Aggiornamenti in tema di tutela della salute occupazionale dei lavoratori della sanità

The board of the Thematic Section on Preventive Medicine for Health Care Workers of the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII) programmed a national conference on occupational risks of health care workers to be held in late 2009. Main topics will be: a) biohazards; b) biomechanical risk; c) psychosocial factors. Three different working groups were established to tackle critical aspects and suggest practical recommendations to occupational health professionals. Preliminary issues are presented while final results will be presented at the conference on September 2009. © PI-ME, 2008

Neuropsychological effects of chronic low-dose exposure to polychlorinated biphenyls (PCBs): A cross-sectional study

BACKGROUND: Exposure to indoor air of private or public buildings contaminated with polychlorinated biphenyls (PCBs) has raised health concerns in long-term users. This exploratory neuropsychological group study investigated the potential adverse effects of chronic low-dose exposure to specific air-borne low chlorinated PCBs on well-being and behavioral measures in adult humans. METHODS: Thirty employees exposed to indoor air contaminated with PCBs from elastic sealants in a school building were compared to 30 non-exposed controls matched for education and age, controlling for gender (age range 37–61 years). PCB exposure was verified by external exposure data and biological monitoring (PCB 28, 101, 138, 153, 180). Subjective complaints, learning and memory, executive function, and visual-spatial function was assessed by standardized neuropsychological testing. Since exposure status depended on the use of contaminated rooms, an objectively exposed subgroup (N = 16; PCB 28 = 0.20 μg/l; weighted exposure duration 17.9 ± 7 years) was identified and compared with 16 paired controls. RESULTS: Blood analyses indicated a moderate exposure effect size (d) relative to expected background exposure for total PCB (4.45 ± 2.44 μg/l; d = 0.4). A significant exposure effect was found for the low chlorinated PCBs 28 (0.28 ± 0.25 μg/l; d = 1.5) and 101 (0.07 ± 0.09 μg/l; d = 0.7). Although no neuropsychological effects exceeded the adjusted significance level, estimation statistics showed elevated effect sizes for several variables. The objectively exposed subgroup showed a trend towards increased subjective attentional and emotional complaints (tiredness and slowing of practical activities, emotional state) as well as attenuated attentional performance (response shifting and alertness in a cued reaction task). CONCLUSION: Chronic inhalation of low chlorinated PCBs that involved elevated blood levels was associated with a subtle attenuation of emotional well-being and attentional function. Extended research is needed to replicate the potential long-term low PCB effects in a larger sample

Changes at workplace as antecedents of bullying

Bullying is a complex and multi-causal phenomenon that cannot be explained by one single factor, but rather by an interaction of different factors; it is a process that typically begins with indirect actions and degenerate in direct and aggressive behaviours (Einarsen et al., 2003). Usually the victims are not immediately aware of the real nature of the situation but, after a variable amount of time, the very moment of the onset is recognised. The aim of the study, currently in progress, is to identify the main antecedents of bullying as reported by a sample of patients victims of bullying examined at the Medical Centre for Occupational Stress and Harassment of \u201cClinica del Lavoro Luigi Devoto\u201d (Milan) for work-related psychiatric disorders. The patients (N=77) were subjected to a three-day protocol. Qualitative analysis of occupational history, as collected by an occupational physician and a psychologist, was conducted. The results show that the most frequent antecedents of bullying are restructuring (23.4%) (new management, new bosses, new colleagues and proprietor) and the change of one or more superiors (23.4%), without restructuring. 14.3% of the subjects stated that problems began when they requested the respect for their rights or posed other demands (a promotion, a transfer etc.). 10.4% of the subjects reported that their problem began soon after their employment in a new workplace. 9.1% said that problems occurred when they were moved to a new office. Only 5.2% affirmed having been discriminated after refusing sexual proposals or when they reported being affected by a disease. These results show that the change, of different type, at the workplace is a critical factor and that, although per se insufficient, can trigger the bullying process. This is the reason why the management of change seems to be a very important intervention for preventing bullying

Victims of workplace bullying : considerations about personal characteristics using the Wartegg Drawing Completion Test

This presentation addresses the topic of personality among victims of workplace bullying, drawing upon information collected through both empirical and clinical evidence. Bullying at work has been described as a phenomenon with a multi-factorial aetiology, including, at the individual level, personality characteristics of both victims and perpetrators. According to Zapf and Einarsen (2003), a comprehensive model of bullying should include individual factors and their contribution to the onset, escalation and consequences of the bullying process. A number of studies reported that victim characteristics may play a role in the bullying process. Victims are described as anxious and neurotic, inadequate in social skills and self-esteem, and overly conscientious and overcommitted. Further studies investigated on the existence of a typical victim personality. Matthiesen and Einarsen (2001), by examining MMPI-2 profiles, have found three different personality profiles, suggesting that, although personality may actually play a role, there is no evidence of a general \u201cvictim personality\u201d. A similar conclusion was drawn by Glas\uf8 at al. (2007). By using the Big Five Model, these authors have found that one-third of the victims tended to be significantly more anxious and neurotic and less agreeable, conscientious and extravert than non-victims, but the major part of victims turned out to be similar to non-victims. As opposite to this view, Leymann and Gustafsson (1996) argued that \u201cpremorbid personality\u201d does not play any role in the onset of bullying situations. These authors claim that the victimisation process has the potential of permanently changing victim personality. The use of self-reported measures of personality may lead to bias such as the voluntary effort to alter reporting of individual characteristic. The projective technique for personality evaluation that we adopted in this study may have the advantage of limiting such bias. Study aim. The aim of the present study is to evaluate personal characteristics of victims of workplace bullying by means of the semi-structured projective technique Wartegg Drawing Completion Test, and to investigate their relationship with exposure to bullying, as measured by a self-report questionnaire (CDL). Sample. We analysed a sample of 198 subjects seeking health care for bullying-related complaints, at the Service for Stress and Harassment of the \u201cClinica del Lavoro Luigi Devoto\u201d in Milan. The sample was evenly composed of men and women and mostly of subjects in the age group 35-54 (75.3%). Education was medium-high (54.5% secondary school, 16.2% university degree). As for occupation type, white-collars (52.5%) and workers employed in large companies (61.6%) accounted for the major part of the sample. Instruments. Subjects were administered an ad hoc protocol for harassment-related disorder aimed at the evaluation of a potential bullying condition and the assessment of related health outcomes. The Wartegg test is a drawing projective technique, made up by eight panels, laid out in two rows, each containing a different graphic stimulus-sign, tapping distinct psychological dimensions. The subject is invited to complete, with a spontaneous drawing, each panel graphic-sign which has the potential of revealing profound personality areas, thus providing information about core personal characteristics. Tests have been analysed according to the Crisi\u2019s quantitative scoring system (Crisi, 1998). The Evocative character (EC), the Affective quality (AQ) and the Formal quality (FQ) of the drawings were considered. EC refers to the symbolic ability to perceive and process stimuli, indicating subjective skills to adapt and interact with the environment. AQ refers to the general affective and emotional disposition of the subject, indicating the quality of interpersonal relationships. FQ refers to cognitive integrity, indicating adequacy in reality evaluation. The CDL questionnaire is a self-report instrument, made up of 30 items, developed with the aim to collect information about type, number and frequency of negative actions. Results. Of the sample subjects, 42.4% reported medium scores in Evocative Character, suggesting adequate skills in situation adjustment; 43.4% showed rigidity in adaptation and lack of flexibility, and 14.1% extreme sensitiveness to the environment. As far as Affective Quality is concerned, 31.8% of the victims reported emotional stability, 57.6% a general depressive state (introversion and withdraw from interpersonal relationships), whereas 10.6% were characterized by excessive adaptation to the environment and overly obligingness in interpersonal relationships. As for Formal Quality, 15.7% displayed a good intellectual control on emotional-affective manifestations, 17.2% an excessive intellectual control and perfectionism, 53% an interference of emotional-affective disturbances on cognitive performance (attention and concentration), while the remaining 14.1% showed cognitive disturbances. As regards the relationship between personality and bullying victimization, victims who resulted as more agreeable reported more negative actions according to the CDL questionnaire. However, no other differences were observed for self-reported exposure to bullying in relation to personal characteristics. Preliminary conclusions. These results indicate that in our sample of victims of bullying, there are cases scoring outside the \u201cnormal\u201d range across three psychological dimensions of the Wartegg test. However, the absence of a control group of non-victims prevents us from drawing definite conclusions about whether victims and non-victims of workplace bullying differ in regards to personality characteristics. Comparative analyses using scores obtained from an ongoing administration of the Wartegg test in a control group, will provide better insight on this topic