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

Individual consequences of workplace bullying : a study on a sample of victims seeking health care

Research has evidenced that workplace bullying may have severe consequences on victims’ health, including psychosomatic illnesses, emotional disorders, and the life context, e.g. social isolation. A study was conducted on a sample of patients reporting exposure to bullying and seeking health care at the Service for Stress and Harassment of the “Clinica del Lavoro Luigi Devoto” in Milan. The Service, activated in 1996, carries out diagnostic activities as well as preventive/rehabilitation interventions on patients reporting health outcomes consequent to occupational stress. It is a public hospital centre with a staff of occupational physicians, psychologists, psychotherapists and technicians. An ad-hoc protocol for harassment-related disorder is used including a general medical examination (with a thorough occupational history collection), a psychological interview and a battery of psychological tests. A sample of 226 patients was selected out of 2455 cases examined from 1997 to 2003 for stress-related disorders. The aim of the study was to describe bullying at work, as reported by victims, and health effects, as ascertained by health professionals and psychological tests. Clinical records were analysed. The sample was composed mostly of women (53,1%), and of subjects in the age group 35-54 (76.5%). There was a great variety of jobs, especially white-collars (53.5%) and workers employed in large companies (62%). In one third of the sample, workplace bullying occurred within 4 years from hiring and mostly during company reorganization and changes in management staff. Negative acts included most frequently social isolation and demotion. The most frequently reported symptoms were exhaustion, sleep, mood and sexual disorders. The number of symptoms was not related to bullying duration but to the number and frequency of negative actions. 61.1% of the subjects took psychotropic drugs. Personality profiles were examined and the role of personality discussed. The present study confirms that bullying at work may have a severe impact on health, social relationships and future professional career, and points to the importance of primary prevention

Victims of bullying at work: description of MMPI profiles

Introduction There are very few studies focusing on the relationship between bullying at work and victim personality and only two studies have investigated MMPI-2 profiles. Gandolfo (1995) examined MMPI-2 profiles of workers with work-harassment complaints in the United States. He found that the highest scales were 1, 2 and 3 (Hs, D, Hy), which is characteristic of somatization of psychological distress and depression. He also found a high elevation of scale 6 (Pa) suggesting that perceived mistreatment on the job probably accounts for being oversensitive, suspicious, angry and restful. Matthiesen and Einarsen (2001), in a Norwegian sample, found an elevated personality profile with the most pronounced elevations in scales 1, 2 and 3 and no significant gender differences. When further analyses were performed, they found that 32% of the victims had extremely elevated profiles with scales 1, 2, 3 (Hs, D, Hy) and 6, 7, 8 (Pa, Pt, Sc) particularly pronounced. Objectives The aim of this study is to analyse psychological consequences of bullying by studying MMPI profiles of victims. Method Subjects were selected among the patients examined for a suspected harassment-related disorder, at the Italian Medical Centre for Occupational Stress and Harassment (CDL). At CDL, an ad hoc protocol for harassment-related disorders was administered to the patients; it includes a medical examination, occupational history collection, psychiatric and psychological interviews and a battery of psychological tests, including MMPI. The aim of the examinations is to obtain a profile of the social-emotional balance, the personality, and behavioural disorders and to establish the compatibility between the clinical picture and harassment. A sample of 112 subjects was randomly selected among patients with recognised harassment related disorders. The sample is composed of 59 women (53%) and 53 men (47%); for 80.4% of the sample the age range is 35-54; the patients received a diagnosis of Adjustment Disorder in 83,9% of cases and of symptoms of Post Traumatic Stress Disorder in 7,1% of cases. Frequency analyses was performed on MMPI profiles using the statistic package SPSS 11.0. The total sample profile was calculated and patients’ profile with Pa and Sc scales beyond threshold (t=70) was calculated separately. In this selected sample scales 6 and 8 were further investigated. Results Results show profile elevations, very similar to those reported in other studies. In particular scales 1, 2 and 3 (Hs, D, Hy) show the higher elevation (with a mean respectively of t=79,4; t=81,8 and t=79,7). Also scales 6, 7 and 8 (Pa, Pt, Sc) have values near threshold score (t=70). No difference was found between women and men profiles. Since clinical experience and previous studies have shown that some victims have particularly high profiles and high elevation in scales Pa and Sc, profile of subjects with scale Pa and Sc >70 (30% of the total sample) was calculated separately. This selected sample showed a higher profile with 8 scales in 10 reporting values above the threshold. For these patients a further elaboration was performed to define which items of scales Pa and Sc contributed to the elevation of the scores and which items regarding positive symptoms of paranoia or schizophrenia were satisfied. None of these patients had positive answers suggesting paranoid or psychotic syndrome. The elevation of profiles is indicative of serious psychological disorders in patients victims of bullying; the 2-3-1 configuration is indicative of psychosomatic and depressive troubles. The group of patients with Pa and Sc >70 shows very high profiles but no diagnosis of paranoia or schizophrenia. This group of patients shows hypersensitivity, suspiciousness, susceptibility, social isolation, loss of interest for relationship and activities, probably as a reaction to frequent and enduring job mistreatment situations. This study, mainly descriptive, will be followed by analysis of the correlations between MMPI profiles and other significant variables, such as frequency, duration and multiformity of negative acts, in order to compare results with previous studies. References Gandolfo R. (1995) “MMPI-2 profiles of worker’s compensation claimants who present with complaints of harassment” Journal of Clinical Psychology, 51(5): 711-715. Matthiesen S. B. and Einarsen (2001) “MMPI-2 configurations among victims of bullying at work” European Journal of Work and Organizational Psychology, 10(4):467-484

Mapping to distal Xq28 of nonspecific X-linked mental retardation MRX72: linkage analysis and clinical findings in a three-generation Sardinian family

Families with mentally retarded males found to be negative for FRAXA and FRAXE mutations are useful in understanding the genetic basis of X-linked mental retardation. According to the most recent data (updated to 1999), 69 MRX loci have been mapped and 6 genes cloned. Here we report on a linkage study performed on 20 subjects from a 4-generation Sardinian family segregating a non-specific X-linked recessive mental retardation (XLMR)(MRX72) associated with global delay of all psychomotor development. Five of 8 affected males have been tested for mental age, verbal and performance skills and behavioral anomalies; mental impairment ranged from mild to severe. Only minor anomalies were present in the affected subjects. Two-point linkage analysis based on 28 informative microsatellites spanning the whole X chromosome demonstrated linkage between the disorder and markers DXS1073 and F8c in Xq28 (maximum Lod score of 2. 71 at straight theta = 0.00). Multipoint linkage analysis confirmed the linkage with a Z(max) of 3.0 at straight theta = 0.00 at DXS1073 and F8c. Recombination in an affected male at DXS1073 and F8c allowed us to delimit centromerically and telomerically the region containing the putative candidate gene. The region, where MRX72 maps, overlaps that of another MRX families previously mapped to Xq28, two of which harbored mutations in GDI. Involvement of this gene was excluded in our family, suggesting another MRX might reside in Xq28

Neurobehavioral functions in operating theatre personnel: a multicenter study

The study was conducted to evaluate neuropsychological symptoms, subjective stress and response speed functions in subjects occupationally exposed to low levels of anesthetic gases. A group of 112 operating theatre personnel exposed to anesthetic gases (nitrous oxide and isoflurane), and 135 non exposed hospital workers from 10 hospitals in Northern Italy were examined before and after the shift on the first and the last day of the working week. Three different tasks were administered: a complex reaction time test (the Stroop Color Word); a questionnaire for neuropsychological symptoms (EURO-QUEST); the block design subtest (WAIS). Biological and atmospheric indicators of exposure were measured. In the exposed group, the geometric mean of urinary nitrous oxide at the end of the shift was 7.1 micrograms/l (95th percentile 12.4, range 1.5-43) on the first and 7.8 micrograms/l (95th percentile 21.5, range 1.0-73.3) on the last day of the working week. On the same days, end of shift urinary isoflurane was 0.7 microgram/l (95th percentile 2.6, range 0-4.7) on the first day and 0.8 microgram/l (95th percentile 2.0, range 0-5.6) on the last. The exposed and control subjects were comparable for both basic intellectual abilities and subjective stress levels. No statistical differences were observed between exposed and control subjects for neuropsychological tests and symptoms. No dose-effect relationships were observed between the exposure indicators and the test results. In conclusion, no early behavioral effect on the central nervous system was detectable at the exposure levels measured. The biological exposure limits of 13 micrograms/l for nitrous oxide and 1.8 micrograms/l for isoflurane corresponding respectively to the atmospheric concentrations of 25 ppm and 0.5 ppm seem to be adequately protective for the integrity of workers' neurobehavioral functions, as measured with the tests used

Neurobehavioral functions in operating theatre personnel: a multicenter study.

11nonenoneR. LUCCHINI; BELOTTI L; CASSITTO MG; FAILLACE A; MARGONARI M; MICHELONI GP; SCAPELLATO ML; SOMENZI V; SPADA T; TOFFOLETTO F; GILIOLI RLucchini, Roberto; Belotti, L; Cassitto, Mg; Faillace, A; Margonari, M; Micheloni, Gp; Scapellato, Ml; Somenzi, V; Spada, T; Toffoletto, F; Gilioli, R

La prevenzione del disagio psicosociale lavorativo e delle dipendenze negli addetti alla realizzazione delle grandi opere infrastrutturali : primi risultati di una esperienza in territorio fiorentino

The research on stress, mobbing, and subslance dependence in workers employed in the building of the great infrastructures is part of the project Euridice-Ten. The 75% of the workers employed tookpart in the research through an anonymous and structured questionnaire. The Clinica del Lavoro of the University of Milan elaborated the data. They point out a high risk of stress, a low level of control, a marked risk of mobbing, a high chronic fatigue in the most exhausting jobs, sleep disorders, problems in the social life as well as at home, in nourishment and at work. Many workers drink too much alcohol and the 9% of the workers know workers who use cocaine

Il disagio psicosociale negli addetti alle grandi opere infrastrutturali

L'indagine documenta i livelli di disagio psicosociale vissuto dagli addetti alle grandi opere infrastrutturali. Una percentuale significativa di lavoratori (tra un terzo e la met\ue0) denunciano una condizione di stress elevato dovuto a un mix di fattori che vanno dall'uso sistematico dello straordinario ai turni di lavoro a ciclo continuo, al sovraccarico di lavoro con scarsa autonomia decisionale o, al contrario, alla "passivit\ue0". Esiste una diffusa conflittualit\ue0 interpersonale, fonte spesso di disagio lavorativo con il conseguente abuso di alcol, tabagismo e perdita di salute