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

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-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

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

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Il reinserimento lavorativo dopo malattia o infortunio

Il capitolo discute il ruolo del medico del lavoro nel gestire il rientro al lavoro dopo malattia o infortunio. Sono presentati i seguenti aspetti: contesto legislativo e aspetti etici; disturbi muscolo-scheletrici e idoneità al lavoro; la ripresa occupazionale dopo infortunio osteoarticolare sul lavoro; il rientro al lavoro dopo procedure invasive cardiache (progetto "CardioLavoro"), il lavoratore oncologico

Il ruolo del medico competente nelle vaccinazioni anti-Covid

La pandemia di Covid-19 rappresenta una minaccia alla salute globale con un impatto senza precedenti negli ultimi 100 anni. Gli interventi di prevenzione non farmacologici fondati sul distanziamento fisico e sociale, sull’impiego di dispositivi di protezione individuale (DPI) e sul frequente lavaggio e disinfezione delle mani sono stati le uniche armi a disposizione nei primi mesi di pandemia per il contenimento dei contagi. L’introduzione del vaccino anti Covid-19 ha avuto un forte impatto a livello mondiale, comportando in pochi mesi un calo delle forme gravi di malattia e del numero di decessi giornalieri. La riduzione della pressione a carico del sistema sanitario è stata possibile rendendo gli operatori sanitari l’obiettivo prioritario delle campagne di vaccinazione. Fondamentale è stato il ruolo del medico competente, figura centrale nel complesso sistema di tutela e promozione della salute e della sicurezza nei luoghi di lavoro

Two cases of asbestosis and one case of rounded atelectasis due to non-occupational asbestos exposure

Asbestos is a well-known cause of several neoplastic (malignant mesothelioma, lung cancer) and non-neoplastic (asbestosis, pleuropathies) occupational diseases. Lower-level exposure in the general environment may induce pleural plaques and thickenings, and is associated with an increased mesothelioma risk. We present two patients (a 68-year-old man and a 72-year-old woman) who developed asbestosis (in association with pleural plaques and calcifications), and a 78-year-old man who developed rounded atelectasis (with pleural plaques and benign effusion), after living for several decades in the proximity of large Italian asbestos-cement plant. None of them had been exposed to asbestos occupationally. Besides living in a contaminated area, the woman used to clean the work clothes of her brother, who was employed in the local asbestos factory. The three cases indicate that non-neoplastic, long-latency asbestos-related diseases which are usually observed as a consequence of occupational exposures, may rarely develop in subjects living in contaminated geographical sites and buildings. These unusual environmental diseases raise the diagnostic problem of differentiating them from other, more common respiratory illnesses, and impose the duties of patient notification, assessment and follow-up, to assess the possibility of progression of disease and increased neoplastic risk

La previdenza complementare ed integrativa

Il presente capitolo offre una attenta disamina sui principali aspetti del comparto previdenziale, evidenziando i cambiamenti alla luce della recente introduzione della nuova cornice regolamentare "IORP II".This chapter offers a careful examination of the main aspects of the pension sector; it also highlights the changes in light of the recent introduction of the new regulatory framework "IORP II"