1,720,969 research outputs found
WORKPLACE DRUG TESTING IN ITALY: NINE YEARS OF EXPERIENCES VIEWED FROM THE OCCUPATIONAL HEALTH PHYSICIAN'S PERSPECTIVE
Full text linkIn Italy, WDT is compulsory by law for specific categories of workers since 2008, offering the opportunity to compare studies conducted within a single regulatory framework.
Aims: (i) To estimate the overall prevalence of WDT positivity (at screening survey) among Italian workers. (ii) To evaluate the percentage of true and false positives at confirmation analysis.
Methods: Systematic review and meta-analysis of the scientific literature on WDT in Italy from January 2008 to March 2015, according to the MOOSE Guidelines. A random effects model was utilised to calculate pooled prevalence. Potential sources of heterogeneity were explored using sensitivity test and subgroup analysis.
Results: The overall meta-analytical prevalence of positivity at WDT among Italian workers was 1.4% [95% confidence interval (CI) = 1.1–1.7%]. It was significantly lower among workers screened with an on-site test (1%; 95% CI = 0.5–1.5%), compared with a bench-top test (1.7%; 95% CI = 1.3–2.1%). Nine studies provided data on false positives at the screening test, with a combined prevalence estimate - calculated on positive cases - of 30% (95% CI = 16-44%).
Conclusion: In Italy, the number of true positives at first level workplace drug testing is low, while the frequency of false positives is relatively high. A revision of the Italian legislation on the subject seems advisable.In Italy, WDT is compulsory by law for specific categories of workers since 2008, offering the opportunity to compare studies conducted within a single regulatory framework.
Aims: (i) To estimate the overall prevalence of WDT positivity (at screening survey) among Italian workers. (ii) To evaluate the percentage of true and false positives at confirmation analysis.
Methods: Systematic review and meta-analysis of the scientific literature on WDT in Italy from January 2008 to March 2015, according to the MOOSE Guidelines. A random effects model was utilised to calculate pooled prevalence. Potential sources of heterogeneity were explored using sensitivity test and subgroup analysis.
Results: The overall meta-analytical prevalence of positivity at WDT among Italian workers was 1.4% [95% confidence interval (CI) = 1.1–1.7%]. It was significantly lower among workers screened with an on-site test (1%; 95% CI = 0.5–1.5%), compared with a bench-top test (1.7%; 95% CI = 1.3–2.1%). Nine studies provided data on false positives at the screening test, with a combined prevalence estimate - calculated on positive cases - of 30% (95% CI = 16-44%).
Conclusion: In Italy, the number of true positives at first level workplace drug testing is low, while the frequency of false positives is relatively high. A revision of the Italian legislation on the subject seems advisable
Manuale di primo soccorso. Ad uso del personale addetto al primo soccorso aziendale
No full textIl manuale espone gli argomenti del programma formativo previsto per gli addetti al primo intervento dal DM 15 luglio 2003, n. 388, recante disposizioni sul pronto soccorso aziendale. Comprende una sintesi storica della normativa italiana in materia di pronto soccorso negli ambienti di lavoro, nozioni elementari d’anatomia e di fisiologia del corpo umano e una sezione dedicata ai rischi per i soccorritori, con consigli utili per evitare agli stessi di diventare “seconde vittime” dell’incidente che ha richiesto il loro intervento. Con l’ausilio di disegni illustrativi, sono quindi descritte le manovre di base e gli interventi di primo soccorso che possono essere effettuati anche dal soccorritore non medico, descrivendo sistematicamente le più comuni situazioni critiche che si possono verificare in ambito lavorativo: urgenze ed emergenze cardiologiche, respiratorie, neurologiche; traumi; infortuni elettrici e termici; incidenti chimici e intossicazioni. Nel contempo è illustrato ciò che non deve essere fatto, onde evitare il rischio di aggravare le condizioni della vittima
Industria del legno
Full text linkDescrizione del ciclo produttivo dell'industria del legno e relativi rischi professionali
Disturbi respiratori del sonno e medicina del lavoro: considerazioni su tre casi clinici
No full textThree subjects suffering from sleep-disordered breathing are described. Two of them (a 37-year-old lorry driver with obstructive sleep apnea, and a 47-year-old bricklayer with upper airway resistance syndrome) had suffered several accidents at work in few months, due to daytime sleepiness. The third patient (45-year-old) had developed (central and obstructive) sleep apnea after having been exposed to organic solvents for 15 years as a painter. In all the three subjects, polysomnography led to correct diagnosis, and nocturnal ventilotherapy with nasal CPAP (continuous positive airway pressure) considerably improved the clinical picture. The cases presented illustrate the twofold interest of sleep-disordered breathing for Occupational Medicine: on the one hand, these syndromes may reduce job performance and increase the accident risk; on the other hand, they may recognize as a risk factor the occupational exposure to solvents
Poor weight control, alcoholic beverage consumption and sudden sleep onset at the wheel among Italian truck drivers: A preliminary pilot study
Full text linkObjectives: The aim of this study was to investigate the prevalence of obesity, alcoholic beverage consumption, unhealthy alcohol use and sudden sleep onset at the wheel among Italian truck drivers. In addition to prevalence rates, this study also aimed at investigating potential predictors for sudden-onset sleepiness and obesity. Material and Methods: A sample of truck drivers was extracted from the database of the High Risk Professional Driver Study. Data concerning demographics, anthropometry, medical information and working conditions were collected using anonymous questionnaires. Logistic regression analyses were performed to assess the association of the reported body mass index (BMI), alcohol consumption and sudden sleep onset with working conditions and general lifestyle factors. Results: Three hundred and thirty-five questionnaires were collected. According to their BMI, 45% of the participants were overweight and 21.4% of them were obese. Twenty-four point two percent declared they drank alcoholic beverages during working hours or work breaks and 21.3% of the drivers had an Alcohol Use Disorders Identyfication Test Consumption (AUDIT C) score ≥ 5 (the threshold value for unhealthy alcohol use). Forty-one point six percent of the interviewees experienced one episode of sudden sleep onset at the wheel per month (5.5% per week and 0.9% daily). Predictive factors for obesity were: length of service (odds ratio (OR) = 1.09, confidence interval (95% CI): 1.04–1.15, p 55 years old (OR = 5.22, 95% CI: 1.29–21.1, p = 0.020), driving more than 50 000 km per year (OR = 2.89, 95% CI: 1.37–6.11, p = 0.006) and the Chalder Fatigue Questionnaire (CFQ) score > 11 (adjusted OR = 2.97, 95% CI: 1.22–7.21, p = 0.016). Conclusions: This study strongly emphasizes the need for intervention in order to reduce and prevent important risk factors for the sake of road safety and truck drivers’ health
Seven years of workplace drug testing in Italy: a systematic review and meta-analysis
Full text linkIn Italy, Workplace Drug Testing (WDT) has been compulsory by law for specific categories of workers since 2008, offering the
opportunity to compare studies conductedwithin a single regulatory framework. The aims of this paper are to estimate the overall
prevalence of WDT positivity (at screening survey) among Italian workers and evaluate the percentage of true and false positives
at confirmation analysis. A systematic review and meta-analysis of the scientific literature on WDT in Italy from January 2008 to
March 2015 was carried out, according to the MOOSE guidelines. A random effects model was utilized to calculate pooled
prevalence. Potential sources of heterogeneity were explored using sensitivity test and subgroup analysis. The overall
meta-analytical prevalence of positivity at WDT among Italian workers was 1.4% [95% confidence interval (CI) = 1.1–1.7%]. It
was significantly lower among workers screened with an on-site test (1%; 95% CI = 0.5–1.5%), compared with a bench-top test
(1.7%; 95% CI = 1.3–2.1%). Nine studies provided data on false positives at the screening test, with a combined prevalence
estimate - calculated on positive cases – of 30% (95% CI = 16–44%). In Italy, the number of true positives at first-level workplace
drug testing is low, while the frequency of false positives is relatively high. A revision of the Italian legislation on the subject seems
advisable
Occupational poisoning in the current clinical practice
No full textOccupational exposure to chemicals has considerably changed over the years, both qualitatively and quantitatively, in connection with the technological progress, the disappearance of some jobs and the appearance of others, the adoption of better preventive measures with consequent elimination or reduction of some risks, the partial substitution of these latter with new risks.
The recent issuing of the legislative decree 25/2002 (which integrates the known legislative decree 626/1994) imposes an accurate assessment of the risks deriving from the increasing number of chemicals utilized in the most disparate productive processes. With this in mind, and in the light of the case record of our institute, we believe useful to pinpoint the clinical aspects of occupational toxicology which are encountered nowadays in the hospital practice.
•Some “classical” clinical pictures (e.g., florid saturnism, manifest hydrargyrism, benzene emopathy, sulphocarbonism, n-hexane neuropathy), deriving from chronic exposure to medium-high levels of workplace pollutants, have almost completely disappeared.
•On the other hand, the risk of accidental acute poisoning (caused by pesticides, industrial solvents, gases, etc.) mantains its relevance. The victims of such accidents should always be accurately followed up, due to the possibility of long term sequelae (e.g., organophosphate neuropathy, carbon monoxide delayed encephalopathy) that may become evident after a period of apparent recovery.
•Long latency, chemical-induced diseases (pneumoconiosis, occupational cancer) due to occupational exposures suffered in the past are still common. Since these illnesses usually reveal themselves several years after the exposure to the chemical hazard has ceased, occupational anamnesis plays a keyrole for their correct diagnostic identification.
•The problem of the exposure to carcinogenic agents (e.g., asbestos, benzene, nickel, hexavalent cromium, polycyclic aromatic hydrocarbons) remains particularly relevant where the substitution of such substances in the productive processes is not practically feasible. Etiological diagnosis of occupational cancer is extremely difficult, with obvious implications in the medico-legal setting.
•Especially in predisposed subjects, prolonged occupational exposure to low doses of chemicals can induce oligosymptomatic, aspecific clinical pictures (e.g., micromercurialism, subclinical plumbism, “chronic painter syndrome”), which may be misdiagnosed for diseases due to other causes (once again, a careful occupational anamnesis should be collected). Moreover, there is controversial evidence that occupational exposures to microdoses of chemicals participate in the etiopathogenesis of some neurodegenerative disorders (e.g., Parkinson’s disease, Alzheimer disease) which are usually labelled as “idiopathic”.
•The threshold limit values (TLVs) currently adopted in the workplaces protect the majority of the exposed subjects, but not all of them. In other words, a minority of workers may be damaged from the exposure levels tolerated by their colleagues. Allergy is the best examplification of this concept. Indeed, skin and respiratory allergopathies are among the occupational diseases most frequently observed nowadays. Additionally, individual xenobiotic metabolism (linked to genetic, physiological and environmental determinants), or the congenital deficiency of some enzymes (such as glucose-6-phosphate dehydrogenase: G6PD), may cause hypersensitivity to specific toxicants (in the case of G6PD deficiency, to the action of hemolytic poisons) (3). Thus, the technical preventive measures and the observance of TLVs should always be flanked by medical interventions (sanitary surveillance, biological monitoring) aimed at protecting the health of every single worker.
•Occupational toxicology is tightly linked to environmental medicine: pesticides and industrial chemicals often contaminate the natural environment and enter the food chains. Such perturbations may affect more or less directly the living beings, including humans. This is well examplified by the cases of mercury (fish contamination by methylmercury), benzene (risk of leukemia for the general population) and asbestos (“vicinity” mesothelioma)
Silicotuberculosis in the elderly: report of two cases
No full textSilicotuberculosis is observed rarely in the current clinical practice. We present two patients (a 72-year-old man and a 84-year-old woman) who developed silicosis after having worked for several decades in the ceramics industry. In both, pulmonary tuberculosis complicated the clinical picture several years after retirement. The first subject presented a multicavitary lesion in the apex of the right lung, which subsequently evolved with fibrosis. The other developed bilateral tubercular bronchopneumonia and right tubercular pleurisy, that improved after prolonged antimycobacterial polychemotherapy. The two cases confirm that patients with silicosis are at increased risk for developing tuberculosis, and show that, nowadays, silicotuberculosis may represent a geriatric problem. In the elderly, recognition of tuberculosis associated with silicosis is often difficult. Occupational history, radiology (conventional chest radiography and computed tomography) and microbiology (identification of Mycobacterium tuberculosis in sputum and pleural exudate) are helpful for the correct diagnosis, which, in turn, is important for prognosis and treatment, as well as in relation to medico-legal issues and occupational-related compensation claims
Falling asleep at the wheel and distracted driving. The High-Risk Professional Drivers study
No full textBackground: Sleepiness at the wheel and driving while engaged in other activities are well known risk factors for
traffic accidents. This article estimates the prevalence of these factors among Italian Professional Drivers (PDs) and
their impact on reported driving mistakes. Methods: A cross-sectional study was conducted using anonymous questionnaires.
PDs (n=497) were divided into two groups: high-risk PDs (HiRis_PDs) (those who self-reported more
than one incident during the last 3 years and/or more than one mistake during the past year) and non-HiRis_PDs
(subjects who did not meet the above-mentioned inclusion criteria). Logistic regression analyses were performed to
assess the association of self-reported sleepiness and/or risky driving behaviour with the condition of being a high-risk
driver. Results: 161 (32.4%) subjects were defined as HiRis_PDs. Forty-one percent of the interviewees experienced
at least one episode per month of sudden-onset sleep at the wheel. Twenty-eight point two percent reported a regular
use of a hand-held cell phone. Predictive factors for being HiRis_PDs were: at least one self-reported episode per
month of falling asleep at the wheel [odds ratio (OR) 5, 95% confidence interval (CI) 3.21-7.80, P<0.001], driving
while regularly engaged in other activities (mainly hand-held cell phone use) (OR 6.11, 95% CI 2.90-12.84,
P<0.001), and young age (OR 0.96, OR 1 year of age increase, 95% CI 0.94-0.98, P=0.001). Conclusions: Focusing
prevention efforts on recognizing sleepiness at the wheel and on avoiding other distracting activities while
driving can reduce the possibility of driving errors on the road by about 5-6 times
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