 Torino, Italy
| | - Enrico Bertino
- Neonatal Unit, Department of Public Health and Pediatrics, University of Turin, 10124 Torino, Italy
| | - Stefano Sottemano
- Neonatal Unit, Department of Public Health and Pediatrics, University of Turin, 10124 Torino, Italy
| | - Ignazio Barbagallo
- Department of Biological Chemistry, Medical Chemistry and Molecular Biology, University of Catania, 95123 Catania, Italy
| | - Giovanni Livolti
- Department of Biological Chemistry, Medical Chemistry and Molecular Biology, University of Catania, 95123 Catania, Italy
| | - Fabio Galvano
- Department of Biological Chemistry, Medical Chemistry and Molecular Biology, University of Catania, 95123 Catania, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, Università degli Studi G. d'Annunzio Chieti e Pescara, 66100 Chieti, Italy
| | - Chiara Peila
- Neonatal Unit, Department of Public Health and Pediatrics, University of Turin, 10124 Torino, Italy
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D'Aveni A, Stella S, Dallari B, Barile R, Rugarli S, Zellino C, Cerchiaro E, Riboldi L, Verusio C, Consonni D, Ceresoli G, Mensi C. EP07.01-005 Second Primary Cancers in a Population-Based Mesothelioma Registry. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lezo A, D'Eusebio C, Riboldi L, Baldini L, Spada M. HPN Standard of Care and Long-Term Outcomes of CIF Pediatric Patients: Twenty-Eight Years' Experience in a Reference Center. Front Nutr 2022; 9:868273. [PMID: 35757247 PMCID: PMC9218632 DOI: 10.3389/fnut.2022.868273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/29/2022] [Indexed: 11/22/2022] Open
Abstract
Background and Aims Chronic intestinal failure (CIF) therapy changed significantly in recent decades, and both survival and complication rates improved over time. International guidelines claim that early referral of long-term home parenteral nutrition (HPN) patients to an expert center with specific standards of care may positively affect long-term outcomes. Herein, we retrospectively analyse the long-term outcomes of a cohort of pediatric patients with CIF followed-up since our Pediatric Intestinal Failure Unit foundation, in 1989. Methods Data of the 120 children followed up at Pediatric Intestinal Failure Unit during the last 28 years were retrospectively collected. Patients' and HPN characteristics, as well as dependence, survival, and complication rates, were described. Results Incidence and prevalence of CIF increased during the study period particularly due to the increase of HPN for non-digestive disease (NDD) CIF (47.5% of the study sample). Catheter-related bloodstream infection (CRBSI) rate decreased over the study period: 0.33 episodes/1,000 catheters days before 2011 and 0.19 episodes/1,000 catheters days afterwards. Only 1 patient out of 12 died because of HPN complications. The survival rate of patients with PDD was 98.4% at 1 year from the beginning of HPN, 96.5% at 2 years, and 93.8% from the fifth year onwards. Concerning the dependence rate, 70.6% of patients were still on HPN 1 year after the start of HPN, 63.7% at 2 years, 52.4% at 5 years, and 40.8% from the 9th year onwards, with no significant difference according to the underlying intestinal pathology. The survival rate of NDD patients was 91.2% at 1 year from the beginning of HPN, 87.4% at 2 years, and 81.9% from the third year onwards. For what concerns the enteral autonomy, it was regained by 56.7% 1 year after the start of HPN, 74.5% at 2 years, and 95.0% in the 5th year. Conclusions Our data confirmed the importance of appropriate standards of care and suggest that applying a specific set of standards and protocols may further improve patients' outcomes and survival. Indeed, both primary and non-digestive diseases HPN showed good outcomes.
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Affiliation(s)
- Antonella Lezo
- Dietetic and Clinical Nutrition Unit, Paediatric Hospital Regina Margherita, University of Turi, Turin, Italy
| | - Chiara D'Eusebio
- Dietetic and Clinical Nutrition Unit, Paediatric Hospital Regina Margherita, University of Turi, Turin, Italy
| | - Lorenzo Riboldi
- Postgraduate School of Paediatrics, University of Turin, Turin, Italy
| | - Letizia Baldini
- Postgraduate School of Paediatrics, University of Turin, Turin, Italy
| | - Marco Spada
- Dietetic and Clinical Nutrition Unit, Paediatric Hospital Regina Margherita, University of Turi, Turin, Italy
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Parodi E, Riboldi L, Ramenghi U. Hemoglobin life-threatening value (1.9 g/dl) in good general condition: a pediatric case-report. Ital J Pediatr 2021; 47:200. [PMID: 34620203 PMCID: PMC8499567 DOI: 10.1186/s13052-021-01146-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background We report a pediatric patient presenting in good general condition despite a hemoglobin value of 1,9 g/dL, which is normally regarded as life-threatening. Case presentation An African 5 years-old girl presented to our Emergency Department (ED) for worsening asthenia, within a clinical picture of good general condition. The hemoglobin value at admission was 1,9 g/dL. The subsequent diagnostic-therapeutic pathway highlighted the presence of two different causes, both well known to be responsible for chronic anemia (with slow reduction of hemoglobin values): iron deficiency anemia (IDA) due to a very low dietary intake of iron-rich foods, and homozygous sickle cell disease (HbSS). She received transfusions of packed red blood cells (overall 15 ml/kg) and subsequently intravenous iron preparations (total amount 200 mg) followed by oral iron supplements. The Hb value at discharge, 10 days after the admission, was 9.8 g/dL. Conclusions When approaching a picture of severe anemia, we suggest pediatricians take into consideration clinical conditions rather than laboratory values and to take advantage of detailed anamnestic data in order to make the diagnosis.
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Affiliation(s)
- Emilia Parodi
- Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy. .,Pediatric Department University of Torino, Piazza Polonia 94, 10126, Torino, Italy. .,Pediatric and Neonatology Unit, A.O. Ordine Mauriziano, Torino, Italy.
| | - Lorenzo Riboldi
- Postgraduate School of Pediatrics, University of Torino, Torino, Italy
| | - Ugo Ramenghi
- Pediatric Department University of Torino, Piazza Polonia 94, 10126, Torino, Italy
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Fattori A, Cantù F, Comotti A, Tombola V, Colombo E, Nava C, Bordini L, Riboldi L, Bonzini M, Brambilla P. Hospital workers mental health during the COVID-19 pandemic: methods of data collection and characteristics of study sample in a university hospital in Milan (Italy). BMC Med Res Methodol 2021; 21:163. [PMID: 34376151 PMCID: PMC8353421 DOI: 10.1186/s12874-021-01355-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is currently a severe challenge for healthcare workers, with a considerable impact on their mental health. In order to focus preventive and rehabilitation measures it's fundamental to identify risk factors of such psychological impairment. We designed an observational longitudinal study to systematically examine the psychological wellbeing of all employees in a large University Hospital in Italy, using validated psychometric scales in the context of the occupational physician's health surveillance, in collaboration with Psychiatric Unit. METHODS The study started after ethical approval in August 2020. For each worker, the psychological wellbeing is screened in two steps. The first level questionnaire collects sociodemographic characteristics, personal and occupational COVID-19 exposure, worries and concerns about COVID-19, general psychological discomfort (GHQ-12), post-traumatic stress symptoms (IES-R) and anxiety (GAD-7). Workers who score above the cut-off in at least one scale are further investigated by the second level questionnaire composed by PHQ-9, DES-II and SCL-90. If second level shows psychological impairments, we offer individual specialist treatment (third level). We plan to follow-up all subjects to monitor symptoms and possible chronicization; we aim to investigate potential risk factors through univariate analysis and multivariate logistic regressions. RESULTS Preliminary results refer to a sample of 550 workers who completed the multi-step evaluation from August to December 2020, before vaccination campaign started. The participation rate was 90%. At first level screening, 39% of the subjects expressed general psychological discomfort (GHQ-12), 22% post-traumatic stress symptoms (IES-R), and 21% symptoms of anxiety (GAD-7). Women, nurses, younger workers, subjects with COVID-19 working exposure and with an infected family member showed significantly higher psychological impairment compared to colleagues. After the second level screening, 12% and 7% of all workers showed, respectively, depressive and dissociative symptoms; scorings were significantly associated with gender and occupational role. We are currently extending sample size and evaluating subjects over a period of further 12 months. CONCLUSIONS The possibility to perform a systematic follow-up of psychological wellbeing of all hospital workers, directly or indirectly exposed to pandemic consequences, constitutes a unique condition to detect individual, occupational, and non-occupational risk factors for psychological impairment in situations of prolonged stress, as well as variables associated with symptoms chronicization.
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Affiliation(s)
- A Fattori
- Occupational Health Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - F Cantù
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - A Comotti
- Occupational Health Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Tombola
- Department of Neurosciences and Mental Health, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E Colombo
- Department of Neurosciences and Mental Health, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Nava
- Occupational Health Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L Bordini
- Occupational Health Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L Riboldi
- Occupational Health Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Bonzini
- Occupational Health Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - P Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Neurosciences and Mental Health, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Lombardi A, Consonni D, Carugno M, Bozzi G, Mangioni D, Muscatello A, Castelli V, Palomba E, Cantù AP, Ceriotti F, Tiso B, Pesatori AC, Riboldi L, Bandera A, Lunghi G, Gori A. Characteristics of 1573 healthcare workers who underwent nasopharyngeal swab testing for SARS-CoV-2 in Milan, Lombardy, Italy. Clin Microbiol Infect 2020; 26:1413.e9-1413.e13. [PMID: 32569835 PMCID: PMC7305713 DOI: 10.1016/j.cmi.2020.06.013] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/09/2020] [Accepted: 06/13/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The management of healthcare workers (HCWs) exposed to confirmed cases of coronavirus disease 2019 (COVID-19) is still a matter of debate. We aimed to assess in this group the attack rate of asymptomatic carriers and the symptoms most frequently associated with infection. METHODS Occupational and clinical characteristics of HCWs who underwent nasopharyngeal swab testing for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a university hospital from 24 February 2020 to 31 March 2020 were collected. For those who tested positive and for those who tested positive but who were asymptomatic, we checked the laboratory and clinical data as of 22 May to calculate the time necessary for HCWs to then test negative and to verify whether symptoms developed thereafter. Frequencies of positive tests were compared according to selected variables using multivariable logistic regression models. RESULTS There were 139 positive tests (8.8%) among 1573 HCWs (95% confidence interval, 7.5-10.3), with a marked difference between symptomatic (122/503, 24.2%) and asymptomatic (17/1070, 1.6%) workers (p < 0.001). Physicians were the group with the highest frequency of positive tests (61/582, 10.5%), whereas clerical workers and technicians had the lowest frequency (5/137, 3.6%). The likelihood of testing positive for COVID-19 increased with the number of reported symptoms; the strongest predictors of test positivity were taste and smell alterations (odds ratio = 76.9) and fever (odds ratio = 9.12). The median time from first positive test to a negative test was 27 days (95% confidence interval, 24-30). CONCLUSIONS HCWs can be infected with SARS-CoV-2 without displaying any symptoms. Among symptomatic HCWs, the key symptoms to guide diagnosis are taste and smell alterations and fever. A median of almost 4 weeks is necessary before nasopharyngeal swab test results are negative.
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Affiliation(s)
- A Lombardi
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - D Consonni
- Epidemiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Carugno
- Epidemiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Bozzi
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - D Mangioni
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Muscatello
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Castelli
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E Palomba
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A P Cantù
- Medical Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Ceriotti
- Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - B Tiso
- Medical Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A C Pesatori
- Epidemiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Riboldi
- Occupational Health Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Bandera
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - G Lunghi
- Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Gori
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
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Consonni D, Mendola M, Dallari B, Sokooti M, Tabibi R, Callegari R, Riboldi L, Mensi C. 1360 Differences between peritoneal and pleural mesothelioma in lombardy, italy. Occup Med (Lond) 2018. [DOI: 10.1136/oemed-2018-icohabstracts.1053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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De Liso F, Bonara P, Vigna L, Novembrino C, De Giuseppe R, Bamonti F, Carbonelli V, Frugoni C, Tirelli A, Maiavacca R, Riboldi L. Oxidative Stress and Low-Grade Inflammatory Status as Cardiometabolic Risk Factors in Italian Occupational Overweight/Obese Subjects. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Obesity is associated with increased risk of cardiometabolic diseases. Adipocytokines (e.g. leptin), produced by the endocrine function of adipose tissue, can contribute to cardiometabolic risk in overweight and obese people. Oxidative stress, imbalance between oxidants and antioxidants, is considered a cardiovascular risk factor. High serum oxidized LDL (oxLDL) levels, marker of lipid peroxidation, a primary cause of atherosclerosis, can contribute to its progression. The aims of this study are to assess markers of oxidative status and cytokine profile and evaluate their role as cardiometabolic risk factors and possible correlations. In this cross-sectional study, we enrolled 76 occupational overweight-obese adults (46 females, 30 males; aged 46.8±9.5; BMI 33.7±4.8 kg/m2) without any previous cardiovascular disease. Oxidative status was measured by evaluating serum Reactive Oxygen Species (ROS) levels, Total Antioxidant Capacity (TAC) and oxLDL concentrations. All subjects' soluble cytokine and adhesion molecule levels were evaluated by cytofluorimetric method and compared with 35 controls matched for sex and age. ROS and oxLDL levels were high in 84% and 92% of the study population, respectively, despite adequate TAC (68%). Female ROS levels were significantly higher than those of males (414±99.3 vs 318±48.2 UCarr, p<0.0001), while their oxLDL levels were lower (95.3±22 vs 105.2±19.4 U/L, p=0.1). Leptin and sICAM-1 (intracellular adhesion molecule involved in leukocyte migration to inflamed area) levels of the study population were significantly higher than those of controls (93.8±89.1 vs 25.3±23 ng/mL, p=0.0002 and 505.8±236.7 vs 339.2±119.6 ng/mL, p=0.0009, respectively). Overweight/obese occupational subjects showed oxidative stress conditions accompanied by low chronic inflammatory status, possibly contributing to increased cardiometabolic risk.
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Affiliation(s)
- F. De Liso
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, UOC Ematologia e CTMO, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P. Bonara
- UO Mediana Interna 1b, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L. Vigna
- Dipartimento Area della Medicina Preventiva, U.O. Medicina del Lavoro 1, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C. Novembrino
- Laboratorio Centrale di Analisi Chimico Cliniche e Microbiologia, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - R. De Giuseppe
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, UOC Ematologia e CTMO, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F. Bamonti
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, UOC Ematologia e CTMO, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V. Carbonelli
- Dipartimento di Fisiopatologia Medico-Chirurgica e del Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C. Frugoni
- UO Medicina Trasfusionale, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A.S. Tirelli
- Laboratorio Centrale di Analisi Chimico Cliniche e Microbiologia, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - R. Maiavacca
- Laboratorio Centrale di Analisi Chimico Cliniche e Microbiologia, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L. Riboldi
- Dipartimento Area della Medicina Preventiva, U.O. Medicina del Lavoro 1, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
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11
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Crapanzano R, Vigna L, Tirelli AS, Sommaruga D, Cassinelli L, Bertazzi PA, Riboldi L. [Vitamin D as a cardiovascular risk factor in workers]. G Ital Med Lav Ergon 2012; 34:196-198. [PMID: 23405618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Numerous evidence suggests that vitamin D deficiency is implicated in the development of cardiovascular risk. It has been investigated the relationship between cardiovascular risk factors and vitamin D concentrations in 264 consecutive workers from Centro Obesità e Lavoro della Clinica del Lavoro di Milano. For these studies, glicometaboliche analysis, anthropometric measurements and impedance evalutation were performed and questionnaires to estimate nutrient levels in the diet were administered. The levels of vitamin D are found to be deficient in 166 patients (less than 20 ng/mL), insufficient in 63 patients (less than 30 ng/mL) and optimal for the remaining 35 patients. A significant negative association was observed between the concentrations of vitamin D and cardiovascular risk factors (HOMA ratio and TG/HDL) ratios and BMI. Vitamin D is a cardiovascular risk factor "corrected" for example by changing the eating habits of workers.
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Affiliation(s)
- R Crapanzano
- Scuola di Specializzazione in Medicina del Lavoro, Università degli Studi Milano, Italy
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12
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Vigna L, Agnelli GM, Belluigi V, Calvelli L, Riboldi L. [Workplace campaigns for metabolic syndrome prevention and healthy lifestyles promotion in mechanical engineering industries]. G Ital Med Lav Ergon 2012; 34:440-442. [PMID: 23405684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The paper describes 2 years outcome on BMI, smoking habits and physical activity of 2 WHP carried in engineering plants. Three important results were achieved: stationarity of body weight despite ageing of examined population; increase of workers that perform regular physical activity and a slight increase of smoking cessation. NSAS questionnaire showed a marked improvement in life styles compared to the data obtained 2 years before. Our findings suggest that an efficacy on life style modification can be achieved by WHP campaigns with little time and cost consuming. The collaboration between occupational physician, employer and employees but also with external professionals is the key of success.
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Affiliation(s)
- L Vigna
- UO Medicina del Lavoro 1, Clinica del Lavoro L Devoto, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano.
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13
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Fustinoni S, Campo L, Pasini R, De Comite A, Missineo P, Riboldi L, Bertazzi PA. [The assessment of risk for xylene exposure in a laboratory of anatomy: comparison between computational models and environmental and biological monitoring]. G Ital Med Lav Ergon 2012; 34:794-795. [PMID: 23405781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Exposure to xylene in a pathology laboratory was evaluated using two algorithms: Stoffenmanager and Archi.me.de. The results were compared with those obtained by applying the environmental and biological monitoring of the exposure. The use of models required a period of self-learning and, for Stoffenmanager, knowledge of the English language. Information on the toxicity and safety of xylene, available from the medial and safety data sheets, and the conditions and amount of use, obtained through a survey and interviews with operators, have been imputed. Stoffenmanager estimated low the inhalation exposure and medium the dermal exposure, with a value of personal exposure during the work shift of 1.4 mg/m3. A.r.chi.me.d.e. estimated negligible the risk to health. These ratings are consistent with those obtained using the experimental approach. This result, combined with the simplicity and low cost, makes the algorithms very interesting tools for the assessment of chemical risk in the workplace.
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Affiliation(s)
- S Fustinoni
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano e Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via S. Barnaba, 8 -20122 Milano.
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14
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Bordini L, Riboldi L, Ferrario MM. [Psychotropic substances and driving]. G Ital Med Lav Ergon 2012; 34:54-57. [PMID: 23405581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Consumption of psychotropic substances (alcohol, drugs, medication) has a major impact on complex activity performance such as driving. This issue is of relevant social interest for the high number of potentially involved subjects and the often fatale outcomes, and affects also occupational physicians because of the high number of people whose job is driving. There are still few studies trying to assess the presence of a possible association between increased risk of accident/injury at work and consumption of psychotropic substances and results are not always in agreement. In spite of such uncertainties and some Italian regulations still worth being amended by Legislator, the possible impact of consumption of psychoactive substances on driving is an issue to be still better defined for which occupational physicians may play a basic role in the field of prevention, clinics and rehabilitation.
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Affiliation(s)
- L Bordini
- U.O. Medicina del Lavoro 1, "Clinica del Lavoro L. Devoto", Fondazione IRCCS CA' GRANDA Ospedale Maggiore Policlinico-Milano.
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15
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Bogni M, Basotti A, Vigna L, Brunani A, Bertazzi PA, Riboldi L. [Evaluation of the work-related disability in people affected by Ehlers-Danlos syndrome]. G Ital Med Lav Ergon 2012; 34:238-239. [PMID: 23405630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The Ehlers-Danlos syndrome (EDS), inherited disorder of connective tissue, frequently leads to impairment of various functional areas, including employment. In 35 subjects with classic type EDS, 14 hypermobile, 3 vascular was administered 7 visual analogical scales (pain, stiffness, activities of daily living, instrumental activities of daily living, work, social relations). An impairment of particular significance in total score and in individual areas emerges is in the hypermobile group, followed by classic, less for the vasculature. Overall there is a significant alteration of the quality of life that deserves proper evaluation to facilitate the definition of fitness and the improvement of job insertion in patients with EDS.
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Affiliation(s)
- M Bogni
- Scuola di Specializzazione in Medicina del Lavoro, Università degli Studi Milano, Italy.
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16
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Nicosia C, Vigna L, Monsellato S, Patrini L, Consonni D, Bertazzi PA, Riboldi L. [Prevalence of obstructive sleep apnea syndrome in a group of obese workers]. G Ital Med Lav Ergon 2012; 34:385-387. [PMID: 23405669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The Obstructive Sleep Apnea Syndrome (OSAS) is a quite diffused in workers disease, mainly in obese or overweight subjects. This syndrome can cause cardiovascular and cerebral complications and have negative effects on job performances. We evaluated 214 obese/overweight workers referred from different job areas. A diagnosis of OSAS was pre-existent in about 5% of the examined subjects, and clinical elements suggesting suspect of OSAS were present in about 15% of the sample. The risk of development Obstructive Sleep Apnea Syndrome seems to be linear correlated with BMI, neck and waist circumference. We did not find any correlation between OSAS risk and job area. We strongly suggest that health surveillance should include the evaluation of the possible presence of sleep disorders to reduce the risks associated and the negative consequences on job performances.
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Affiliation(s)
- C Nicosia
- Scuola di Specializzazione in Medicina del Lavoro, Università degli Studi di Milano.
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17
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Lucatello F, Vigna L, Carugno M, Tirelli AS, Bertazzi PA, Riboldi L. [Comparison of indexes for assessing insulin resistance for the health surveillance among workers]. G Ital Med Lav Ergon 2012; 34:748-749. [PMID: 23405768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Night shift workers present a high risk to develop metabolic and cardiovascular disorders for alterations that involve effects on circadian rhythms at the level of insulin resistance (IR). Monitor such parameter in this category of workers, therefore, is a crucial step in health surveillance. To this aim, the currently in use test consists in the calculation of the HOMA index [basal insulin (MU/ml) x basal glycemy(mmol/l)/22.5], a measurement with a considerable cost (about 13 Euros). Recent studies demonstrated that the measurement of TyG index calculated as Ln[Triglycerids (mg/dl) x Glucose(mg/dl)/2] and of the triglycerids/HDL-cholesterol ratio correlates with HOMA index. These analyses cost altogether about 5 Euros, allowing a clear decrease of expenses. Our study, carried out on 217 workers at Centre for Obesity and Occupational Medicine of the Occupational Medicine Clinic of Milan, confirmed such correlation and identified the TyG as the index with the best cost/performance ratio. Our future goal is to establish cut-off values, necessary to adopt the TyG as first choice index.
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Affiliation(s)
- F Lucatello
- Scuola di Specializzazione in Medicina del Lavoro dell'Università degli Studi di Milano, via San Barnaba 8, 20122 Milano.
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18
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Bogni M, Vigna L, Carugno M, Brunani A, Capodaglio P, Bertazzi PA, Riboldi L. [Applicability of the test SIO on obesity-related disability (TSD-OC) in occupational medicine for the evaluation of work problems linked to overweight-obesity condition]. G Ital Med Lav Ergon 2012; 34:450-452. [PMID: 23405687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Obesity is frequently associated with functional changes that may affect work capacity, so we administered to a group of 198 overweight-obese subjects with median BMI of 32.7 and median waist circumference of 101 cm, the test-TSD OC which consists of 7 sections (pain, stiffness, activities of daily life, activities of the house, instrumental activities of daily living, work, social relations) for a total of 36 visual analogical scales. After the identification of 4 workers categories (health, services, administration, commerce/industry), resulted homogeneous for age, BMI, CV, we saw that the work section was more compromised for health and services. The overall disability increases especially in relation to BMI and seems influenced by age and sex.
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Affiliation(s)
- M Bogni
- Scuola di Specializzazione in Medicina del Lavoro, Università degli Studi Milano.
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19
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Riboldi L, Bordini L, Ferrario MM. Fitness for work in health care workers: state of the art and possible operational recommendations for its formulation and management in relationship to alcohol and drug addiction. Med Lav 2012; 103:203-211. [PMID: 22838298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Both chronic and acute alcohol or drug consumption have severe health consequences, alter the subject's cognitive functions and work performance and increase the risk of work-related accidents, for the worker and for third parties (e.g., co-workers and other people subject to negative impact of worker's actions). Limited scientific evidence has suggested that some working conditions present in the health care sector (e.g., high levels of responsibility, competitiveness, burnout, shiftwork, work-related stress) may favour alcohol and drug abuse. The aim of the present report is to describe the problem of alcohol and drug consumption among health care professionals and to evaluate the problem of related fitness for work. The magnitude of this problem remains unclear; recent estimates have reported alcohol abuse and addiction problems in 1-14% and psychotropic, illicit and non-illicit, substance abuse in 6-15% of health care workers. The prevalence of tranquilizer and sedative/hypnotic drug use is high, particularly among physicians. However, it remains unclear whether the incidence of workplace accidents and injuries is higher among drug abusers, and whether the statutory introduction of prevention programmes has led to actual control of this problem in the workplace. Italian legislation identifies the occupational physician as a key figure to prevent psychotropic substance abuse in some work activities, but some difficulties in its application remain. Legislators should issue simple norms that clearly define the responsibilities and skills of each actor involved in safeguarding workplace health and safety, as well as clearly outlining workplace monitoring procedures.
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Affiliation(s)
- L Riboldi
- Clinica del Lavoro Luigi Devoto, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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20
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Carugno M, Mensi C, Sieno C, Consonni D, Riboldi L. Asbestos exposure among hairdressers. Med Lav 2012; 103:70-71. [PMID: 22486078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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21
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Mensi C, Bonzini M, Macchione M, Sieno C, Riboldi L, Pesatori AC. Differences among peritoneal and pleural mesothelioma: data from the Lombardy Region Mesothelioma Register (Italy). Med Lav 2011; 102:409-416. [PMID: 22022760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The relationship between asbestos exposure and peritoneal mesothelioma (PEM) is under investigation. Some authors suggest that the association could be weaker than that observed for pleural mesothelioma (PLM). OBJECTIVE To compare individual, clinical and exposure characteristics of peritoneal and pleural mesothelioma cases that occurred in the Lombardy Region (Italy). METHODS Cases were drawn from the regional mesothelioma registry (base population > 9 million). We selected all PEM cases diagnosed between 2000 and 2007 (N = 110) and all PLM cases that occurred between 2000 and 2001 (N = 515). Asbestos exposure data (occupational, environmental/familial, or both) were collected by a standardized and validated questionnaire administered to each case or case's relative. Based on available chest CT scans, we also investigated the concomitant presence of asbestosis and/or pleural plaques as markers of asbestos exposure. RESULTS PEM and PLM cases had similar proportions of occupational (around 60%) and environmental/familial (7%) asbestos exposure. The proportion of PEM subjects with co-existent occupational and environmental/familial exposures was, however, twice as high as PLM cases (6.1% vs 3.1%). Asbestosis and pleural plaques were more frequent in PEM than in PLM cases (7.7% and 20.9% vs 0.4% and 12.1%, respectively). No differences were detected for duration of exposure and latency among occupationally exposed cases. CONCLUSION Our findings from a population-based Registry suggest that high cumulative asbestos exposures are the main risk factors not only for pleural but also for peritoneal mesothelioma.
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Affiliation(s)
- Carolina Mensi
- Clinica del Lavoro "Luigi Devoto", Department of Preventive Medicine, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
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22
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Mensi C, Sieno C, De Matteis S, Consonni D, Riboldi L, Bertazzi PA. [Incidence of malignant mesothelioma and asbestos exposure in the Lombardy region, Italy, 2000-2008]. G Ital Med Lav Ergon 2011; 33:96-98. [PMID: 23393811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We evaluated the trend of incidence and asbestos exposure of malignant mesothelioma (MM) in 2000-2008 in the Lombardy Region (Italy). We recorded 2,816 MMs (1,793 men, 1,023 women). The age-standardized rates (x 100,000/year) were 3.4 (men) and 1.4 (women) (standard population: Europe). We found a 3.0% and 0.9% increase per year of number of cases and rate, respectively. Exposure was obtained in 2,671 cases (94.9%). Occupational exposure to asbestos was found for 1,296 (72.3%) men and 377 (36.9%) women, non-occupational exposure in 141 (13.8%) women and 58 (3.2%) men. The exposure profile within gender did not vary over years.
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Affiliation(s)
- C Mensi
- Dipartimento di Medicina Preventiva, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
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23
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Bogni M, Vigna L, Capodaglio P, Brunani A, Cimolin V, Donini LM, Riboldi L. [Impact of obesity-related disability in different work categories]. G Ital Med Lav Ergon 2011; 33:364-366. [PMID: 23393877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Absenteeism and sick leave are often reported in obese workers. To evaluate disability work related we assess 180 overweight-obese subjects [BMI 34,6 + 6,4, range 26,0-59,0) with TSD-OC questionnaire divided into 7 items (pain; stiffness; ADL; housework; IADL; occupational activities; social life) with a total of 36 visual analogue scales. Among the job categories, health-care workers showed the highest TSD-OC total score (26,9 + 22,5%, ANOVA p < 0,05) and BMI (BMI 37,7 + 6,9 kg/m2). Among the items, pain was statistically significant in health-care workers (16,1 + 13,2%), in Services (16,3 + 14,3%), in Education (15,1 + 11,4%) and in Administration (13,3 +11,0%) ( p <0,05). "Occupational activities" item was statistically significant in health-care (11, 6 +10,6%, p <0,05).
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Affiliation(s)
- M Bogni
- Scuola di Specializzazione in Medicina del Lavoro, Università degli Studi Milano, Italy.
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24
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Mussino F, Vigna L, Riboldi L. ["EOSS" classification in a group of obese workers]. G Ital Med Lav Ergon 2011; 33:367-368. [PMID: 23393878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Current classification of obesity, based on BMI, presents some limitations in evaluating work-related impairments. In fact it does not provide information on presence and/or severity of clinical impairments associated with obesity. On the contrary, EOSS classification takes into account metabolic complications and functional limitations with restrictions of daily living and working activities. Aim of our study is to compare, in a group of obese workers, the different utility for precautionary and work-eligibility purposes of these two classifications. Results on our study population suggest that a more systematic use of the EOSS classification might be useful in occupational medicine.
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Affiliation(s)
- F Mussino
- Scuola di Specializzazione in Medicina del Lavoro, Università degli Studi Milano, Italy.
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25
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Vigna L, Agnelli GM, Tirelli AS, Belluigi V, Aquilina T, Riboldi L. [Obesity and work: proposal for a multidisciplinary intervention model for prevention and its application in an engineering plant]. Med Lav 2011; 102:275-285. [PMID: 21797044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Obesity is often particularly burdensome for subjects at work and leads to hypertension and diabetes preceded by a low grade of inflammation. Measures to promote health at the workplace can be achieved through periodic health surveillance. Simple parameters such as height, weight, body mass index (BMI), waist circumference (CV), blood pressure (BP), as well as taking into account the type of work and tasks, shift work and smoking, are in fact sufficient to identify the most significant features of the working population so as to adequately design the type of intervention required. The paper describes how a health promotion programme aimed at preventing overweight and obesity was implemented based on analysis of the health surveillance data routinely collected by the occupational physician in an engineering plant in northern Italy. SUBJECTS AND METHODS Data on weight, height and BMI were collected for 301 workers with different jobs and shifts in an engineering plant; 32 of these workers, (mean age 44+/-8.4) agreed to undergo a diagnosis and treatment programme at the Obesity and Work Centre of the Clinica del Lavoro in Milan. INTERVENTIONS AND RESULTS A higher incidence of overweight and obesity was found compared to the national average for similar age classes, therefore meetings were organized at the plant on awareness and information on correct lifestyle and diet targeted for shift workers. The workers who had followed the diagnosis and treatment programme had a mean BMI of 32.6 (SD 2.7) and, considering the parameters investigated, the presence of metabolic syndrome was found in a greater proportion of subjects (62.5%) than the average in our practice (46%) and particularly in workers with three day shifts. CONCLUSIONSThe intervention programme began with assessment of the information obtained in the course of routine periodic health surveillance according to the occupational hazards under study. On the basis of this information it was possible to implement the first awareness campaigns. On completion of the multidisciplinary intervention, which was conducted in collaboration with the occupational physician, two major initiatives were taken: one in the canteen with the aim of improving the nutritional content and type of meals offered to suit the dietary needs of overweight or obese workers, and the other consisted of an agreement with local gyms so as to motivate workers to exercise more. A prerequisitefor this type of initiative is the willingness and understanding of the management to recognize the health of the worker as a priority value.
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Affiliation(s)
- Luisella Vigna
- U.O. Medicina del Lavoro 1, Clinica del Lavoro "L. Devoto", Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano.
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Vigna L, Belluigi V, Riboldi L. [Intervention for prevention and therapy of overweight-obesity in an engineering company]. G Ital Med Lav Ergon 2011; 33:61-64. [PMID: 22187928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Obesity is often burdensome for workers. A workplace health promotion starts from simple parameters such as height, weight, body mass index (BMI), waist circumference (CV), blood pressure (BP), together with the type of activity and shift work. Such data can be gathered through periodic health surveillance, and are useful to calibrate properly the type of needed intervention. Here is described a program of health promotion aimed at inprouving overweight-obesity settled in an engineering company of northern Italy. During the periodic health surveillance in relation to occupational hazards assessed was found a higher incidence, compared with age and sex, of overweight/obese workers than national average. Plans of action in the company were: meetings of awareness and information on lifestyle and food targeted to shift workers; offer of diagnostic-therapeutic route in the second level outpatients clinic "Obesity and work"; the presence of metabolic syndrome was found in 62.5% of the subjects examined. At the end of multidisciplinary intervention, conducted in concert with the occupational physician of the plant, were carried out two major initiatives: an action on the canteen aimed at preventing the nutritional type of meals offered to suit the dietary needs of overweight/obese workers and the conclusion of an agreement with gyms adjacent the two company locations motivating workers to increase physical exercise.
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Affiliation(s)
- Luisella Vigna
- U.O. Medicina del Lavoro 1, Clinica del Lavoro "L. Devoto", Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
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27
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Poltronieri A, Patrini L, Pigatto P, Riboldi L, Marsili C, Previdi M, Margonari M, Marraccini P. [Occupational allergic "march". Rapid evolution of contact dermatitis to ammonium persulfate into airborne contact dermatitis with rhinitis and asthma in a hairdresser]. Med Lav 2010; 101:403-408. [PMID: 21141453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Hairdressers are exposed to irritants and allergenic compounds that may cause contact dermatitis, rhinitis and asthma. OBJECTIVES In this paper we describe the case of a female, age 33 years, who developed contact dermatitis after 10 years of exposure to ammonium persulfate. METHODS After 7 months of progressively extensive and persistent skin lesions, respiratory symptoms appeared that were related to the occupational exposure (on-off test). SIDAPA and specific occupational patch test for hairdressers and occupational challenge with ammonium persulfate were performed. Clinical parameters of inflammation, ECP (eosinophil cationic protein) and exhaled nitric oxide (FeNO) were detected before and after the specific bronchial challenge. RESULTS The patch test was positive to ammonium persulfate (++), and bronchial challenge for ammonium persulfate showed a significant late response (FEV1 decrease--33%). Both FeNO and ECP showed a significant increase after 24 hours. Dermatitis, urticaria and angioedema occurred on the uncovered skin due to airborne contact. Topic steroids and anti-histaminic drugs resolved the clinical symptoms. CONCLUSIONS Bronchial challenge is, in fact, considered to be the gold standard for the diagnosis of occupational asthma, although new inflammatory parameters can contribute to the diagnosis and can be useful for monitoring after a specific inhalation test with occupational agents. The described case summarizes the evolution from contact dermatitis to inhalation allergy, suggesting the occurrence of an allergic "march" for occupational allergy.
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MESH Headings
- Adult
- Air Pollutants, Occupational
- Ammonium Sulfate/adverse effects
- Angioedema/chemically induced
- Angioedema/drug therapy
- Anti-Allergic Agents/therapeutic use
- Asthma/chemically induced
- Asthma/diagnosis
- Asthma/drug therapy
- Barbering
- Breath Tests
- Bronchial Provocation Tests
- Dermatitis, Occupational/diagnosis
- Dermatitis, Occupational/drug therapy
- Dermatitis, Occupational/etiology
- Diagnostic Errors
- Disease Progression
- Female
- Gastroesophageal Reflux/diagnosis
- Hair Bleaching Agents/adverse effects
- Humans
- Nitric Oxide/analysis
- Occupational Diseases/chemically induced
- Occupational Diseases/diagnosis
- Occupational Diseases/drug therapy
- Patch Tests
- Rhinitis, Allergic, Perennial/chemically induced
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/drug therapy
- Urticaria/chemically induced
- Urticaria/drug therapy
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Affiliation(s)
- Anna Poltronieri
- Scuola di Specializzazione in Medicina del Lavoro, Università di Milano
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28
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Mensi C, Garberi A, Bordini L, Sieno C, Riboldi L. Asbestos-related diseases in entertainment workers. Med Lav 2010; 101:416-418. [PMID: 21141346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To investigate asbestos exposure in 4 patients (3 cases of malignant mesothelioma and 1 case ofpleural plagues) previously employed in the entertainment business. METHODS The patients were seen at the Occupational Health Unit of the "Clinica del Lavoro Luigi Devoto" in Milan (Italy). Information regarding exposure to asbestos (occupational, environmental, and familial) was collected through a standardized questionnaire administered to the patients by an occupational physician. RESULTS AND CONCLUSION The presence of asbestos in the building structures and its use were described by all patients. The presence of asbestos in public buildings used for entertainment such as cinemas and theatres was in fact confirmed by the Occupational Health Services of the Local Heath Unit. An occupational aetiology was recognised in all the cases mentioned above, thus leading to the identification of an atypical occupational sector at risk in the past for asbestos exposure,
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Affiliation(s)
- Carolina Mensi
- Clinica del Lavoro Luigi Devoto, Dipartimento di Medicina Preventiva, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
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Mensi C, Sieno C, Riboldi L, Bodini L, Boni C, Sarzila B, Terziotti L. [Tumors of the nasal cavity and paranasal sinuses: a case of atypical occupational exposure to wood dust]. Med Lav 2010; 101:472-473. [PMID: 21141459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Riboldi L, Boscoletto N. [Work and social rehabilitation: the example of prisons]. G Ital Med Lav Ergon 2010; 32:146. [PMID: 21438243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Bordini L, Riboldi L. [Upgrade on alcohol abuse]. G Ital Med Lav Ergon 2010; 32:199-202. [PMID: 21438261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Problematic use of alcohol configures an element of interest in the context of preventive interventions aimed to ensuring the performance of any work in safety conditions. To contrast the acute alcohol abuse in the workplace the existing legislation provides alcoholimeters controls and prohibition of recruitment and administration of alcohol. Recent legislation (D.Lgs. 81/08) establishes health surveillance for alcohol dependence and appears still incomplete and difficult to apply. Clinical diagnostic tools available to the physician for alcohol dependence identification are well-defined and recently improved thanks to new laboratory markers with high sensitivity and specificity (CDT) and self-administered questionnaires. In this contest we are awaiting for legislative action to specify conditions and procedures for inspections in the workplace in order to face the problem of alcohol dependence without excessive bureaucracy and with more attention to preventive aspects.
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Affiliation(s)
- L Bordini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Medicina Preventiva, Clinica del Lavoro L. Devoto, Milano (MI), Italy
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Riboldi L, Carrer P, Magnavita N, Porru S. [Biological risk. Relevant problems: risk to third parties]. G Ital Med Lav Ergon 2010; 32:304-311. [PMID: 21061714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
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.
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Affiliation(s)
- L Riboldi
- Clinica del lavoro, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy
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Vigna L, Novembrino C, De Giuseppe R, de Liso F, Sommaruga D, Agnelli G, Belluigi V, Riboldi L, Bamonti F. Nutritional and oxidative status in occupational obese subjects. Mediterr J Nutr Metab 2010. [DOI: 10.1007/s12349-010-0003-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vigna L, Novembrino C, De Giuseppe R, de Liso F, Sommaruga D, Agnelli G, Belluigi V, Riboldi L, Bamonti F. Nutritional and oxidative status in occupational obese subjects. Mediterranean Journal of Nutrition and Metabolism 2010. [DOI: 10.3233/s12349-010-0003-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- L. Vigna
- Dipartimento Medicina Preventiva, del Lavoro e dell' Ambiente-Clinica del Lavoro L. Devoto, U.O. Medicina del Lavoro I, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via S. Barnaba 8, 20122 Milan, Italy. e-mail:
| | - C. Novembrino
- Dipartimento di Scienze Neurologiche, Università degli Studi di Milano, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy
| | - R. De Giuseppe
- Dipartimento di Scienze Mediche, Università degli Studi di Milano, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy
| | - F. de Liso
- Dipartimento di Scienze Mediche, Università degli Studi di Milano, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy
| | - D. Sommaruga
- Servizio Dietetico Direzione Sanitaria di Presidio, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy
| | - G. Agnelli
- Dipartimento Medicina Preventiva, del Lavoro e dell' Ambiente-Clinica del Lavoro L. Devoto, U.O. Medicina del Lavoro I, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via S. Barnaba 8, 20122 Milan, Italy. e-mail:
| | | | - L. Riboldi
- Dipartimento Medicina Preventiva, del Lavoro e dell' Ambiente-Clinica del Lavoro L. Devoto, U.O. Medicina del Lavoro I, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via S. Barnaba 8, 20122 Milan, Italy. e-mail:
| | - F. Bamonti
- Dipartimento di Scienze Mediche, Università degli Studi di Milano, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy
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Mensi C, Sieno C, Bordini L, Dicredico N, Pesatori AC, Riboldi L. [Systematic surveillance of occupational cancer: the Lombardy Sinonasal Cancer Registry]. Med Lav 2010; 101:19-25. [PMID: 20415045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Sinonasal cancer (SNC) includes uncommon tumours that are characterized by a high occupational etiologic component. For this reason they are an easy target for systematic surveillance by setting up a specific disease registry. The National Registry of these tumours is located at the Italian Institute for Occupational Safety and Prevention (ISPESL) and is based on data from Regional Operating Centres (ROCs). In the Lombardy Region a ROC was established in 2008 at the Clinica del Lavoro "Luigi Devoto" in Milan aimed at making surveillance systematic and thus provide adequate support for scientific research and prevention measures in the high risk work sectors. OBJECTIVES To estimate the incidence of SNC, to define different sources of occupational exposure both known (wood, leather, nickel, chromium) and unknown. METHODS The Registry collects all the new incident cases of epithelial SNC occurring among residents ofthe Lombardy Region. The Regional Registry is managed in accordance with the specific National Guidelines and uses the experience already acquired with the organizational and operational management of the Regional Mesothelioma Registry. RESULTS During the first period of activity (1.1.2008-30.9.2009) 556 cases of suspected SNC were reported to the Registry; only 62 (11.2%) of these actually complied with the inclusion criteria of the Registry and were mainly adenocarcinoma and squamous carcinoma. Occupational exposure to wood or leather dust was ascertained in 50% of cases. CONCLUSION Data collected up to now confirm that occupational exposure to wood and leather dusts are the most significant risk factors for SNC. The study of occupational sectors and job tasks in cases with as yet undefined exposure might suggest new etiologic hypotheses.
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Affiliation(s)
- Carolina Mensi
- Dipartimento di Medicina Preventiva, del Lavoro e dell'Ambiente, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena, Clinica del Lavoro L. Devoto, Milano.
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Riboldi L, Porru S, Feltrin G, Latocca R, Bonzini M, Bordini L, Ferrario MM. [Prevention and control of substance abuse in the workplace: a new and significant opportunity for the occupational physician]. Med Lav 2009; 100:323-343. [PMID: 19960775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Substance abuse is nowadays a recurrent theme in the daily practice of occupational physicians (OP), mainly owing to recent legislation prescribing mandatory assessments for workers performing job tasks involving danger to third parties. While some degree of bureaucracy is inevitable and legislation seems to be inclined towards deterrence, it is recommended to take advantage of the opportunities offered for practical interventions which, in accordance with science and ethics, the OP can carry out in the workplace. Risk assessment, health surveillance, fitness for work, health promotion and cooperation in management issues are the areas of intervention required for the OP to fully accomplish his role in the practice of modern occupational health. CONCLUSIONS We propose specific activities for the OP so as to highlight roles and obligations, based on available scientific evidence and established codes of ethics. Lastly, we wish to emphasize the overall role of the OP in taking on responsibilities shared jointly with all the parties and in the approach to the substance abuse problem in all workplaces with the ultimate goal of acting for the benefit of workers, enterprises and society in general.
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Affiliation(s)
- L Riboldi
- Clinica del Lavoro "Luigi Devoto", Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milano.
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Giacomini S, Mensi C, Sieno C, Riboldi L. [Asbestos-related malignant mesothelioma of the pleura in a young person]. Med Lav 2009; 100:396. [PMID: 19960781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Fustinoni S, De Vecchi M, Bordini L, Todaro A, Riboldi L, Bertazzi PA. [Validity of carbohydrate-deficient transferrine (CDT) in assessing chronic abuse of ethyl alcohol in urban public transport workers]. Med Lav 2009; 100:359-369. [PMID: 19960777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES The aim of this study was to verify the ability of some chemical-clinical parameters, with particular emphasis on carbohydrate-deficient transferrin (CDT), in assessing chronic abuse of ethanol in a group of urban public transport workers. METHODS In the 512 subjects, public transport tram drivers, all males, who entered the study, information on the intake of alcoholic beverages was collected during the periodical health surveillance controls performed according to Italian legislation (DM88/99). In the study subjects the following clinical-chemical parameters were measured: CDT gamma-glutamyltransferase (GGT), mean corpuscular volume of erythrocytes (MCV), aspartate aminotransferase (AST), alanine aminotransferase (ALT). RESULTS The subjects were divided into five groups according to different levels of alcohol intake: non-drinkers, occasional drinkers, moderate drinkers, habitual drinkers and heavy drinkers. The median values of CDT GGT and MCV were higher in drinkers than in non-drinkers, with an increasing trend in proportion to the amount of ethanol ingested. The validity of each parameter in determining chronic abuse of ethyl alcohol was calculated taking as true the statement on alcohol intake made spontaneously by the subject. CDT was confirmed as the parameter with the best sensitivity and specificity: 90% and 98%, respectively, the negative predictive value was 99%, while the positive predictive power was 45%. The combination of CDT with GGT or MCV led to small improvements in the positive predictive ability, which reached 50% for CDT and MCV and 60% for CDT and GGT. CONCLUSIONS Our results confirmed that, also in the workplace, CDT is the most important parameter for the diagnosis of chronic abuse of alcohol intake, but also showed that the positivity of this marker cannot be taken as certainty of abuse. The adoption of further diagnostic tools is therefore proposed, such as a specific questionnaire to collect information on alcohol intake, and in case of positive CDT a second-level test with a high specificity.
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Affiliation(s)
- Silvia Fustinoni
- Unitá Operativa di Epidemiologia, Dipartimento di Medicina Preventiva, del Lavoro e dell'Ambiente "Clinica del Lavoro L. Devoto", Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena e Università degli Studi di Milano, Milano, Italy.
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Riboldi L, Bordini L. [Acute and chronic alcohol abuse and work]. G Ital Med Lav Ergon 2008; 30:56-66. [PMID: 19288791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A not moderate alcohol consumption or its abuse have relevant consequences not only on the health of the general population but also on the possibility to carry out any work in safety conditions. These behaviours have focused the attention of the institutions, which have promoted in the last years a growing number of preventive and informative actions and have adopted specific laws that have significantly involved the figure of occupational physician. Over the clinical implications, in fact, those behaviours, in the employment context, are associated with an increased risk of injuries (from 10 to 30% of total), an increase in the number of absences from work, with greater precariousness, with the possible interaction and/or strengthening of other occupational toxics and with the progressive reduction of working capacity. Diagnostic tools available for the detection of alcohol abuse or dependency consist, in acute cases by direct measuring of alcohol on blood, saliva and exhaled air, while in the chronic situations in addiction to the more traditional indicators (AST, ALT, GGT, MCV) there are recently introduced marker (CDT)--or in validation (ethyl glucuronide)--that representing, also with specific questionnaires (AUDIT, MAST, MALT, CAGE), useful integrated tools in the clinical-diagnostic path. The role and contribution of occupational medicine in the management of alcohol related problems is vital and relevant. Must be clear however that these are problems associated with a particular behaviour of the person and not with risks present on work-site.
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Affiliation(s)
- L Riboldi
- U.O. Medicina del Lavoro 1, Clinica del Lavoro Luigi Devoto, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via San Barnaba 8-20122 Milano, Italy.
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Ferrario MM, Apostoli P, Bertazzi PA, Cesana G, Mosconi G, Riboldi L. [Occupational medicine faces new health challenges: the example of alcohol dependence]. Med Lav 2007; 98:443-445. [PMID: 18041462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The regulations for application of the legislation on control of alcohol consumption at the work place, which were published in the Gazzetta Ufficiale No. 75, March 30, 2006, set the occupational physician a more challenging task, in addition to regular activities related to the prevention of the usual work-related risk factors. The aim of the legislation, which was derived from and inspired by the European Alcohol Action Plan 2000-2005, drawn up by the European Office of the WHO, is to prevent alcohol abuse and its consequences, i.e. accidents and injuries to third parties, and to permit subjects with alcohol dependence to go on working. In this context, occupational physicians are asked to contribute to the early identification of subjects prone to alcohol abuse and assess whether alcohol-dependent subjects can return to work in conditions of safety for themselves and for other workers. Various problems arise for the achievement of these aims in practice, and concern confidentiality, ethical aspects, i.e. use of alcohol screening at hiring, integration of such tests with those used for monitoring conventional occupational exposures, interactions with exposures to other chemical products, just to mention the major issues. Due to these difficulties in the application of the new regulations, field trials become all the more important, since they offer the possibility of assessing efficacy and efficiency of the different approaches.
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Bordini L, Patrini L, Ricci MG, Verga A, Riboldi L. [Alcohol intake, complex ability and responsibility towards others: experience on a cohort of personnel employed to public transport services]. Med Lav 2007; 98:501-512. [PMID: 18041471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND The excessive intake or the abuse of alcoholic substances represent an important hazard's source for the individual health and for the carrying out of any complex working activities, above all if characterized by elevated responsibility toward other people. In this context the recent Provision of 16 March 2006 of the Permanent Lecture for the Relationships among the State the Regions and the Autonomous Provinces of Trento and Bolzano, has individualized bus driver among the activities or tasks of which is forbidden the assumption of alcoholic drinks at work and can performed alcoholic controls by the competent physician (art. 15 of the Law March 30 th 2001, n. 125). Within the normative considering the DM 23 February 1999 n. 88s (Rule bringing norms dealing about the check and the control of the physical and psycho-aptitude ability of the personnel employed to public transport services), we introduced experience growing up in the period from January 2005 to August 2006, on about 1500 employees, for over 90% of men, employed in a public transport company of the Lombardy as bus driver or railwayman. METHODS In order to assess driver's alcoholic abuse the analytical determination of carbohydrate-deficient transferring (CDT) has been used as a marker of alcohol intake. Within the visits of hiring in service (equal to 10% of the total one of the effected visits) the determination of the CDT has always been performed, while in revision visits (equal to 90% of the total one) this analytical determination has been performed only if possible alcohol abuse has been hypothesized by elevated values of gamma-GT before the Provision March 16th 2006 (and eventually of MCV, AST and ALT) and of routine from April 2006. CONCLUSIONS This experience on this large population has confirmed the importance of a careful behaviours of abuse monitoring in workers with high responsibility toward other people. The CDT values reflect high alcoholic consumption, while is poorly remarkable the contribution furnished by anamnestic questionnaire.
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Affiliation(s)
- L Bordini
- Clinica del Lavoro Luigi Devoto, Fondazione IRCCS - Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milano.
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Todaro A, Bordini L, Rubagotti M, Mensi C, Riboldi L. [Health surveillance in workers with a previous exposure to asbestos: a method of retrospective evaluation of exposition]. G Ital Med Lav Ergon 2007; 29:641-642. [PMID: 18409883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The medical surveillance of the previously exposed to asbestos like method of retrospective appraisal of the exposure. The medical surveillance of the previously exposed to asbestos is effected on indication of the Competent Physician by the DL 257/2006. An aspect that often countersigns such typology of surveillance is the lack of relative data about past environmental asbestos exposure. There've been submitted to sanitary controls 140 subject employees in a steel metal company where in past activity of heavy carpentry has been developed. All the subjects have been submitted in the period 1998-2007 to medical visit, PFR with DLCO, radiography of the chest, in some cases TC and BAL. The past exposure has been resulted inclusive between 1962 and 1981. None of these workers has developed asbestosis, while the 10% of the subjects have showed bilateral pleural plaques. 12 subjects have been submitted to close examination through BAL for the determination of the internal dose of asbestos with comparison of middle values of 3.9 ca /ml. Four cases of pulmonary neoplasm and any case of mesothelioma have been diagnosed. This experience shows as the medical surveillance of a homogeneous group of workers can furnish useful data also to frame previous asbestos exposure in absence of environmental data.
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Affiliation(s)
- A Todaro
- Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milano
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Ferrario MM, Calderini D, Cambiano V, Panizza C, Riboldi L, Pianosi G, Occhipinti E, Cantoni S. [Occupational safety and health in hospitals of Regione Lombardia. Are there differences among public, private nonprofit and private profit hospitals?]. G Ital Med Lav Ergon 2007; 29:799-801. [PMID: 18409968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In 2006 an extensive survey took place in all hospitals of Lombardia, to assess, through inspections, the safety conditions and the efficiency of the organisations invested to assure that. During these inspections were evaluated 6 safety sections and hospital organization and efficiency, by means of a questionnaire. The aim was to assess the internal consistency of questionnaire sections, the presence of differences of such scores among public, private non-profit and profit hospitals and the correlations among safety scores and among these latter and efficiency indexes. Significant differences for size factors and efficiency indexes have been pointed out among different types of hospitals. Instead, safety scores showed good internal consistency and have been resulted statistically significant correlated in most cases. For all types of hospital have been observed high values for safety scores, with exception of occupational health service, better organized in public hospitals, and of safety conditions of worker from external agencies, which have been displayed low. This last consideration stick out the need to pay more attention to safety conditions of these workers.
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Affiliation(s)
- M M Ferrario
- Medicina del Lavoro e Preventiva, Dipartimento di Scienze Cliniche e Biologiche, Università degli studi dell'Insubria, Viale Borri, 56, 21100 Varese, Indirizzo.
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Mensi C, Macchione M, Termine L, Rivolta G, Riboldi L, Chiappino G. [Information of the registry of mesothelioma in Lombardy: the asbestos risk in rotogravure]. Med Lav 2006; 97:726. [PMID: 17171985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Merluzzi F, Pira E, Riboldi L. ["The Italian decree 195/2006 on the protection of workers against risks arising from noise"]. G Ital Med Lav Ergon 2006; 28:245-7. [PMID: 17144410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The Italian decree 195/2006 incorporates the European Directive 2003/10/CE on the minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents (noise). It is rather different to previous decree 277/1991, particularly as regard of the new exposure limit value and the elimination of annex VI and VII. We discus here only two aspects that we consider relevant and quite critical: 1) The calculation of the exposure limit values as noise equivalent level: it is a method that underestimates the potential damage of impulsive noise, so the risk evaluation remains quite inaccurate. 2) To take account of the attenuation provided by the individual hearing protectors worn by the worker in determining the worker's effective exposure when applying the exposure limit values: this must not apply to the obligations of employer to control the risk at source avoiding or reducing exposure to the minimum. Furthermore the attenuation power of individual hearing protectors is difficult to measure because his variability during the time and among different subjects. Then we evaluate and discus the new duties of Occupational Physician in this matter. The daily exposure limit values and action values are in fact in part modified as well as the methodology for organize the programs of prevention, health surveillance, information and formation of workers. As support for his activity we proposed the guidelines that The Italian Society of Occupational Health and Industrial Hygiene (SIMLII) has published in 2003, which provides recommendations for the health surveillance for the prevention of noise induced hearing loss at the workplace.
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Affiliation(s)
- F Merluzzi
- Dipartimento di Medicina del Lavoro Università degli Studi di Milano.
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Todaro A, Vitelli N, Riboldi L, Maggi L, Belotti L, Mosconi G. [A particular case of hard metal disease]. Med Lav 2006; 97:586-91. [PMID: 17017385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
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.
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Affiliation(s)
- A Todaro
- Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Dipartimento di Medicina del Lavoro, Clinica del Lavoro L. Devoto, Milano.
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Rivolta G, Della Foglia M, Donelli S, Riboldi L. [Health surveillance of workers with prior exposure to asbestos. Application in the metallurgy/metal mechanical field]. G Ital Med Lav Ergon 2006; 28:169-72. [PMID: 16805450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
To improve the health surveillance program for workers with a known previous exposure to asbestos in a big metallurgic-mechanical industry from Lombardy, the sources of risk and the different exposure levels hare been reconstructed based on specific jobs. The eligibility criteria and a specific work program including information and organization supports hare been established by a work group composed by health physicians, workers and industrial hygienists. The major goals of the program were: to listen and support each worker who perceives worries about his health status; to prevent, if possible, diseases, especially cancer, resulting from exposure; to document the existing injuries for legal compensation. The resulting actions consist of counselling; indication to follow an adequate life and work style; indication, based on specific request of worker, of sanitary checks of first or eventually second level.
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Affiliation(s)
- G Rivolta
- Clinica del Lavoro Luigi Devoto, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Italy
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Mensi C, Canti Z, Rivolta G, Riboldi L, Chiappino G. [Malignant mesothelioma in the maritime professions]. Med Lav 2006; 97:82. [PMID: 17009677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Mosconi G, Cassina T, Catenacci G, Ditaranto D, Frigeri G, Imbriani M, Merluzzi F, Mutti A, Riboldi L, Roscelli F, Saretto G, Toffoletto F, Violante F, Apostoli P. [Research and formal demonstration of evidence of efficiency in occupational medicine]. G Ital Med Lav Ergon 2006; 28:135-48. [PMID: 16711131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
There is an increasing pressure on occupational health professionals to ensure that their practice is based on a quality standard and an evidence of appropriateness. The efficacy-effectiveness of their activity strictly depends on their intellectual and professional integrity, their technical and legal competence, but also on the quality of the relations with the company organisation they are able to establish. We asked to some occupational physician when they considered their interventions in the workplace to be efficacious. Then, accordingto our epexrience, we propose some effectiveness indicators, particular concerning health surveillance and health educttaon, that should be evaluated to verify the health professional agccvity agreement to quality standards.
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Affiliation(s)
- G Mosconi
- Associazione Lombarda di Medicina del Lavoro e Igiene Industriale.
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