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

Industria alimentare

La scheda contiene la descrizione sintetica dei principali cicli produttivi nel settore dell'industria alimentare ed evidenzia per ciascun ciclo produttivo i principali fattori di rischio per la salute dei lavoratori

Metalmeccanica

La scheda contiene la descrizione sintetica dei principali cicli produttivi nel settore dell'industria metalmeccanica ed evidenzia per ciascun ciclo produttivo i principali fattori di rischio per la salute dei lavoratori

Respiratory occupational allergies: the experience of the Hospital Operative Unit of Occupational Medicine in Lombardy from 1990 to 1998

A retrospective study on occupational rhinitis and asthma diagnosed in 7 occupational health institutes in Lombardia (North-West Italy) was performed using a standardized card. 141 cases of rhinitis and 281 cases of asthma due to sensitization to occupational agents were analyzed and their clinical characteristics, aetiology, diagnostic methods and associated allergic diseases were determined. In this population the most frequent agents of occupational rhinitis were wheat flour and latex, whereas those of occupational asthma were latex and isocyanate. More than half of the subjects had more than one clinical manifestation of allergy. In 92 out of the 281 asthmatic patients rhinitis was the first clinical manifestation, particularly in subjects sensitized to high molecular weight substances, and preceded, asthma by 12 months as a mean. Specific bronchial provocation tests were useful for the diagnosis of asthma in 153 of the asthmatic patients and 45 of them had an isolated late bronchial reaction following the specific stimulus. At diagnosis 61 subjects (21.7%) had FEV1 < 80% of predicted; factors associated to ventilatory impairment were sensitization to high molecular weight substances, duration of exposure to the sensitizing agent, persistence of exposure after onset of symptoms

Bronchial reactivity to methacholine in HIV-infected individuals without AIDS

To evaluate bronchial reactivity to methacholine in human immunodeficiency virus (W) infection, we submitted 25 HIV-seropositive subjects without full-blown AIDS and 25 HIV-seronegative subjects, all inmates in a drug rehabili- tation center for previous intravenous drug abuse, to interview and to bronchial challenge with methacholine. Four (16 percent) HIV-seropositive and three (12 percent) HIV-seronegative subjects noted bronchospastic symptoms. Baseline FEV, and MEF50 percent were within the normal range in every patient. Bronchial hyperreactivity to meth- acholine (PD20FEV,<1,400 pg) was found in two (8 per- cent) HIV-seropositive and in four (16 percent) HIV-sero- negative subjects, with no significant difference in the frequency between the two groups. We conclude that HIV infection without AIDS in intravenous drug users does not appear to be associated with an increased frequency of bronchospastic disorders and to bronchial hyperreactivity to methacholine

Local immunotherapy by inhalation of a powder extract in asthma due to house dust mite Dermatophagoides pteronyssinus: a double-blind comparison with parenteral immunotherapy

To verify the efficacy and the tolerability of local immunotherapy (LI) by inhalation of a powder extract of house dust mite (HDM), in comparison with parenteral immunotherapy (PI) by injection, 10 patients with asthma due to HDM were studied in a blind fashion. 5 patients (Group A) underwent LI and subcutaneous injections of placebo, 5 patients (Group B) underwent PI and inhalation of lactose for 6 months. In both groups each inhalation was preceded by premedication with disodium cromoglycate (DSCG) (40 mg). In Group A a significant decrease in symptoms score and in peak expiratory flow (PEF)-derived parameters was observed already after 3 months of treatment, and 2 patients lost the late component of the bronchial response to the challenge with HDM. No significant variation was found in bronchial responsiveness to methacholine and ultrasonically nebulized distilled water (UNDW) and in immunologic humoral and cellular parameters in peripheral blood after treatment in either group. No local important adverse reactions were observed in Group A and no systemic side effects were observed in either group. We conclude that LI is as effective as PI, but more rapid in its action, in the treatment of asthma due to HDM. Moreover, LI is locally well tolerated, providing DSCG is inhaled before each therapeutic inhalation, and does not induce systemic side effects

L’esposizione a persolfato d’ammonio riduce il controllo non adrenergico, non colinergico inibitorio (NANC-i) nelle vie aeree di cavia

To evaluate the effect of repeated exposure to ammonium persulphate (AP) on NANC inhibitory innervation of guinea-pig airways, we exposed male guinea-pigs to AP, by aerosol inhalation at a concentration of 1 mg/m3 for 30 minutes for 5 days for three weeks. Control animals inhaled saline aerosol. After the last exposure, the animals were killed and the isolated whole trachea was cannulated at each extremity and mounted in an organ bath. Intraluminal pressure variations were measured by means of a pressure transducer. The inhibitory NANC responses to electrical field stimulation (3 and 10 Hz) were evaluated in the presence of hyoscine, piperoxane and propranolol. To evaluate both the amplitude and the duration of the responses, the area under the curve (AUC) was measured as Pa · seconds. Statistical analysis, was performed by analysis of variance. In the exposed animals, the in vitro NANC relaxations at 3 and 10 Hz were significantly reduced (P < 0.01). In particular, the AUC was 45.9 ± 12.1%, as compared to control at 3 Hz and 52.7 ± 14.1% at 10 Hz. In conclusion, the impairment in NANC relaxation may represent one of the mechanisms subserving airway hyperreactivity induced by AP esposure

Bronchial responsiveness to ultrasonic "fog" in occupational asthma due to low molecular weight chemicals

Abstract BACKGROUND: In a previous work we have demonstrated that the use of an indirect stimulus such as ultrasonically nebulized distilled water (UNDW, "fog") challenge, in addition to methacholine, in the assessment of occupational asthma due to TDI improves our ability in detecting sensitized subjects. OBJECTIVE: In the present study we aimed to determine the validity of "fog" in the assessment of occupational asthma induced by various low molecular weight substances. METHODS: Fourty subjects exposed to low molecular weight substances with work-related respiratory symptoms underwent methacholine, UNDW and specific bronchial challenge tests. Diagnosis of occupational asthma was made in 20 of 40 patients who developed bronchoconstrictive responses to the specific challenges (reactors). Sensitivity and specificity of UNDW alone, of methacholine alone, and of the combination of the two tests were determined at two different cutpoints of PD20FEV1 of methacholine, with the results of the specific challenge as the "gold standard". RESULTS: Frequency and severity of bronchial hyperresponsiveness both to UNDW and to methacholine were significantly higher in reactors than in nonreactors. Ultrasonically nebulized distilled water had higher specificity (80% versus 60%) but lower sensitivity (65% versus 75% to 90%) than methacholine. As compared with methacholine alone, the combination in series of the two challenges (both challenges positive) substantially improved specificity (85% versus 60%). CONCLUSIONS: In conclusion, in the assessment of low molecular weight chemical-induced asthma diagnosed with the specific challenge as the "gold standard," UNDW challenge proves more specific than methacholine for occupational asthma, but it is considerably less sensitive. The combination of the two challenges results in very high sensitivity and high specificity for occupational asthma, therefore, although further investigations are required for the definitive diagnosis, it should be regarded as a useful means to confirm objectively a suggestive history

Bronchial responsiveness to ultrasonic fog in occupational asthma due to toluene diisocyanate

To determine the validity of ultrasonic nebulization of distilled water (UNDW, "fog") in comparison with methacholine challenge, in the assessment of toluene diisocyanate (TDI) asthma, we evaluated 75 subjects exposed to TDI with work-related respiratory symptoms. Subjects were submitted to bronchial challenge with methacholine at first, thereafter to UNDW inhalation and to specific challenge with TDI. The diagnosis of TDI-asthma was made in 30 of 75 patients (40 percent) who developed a bronchoconstrictive response to the specific challenge (reactors). Sensitivity and specificity of UNDW alone, methacholine alone, and of the combination of the two tests were determined with the results of the specific challenge with TDI as the "gold standard." Both frequency and severity of bronchoconstrictive response to UNDW (FEV1 decrease > or = 15 percent) and the degree (PD15 FEV1) and frequency of bronchial hyperresponsiveness to methacholine were significantly higher in TDI reactors than in nonreactors. The UNDW had higher specificity (82.2 percent vs 51.1 percent) but lower sensitivity (40 percent vs 76.7 percent) than methacholine. The combination in parallel (positivity of any of the two challenges) of methacholine and UNDW challenge did not change sensitivity to a great extent (80 percent vs 76.7 percent), whereas combination in series (positivity of both challenges) had considerably greater specificity (86.7 percent vs 51.1 percent) than methacholine alone. We conclude that in the assessment of TDI-asthma, the validity of UNDW challenge alone is limited since it is insufficiently sensitive. Instead, combining UNDW and methacholine challenge when methacholine is positive improves our ability in identifying subjects with TDI-asthma diagnosed with the specific challenge. This procedure constitutes a first objective confirmation of a suggestive history of TDI-asthma that is useful for clinical purposes. However, especially for medicolegal purposes, the definitive diagnosis requires the specific challenge