Return to work after coronary revascularization procedures and a patient's job satisfaction: A prospective study

Introduction Research into work reintegration following invasive cardiac procedures is limited. The aim of this prospective study was to explore predictors of job satisfaction among cardiac patients who have returned to work after cardiac rehabilitation (CR). Material and methods The study population consisted of 90 cardiac patients who have recently been treated with coronary angioplasty or heart surgery. They were evaluated during their CR and 12 months after the discharge using validated self-report questionnaires measuring job satisfaction, work stress-related factors, emotional distress and illness perception. Information on socio-demographic, medical and occupational factors has also been collected. Results After adjusting for demographic, occupational and medical variables, baseline job satisfaction (p < 0.001), depression (p < 0.01) and ambition (p < 0.05) turned out to be independent, significant predictors of job satisfaction following return to work (RTW). Patients who had a partial RTW were more satisfied with their job than those who had a full RTW, controlling for baseline job satisfaction. Conclusions These findings recommend an early assessment of patients' psychosocial work environment and emotional distress, with particular emphasis on job satisfaction and depressive symptoms, in order to promote satisfying and healthy RTW after cardiac interventions

Work-related stress and bullying: gender differences and forensic medicine issues in the diagnostic procedure

<p>Abstract</p> <p>Background</p> <p>The attention of international agencies and scientific community on bullying and work-related stress is increasing. This study describes the gender differences found in victims of bullying and work-related stress in an Italian case series and analyzes the critical issues in the diagnostic workup.</p> <p>Methods</p> <p>Between 2001 and 2009 we examined 345 outpatients (148 males, 197 females; mean age: 41 ± 10.49) for suspected psychopathological work-related problems. Diagnosis of bullying was established using international criteria (ICD-10 and DSM-IV).</p> <p>Results</p> <p>After interdisciplinary diagnostic evaluation (Occupational Medicine Unit, Psychology and Psychiatry Service), the diagnosis of bullying was formulated in 35 subjects, 12 males and 23 females (2 cases of Post-Traumatic Stress Disorder and 33 of Adjustment Disorder). Fifty-four (20 males, 34 females) suffered from work-related anxiety, while work-unrelated Adjustment Disorder and other psychiatric disorders were diagnosed in 7 and 112 subjects, respectively. Women between 34 and 45 years showed a high prevalence (65%) of "mobbing syndrome" or other work-related stress disorders.</p> <p>Conclusions</p> <p>At work, women are more subject to harassment (for personal aspects related to emotional and relational factors) than men. The knowledge of the phenomenon is an essential requisite to contrast bullying; prevention can be carried out only through effective information and training of workers and employers, who have the legal obligation to preserve the integrity of the mental and physical status of their employees during work.</p

Brugada syndrome and job fitness: report of three cases

Summary Introduction. Brugada syndrome is an inherited arrhythmogenic disorder predisposing patients to a high risk of sudden cardiac death. Specific guidelines on the health surveillance of affected workers are lacking. Objective. By presenting three illustrative cases, we propose an interdisciplinary approach for the clinical and functional evaluation of Brugada syndrome workers, aimed at continuing the occupational activity, by formulating appropriate prescriptions and limitations. Materials and methods. The subjects were investigated with an interdisciplinary protocol including 24-hour Holter electrocardiography with modified precordial leads, pharmacological test with ajmaline, molecular genetic analysis, electrophysiological study with ventricular stimulation, risk stratification, and occupational medicine evaluation. Results. The first case is a female 42 year-old company manager with positive ajmaline test and CACNA1C gene mutation (judged fit for the job with limitations regarding work-related stress); the second is a male 44 year-old welder with positive ajmaline test, SCN5A gene mutation, and associated OSAS (obstructive sleep apnea syndrome), who was advised to refrain from night shifts and driving company vehicles; the third subject is a male 45 year-old electrical technician with inducible ventricular tachyarrhythmia, who was implanted with a biventricular cardioverter defibrillator, and therefore recommended to avoid exposure to electromagnetic fields and working at heights. Conclusion. Patients with Brugada syndrome may come to the attention of the occupational physician. In this circumstance, the collaboration with an expert cardiologist allows to define the functional capabilities and the arrhythmogenic risk, and to formulate the judgment for job fitness

Work resumption after invasive heart procedures, rehabilitation and ergonomic evaluation: from the hospital to the workplace

Our Institute adopts a multidisciplinary protocol named “CardioWork” for work resumption after invasive cardiac procedures and subsequent rehabilitation: after evaluation of the cardiac functional profile, the occupational physician analyses the work activity prior to the cardiopathological event, identifies the presumed task energy requirement (from specific, published tables), and compares it with the exercise test results. Indications regarding timing and modality of returning to work are formulated accordingly. To verify the reliability of the indications thus provided, we carried out a clinical-functional follow-up study in the workplace, with Holter ECG and Armband measurement of actual energy expenditure. Over the course of two years, we enrolled 36 patients (mostly males, aged between 30 and 70 years), hospitalized after coronary revascularization, valve replacement or cardiac defibrillator implant. After rehabilitation, instrumental diagnostics (Holter ECG, echocardiography, exercise test) showed discrete functional conditions, with better values with regard to cardiac function than exercise capacity and effort tolerance. All subjects were judged fit for the job, in most cases with limitations concerning ergonomic factors, working timetable and/or stress. They returned to work quickly, with good adherence to the indications provided. Workplace Holter ECG did not show appreciable differences compared to the hospital evaluation. In one case, the average energy expenditure measured while working was higher than that inferred from the tables; in the remaining subjects, the actual expenditure coincided with what was expected or was lower. In a minority of cases (39%), the measured average expenditure slightly exceeded the optimal value (35% of the maximal value at the exercise test) recommended at the time of hospital discharge. At the end of the workplace evaluation, it was not necessary to formulate new indications. The study provides further evidence of the effectiveness of the CardioWork protocol in promoting return to work after invasive heart procedures. Though they need continuous updating, the published estimates of presumed task energy requirement remain reliable. In particularly complex cases, it is however advisable to carry out a field check of the ergometric assessments performed at the end of rehabilitation

Baker’s asthma with oculorhinitis: case report

Summary Introduction. Baker’s asthma is one of the most common causes of occupational asthma worldwide. Beside bread production, all occupations in contact with flour (confectioning, pastry making, milling, farming, cereal handling) can be affected. Objective. To illustrate, through the presentation of a clinical case, an updated interdisciplinary diagnostic approach for the evaluation of suspected occupational asthma, with the aim: to identify the possible causal link between the occupational exposure and the disease, and to formulate a correct judgment for job fitness. Materials and methods. Interdisciplinary (occupational medicine and allergology) specialist evaluation, blood and urine analysis, patch tests, total and specific IgE dosage, eosinophilic cationic protein assay, spirometry, non-specific metacholine bronchostimulation, specific inhalation challenge, with monitoring of airway resistance by FOT (forced oscillation technique), and of nasal and bronchial FeNO (fractional exhaled nitric oxide). Results. Fifty-four year-old man, baker since 1993. In recent months, dyspnoea and dry cough, accompanied by ocular and nasal flogosis, as well as itchy skin rash, mainly during work shifts. High total and specific IgE values. Increased eosinophilic cationic protein. Negative metacholine test. Specific inhalation challenge with buckwheat stopped after 15 minutes due to the onset of rhinitis, conjunctivitis, cough with shortness of breath and wheezing. Post-exposure FEV1 decrease (> 12%) and +76% FOT increase. Progressive and persistent nasal FeNO increase with normalization after 24 hours. These findings indicated bronchial and oculonasal allergic response to buckwheat and other cereals. Conclusion. The diagnostic protocol allowed demonstrating the causal link between occupational exposure and the disease, which was reported to the competent authorities. The patient was advised to refrain from further exposure. The evolution of processing techniques and the new substances used in bread production, require continuous updating of diagnostic and health surveillance protocols

Elementi di tecnologia industriale a uso dei cultori di medicina del lavoro

Il trattato esamina i cicli tecnologici industriali, identificando in ciascuna fase di essi i rischi per la salute dei lavoratori

La formazione degli addetti in agricoltura: il ruolo della scuola e degli altri enti pubblici e privati

The authors report their health education experience in the high schools of Pavia, emphasizing the responsibility of the public school in promoting a rational behaviour of the youth aimed at health maintenance, and illustrating the role recently played in this regard by a private institution (linked to the University of Pavia and several other Universities): the Salvatori Maugeri Foundation. Since the authors' experience also encompasses the prevention of work-related injuries and diseases, the article presents a didactic plan specifically aimed at the education of future agriculture workers. The program starts from the fundamental principle that considers risk not as something fatally ineluctable but as probabilty of damage, and then dwells on the consequent predictive meaning of a series of notions which allow interventions useful to minimize the various occupational risk factors (or "causes of damage"). The teaching program is composed by educational steps which gradually becomes more complete and specific according to the advancement of learning