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L Alessio

Publications and source records attributed to L Alessio.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

[The stress index: proposed method for risk assessment of stress and burnout in health care settings].

To assess the risk from exposure to stress and burnout in health care workers, a pilot study was planned to compare and integrate the information based on the risk evaluation obtained through different parameters that can be quantified and elaborated to produce a numerical index, called the "Stress Index", and the subjective symptoms from the individual workers. For these purposes, three internationally validated questionnaires were administered: the Job Content Questionnaire, the State-Trait Anxiety Inventory and the Maslach Burnout Inventory. The study considered six different Units from three divisions of Internal Medicine of a large public hospital in Northern Italy, and a total group of 228 health care workers employed in the six units. The results showed an association between the Stress Index scores and the scores from the questionnaires. In particular, in the two units with the highest levels of the index, a significantly higher unbalance between job demand and decision latitude was observed, together with the highest levels of state and trait anxiety and of depersonalization, indicating higher burnout levels.

Burnout, Professional↗
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[Latex allergy in health care workers: frequency, exposure quantification, efficacy of criteria used for job fitness assessment].

BACKGROUND: The main purpose of this study was to evaluate the latex allergy prevalence in a large population of health care workers, to quantify latex exposure deriving from use of gloves and to verify the efficacy of job fitness evaluations in allergic workers. METHODS: In the period 2001-2002, latex allergy prevalence was evaluated in 1962 health care workers by means of a self-administered questionnaire, clinical evaluation and specific allergological tests. Also, the total protein content (by means of Lowry method modified EN455-3: 1996) and the antigenic latex proteins (by means of RAST inhibition) in 4 different types of gloves were measured. Job fitness assessments for latex allergic workers were made in accordance with the criteria established by the Italian Association of Preventive Medicine for Health Care Workers criteria. The efficacy was verified one year later. RESULTS: 1557 questionnaires out of 1962 (79.35%) were completed; 504 (32.4%) reported work-related symptoms, in particular 283 subjects had probable irritant contact dermatitis, 66 allergic contact dermatitis and 118 reported irregular non-specific symptoms related to the use of both vinyl and latex gloves; 20 subjects out of the remaining 37 had a latex allergy (1.3% out of the 1557 workers responding to the questionnaire), 8 subjects had only urticaria while 12 subjects had urticaria associated with respiratory symptoms and/or angioedema. The measurement of total protein and antigenic protein content showed the highest levels in powdered latex examination gloves, the lowest levels in surgical powder-free latex gloves. Low concentrations of antigenic proteins were also found in nitrile gloves. Job fitness evaluations were efficacious in 11 out of 20 workers, and inefficacious in 3 cases (6 workers had resigned). CONCLUSIONS: This study revealed a very low prevalence of latex allergy probably due to the fact that we examined an unselected population, and only symptomatic subjects were considered; moreover, in our hospital, vinyl examination gloves had been prevalently used during the last ten years. The criteria followed for job fitness assessment seem to be efficacious on the whole. In spite of a low prevalence of latex allergy, we found a high frequency of irritant contact dermatitis in the examined workers, mainly due to the lubricant powder in both synthetic and natural rubber gloves. Most workers made a complete recovery when they started using powder-free gloves. The high biocompatibility of powder-free gloves was confirmed by the measurement of total protein and latex antigenic protein content in the gloves used in the hospital. Moreover, it should be noted that latex antigenic proteins were also demonstrated in nitrile gloves, this is a relevant information since nitrile gloves are often used as an alternative in latex allergic workers.

Adult↗
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[Collaboration between the cardiologist and the occupational health physician needed for formulating the etiological diagnosis and the job fitness evaluation].

BACKGROUND: The cardiovascular system can be the target organ of various occupational risk factors. Moreover, cardiovascular diseases of non-occupational origin may be aggravated and/or triggered by working activity. OBJECTIVES: To review the importance of cooperation between cardiologists and occupational health physicians, both in making an aetiological diagnosis and in job fitness evaluation. METHODS: A review of the literature was carried out. RESULTS AND CONCLUSIONS: An early aetiological diagnosis allows therapy to be started, timely transfer of workers from the jobs involving risk and application for insurance compensation commensurate with the degree of impairment. The identification of a single worker with occupational cardiovascular disease may represent a "sentinel event" which will permit identification of other workers at risk and other subjects with occupational diseases. Specific job fitness assessment is the final act of risk evaluation and health surveillance. The principal aim is to protect the physical and psychological health status of the worker in relation to his job and to employ him in a job that takes account of his skills. A correct specific job fitness assessment is particularly important when the cardiologist and the occupational health physician work in close cooperation in the rehabilitation and occupational reintegration of the cardiopathic worker.

Cardiology↗
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[Report on the activities carried out in the research project of the Ministry of Instruction, University, and Research entitled "Environmental and occupational exposure to inorganic lead: assessment of toxic effects of current doses and related preventive measures"].

It is here presented the project sustained by the Ministry of Public Instruction, University and Research "Environmental and Occupational Exposure to Inorganic Lead: assessment of human health effects due to current doses and preventive measures" ruled out between 2001 and 2003. The aim of the study was to investigate about the toxic effects related to current occupational exposures to inorganic lead (particularly those effects concerning blood pressure, carcinogenic risk, nervous and immunological systems), to identify hypersusceptibility conditions, particularly the ALAD genetic polymorphism and to evaluate the role of traditional biomarker and the possibility of introducing new ones. In the present article the procedures followed during the project lasting and the contribution of each Unit are described. The results of the research, presented in detail in the current issue, do confirm the inadequacy of the biological exposure index nowadays ruled by Lex 25/2002.

Humans↗
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[From lead colic to moderate risk].

During the 20th century, occupational and environmental exposure to lead was among the main relevant issues studied by occupational physicians, hygienists, and public health administrators. During the different decades there was a progressive reduction in exposure levels and in the mean time a progressive reduction in the severity of clinical symptoms due to very high exposure to this metal. During thefirst forty years of the 20th century, a clear decrease in the frequency of encephalopathy and paralysis of the radial nerve was observed while abdominal colics and anaemia where frequently observed until the sixties. In the first part of the seventies, there was a clear change in the preventive approach to lead poisoning both in the field of research and in the clinical-preventive and legal field. These successful results where obtained despite the disagreement of outstanding physicians and international renowed researchers and industrial associations. Every successful battle allowed a great improvement in the field of occupational and environmental prevention, but the above-mentioned disagreements caused a great delay in the solution of the problem and did not improve workers', children's and teenagers' health. In Italy, there was a very deep interest in the prevention of lead poisoning which led to very good results in a relatively short period even though the current laws did not help and also nowadays do not help the occupational professionals studying and dealing with occupational health. Lead undoubtly represents one of the most largely studied environmental industrial toxics and shows a model, also suitable for other matters involving exposure to different industrial toxics. Nevertheless, there are still problems in the understanding of some pathogenetic aspects of lead and in the significance of some of its early effects which deserve further studies. These matters, strictly linked to low-dose exposure, still present numerous questions. For example, there should be a deep interest in the standardization of its internal dose indicators, in the study the role of the metal in the pathogenesis of cardiological and nephrological diseases, in the characterization of its genetic polymorphisms and in the assessment of its carcinogenicity. A lot of these issues, already examined in old studies concerning casistics of workers affected by lead poisoning, have been analyzed in the multidisciplinary study "Progetto MIUR Piombo" (Project on lead by the Italian Ministry of University and Research) conducted by six different Institutes of Occupational Health (Cagliari, Parma, Perugia, Bari, Ancona and Brescia) which will report their results during this Congress.

Colic↗
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Malignant mesothelioma and the working environment: the viewpoint of the occupational physician.

BACKGROUND: Firm scientific evidence supports the causal association between malignant mesothelioma (MM) and occupational exposure to asbestos. Risk attributable to occupation varies from 30 to 80% across different populations. The existence of a threshold level below which there is no risk of MM is still debated. A prompt and thorough assessment of exposure is essential to evaluate and manage MM cases, from diagnostic and epidemiological points of view. OBJECTIVES AND METHODS: To highlight the multiple areas of intervention by Occupational Physicians (OP) in MM evaluation and management, to describe an experience of OP in the province of Brescia. RESULTS: The main areas of interest of the OP are exposure assessment, diagnosis (clinical, etiological), medico-legal issues, social consequences, preventive strategies, risk communication, scientific dispute/uncertainties. By means of an active search, the Brescia MM registry, managed by OP belonging to the local health authority observed 309 MM from 1977 to 2003; the local Institute of Occupational Health, hosted in a hospital of national relevance, evaluated about 200 MM in the last decade. The main outcomes of OP activity are the high percentage of direct interviews, individual case management, expert exposure assessment, etiological diagnosis, counselling, medico-legal assistance, better knowledge of occupational risks, enhanced cooperation among health professionals (oncologists, pathologists, surgeons, pneumologists, general practitioners and OP), important contribution to Registries and to epidemiology (estimates of attributable risks, incidence, survival rates), with positive social and scientific consequences (insurance agencies, trade union organizations, public events, teaching opportunities). CONCLUSIONS: This experience highlights the multifaceted role of OP in active research and evaluation of MM cases, in the context of a multidisciplinary approach.

Adult↗
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Evaluation of fitness for work: the most challenging situations.

Evaluation of fitness for work (FW) is the final task of both health surveillance and risk evaluation. It's aim is to protect the physical and psychological health of workers and respect their professional skills. The Occupational Physician faces several difficulties in the evaluation of FW. Moreover, Italian legislation on this topic can be variously interpreted and this can cause conflicting evaluations. In this session, the most challenging situations in FW evaluation will be taken into consideration.

Humans↗
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Fitness for work in difficult cases: an occupational medicine experience in a University Hospital.

BACKGROUND: Fitness for work (FW) in certain clinical cases poses significant professional challenges for Occupational Physicians (OPs). OBJECTIVES: to discuss the role of a public Institute of Occupational Medicine (IOM) in FW, thorough description of clinical cases. METHODS: the IOM at the University of Brescia is a public clinic available to general practitioners, OPs, other specialists, insurance companies, health authorities, employers, trade unions. IOM expert opinion on FW may be requested by OPs, employers or workers. In each case, occupational and clinical histories are taken, physical examinations, laboratory and instrumental tests might be performed, and technical and clinical documentation is acquired; expert opinions from other specialists might also be sought. Risk assessment (RA) stems from worksite inspections and information from company health and safety representatives, or health authorities. RESULTS: a few peculiar clinical cases are reported: tremors in a dental hygienist trainee, chorioretinitis in a welder, spasmofilia in a nursing aide, obstructive sleep apnoea in a steel worker, epilepsy in a metal engineering worker, as well as a number of cases fom the same workplace. CONCLUSIONS: FW judgement made by a IOM had several advantages from clinical and RA aspects. Work restrictions may not always be evidence based and it might be difficult to balance rights and duties of patients, employers and OPs; the IOM's wider experience, case discussion with the relevant parties, scientific and technical documentation of diagnostic and FW processes, strengthen the role of the IOM in dealing with difficult cases and as a guarantee from technical and ethical viewpoints.

Adult↗
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From clinical activities to didactics and research in occupational medicine.

BACKGROUND: The daily practice of Occupational Physicians in the mot industrialized countries suggests that the frequency of traditional occupational diseases is progressively lowering, their gravity is decreasing, and the etiological factors are changing. This trend should be quantitatively and qualitatively verified with ad hoc studies. The information is particularly relevant for Academic Institutions where medical students and residents in occupational medicine are trained. OBJECTIVES: To analyse the trends of clinical diagnoses and health surveillance activities conducted in the last 15 years by an Italian Institute of Occupational Health, and to gain information on the most relevant topics to be taught in academic program and to be addressed with future research. METHODS: Data sources were represented by the computerised registration of a) diagnostic activities and b) health surveillance programs, conducted by the Institute of Occupational Medicine of the University of Brescia, a highly industrialized area in Northern Italy. The observation period was from 1990 to 2005. The health surveillance programs regarded workers pulled from an iron foundry, a veterinary institute, a health departments for the assistance of elderly subjects, a nursery schools and a municipal department for road maintenance. RESULTS: Diagnostic activities were conducted on 9080 subjects, who had been referred for suspected occupational disease. The diagnosis of occupational disease was confirmed for 3759 cases. Multiple diseases were diagnosed in 1554 subjects, yielding the total number of 5721 occupational diseases. The most frequent diagnoses accounted for allergic skin disease (23.4%), followed by pneumoconiosis (20.4%), chronic obstructive pulmonary disease (15.9%), noise hearing loss (7.1%), musculoskeletal disorders (6.9%), respiratory allergies (6.9%), cancer (5.9%), miscellaneous (6.4%). When limited to the last quinquennium, the analysis showed a definite increase of muskuloskeltal disorders, cancer, and, although at a lesser extent, diseases due to psychosocial factors. The analysis of the health surveillance programs regarded 1207 workers, and showed that various non occupational diseases caused limitation to individual work fitness. The most frequent conditions were musculoskeletal disorders (65%) and skin diseases (14%). CONCLUSIONS: The results from these two investigations are important not only for the didactic program run by the Institute, but also because they indicate the most relevant topics to be addressed with future research, at least at a local level.

Academies and Institutes↗
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[Occupational cancer. The role of the occupational physician in systematic search and aetiological diagnosis of lung cancer. Analysis of a case list].

BACKGROUND: About 15% of lung cancers (LC) might be attributable to occupation. However, clinical practice shows that LC percentage for which occupational aetiology is recognized is lower than expected. OBJECTIVES: To address the role of Occupational Physicians (OP) in systematic search and aetiological diagnosis of LC. METHODS: The search was carried out at a university hospital in Brescia, northern Italy, a highly industrialized area with many workers potentially exposed to occupational lung carcinogens. Through short occupational history forms, physicians of various departments refer all new cases of primary LC to OP When occupational exposure to lung carcinogens is presumed, the OP evaluates the case at the occupational health clinic and sends clinical reports to notifying physicians, containing aetiological diagnosis and indications for medico-legal obligations. RESULTS: Before 1998, few cases were referred to the OP and even less were compensated. The search yielded 1502 LC; after screening, full occupational health evaluation was performed in 693 cases: occupational aetiology was recognized in 182 (26%). Risk factors were silica, asbestos, polycyclic aromatic hydrocarbons, truck driving, painting, road paving; many workers were exposed to multiple carcinogens. 48 cases were compensated, many others are under litigation. CONCLUSIONS: A systematic LC search made it possible to: reach an aetiological diagnosis and reduce the gap between expected LC and those reported/compensated; inform health authorities and undertake preventive action in workplaces; detect sentinel events; provide epidemiological data at community level; promote cooperation among health professionals (oncologists, surgeons, pneumologists, general practitioners, plant OP); increase teaching opportunities for medical students, those taking a specialisation course in occupational health; provide counselling and expert opinions for individual subjects, trade unions, employers, law courts.

Adult↗
PubMedDate not supplied

[Risk of exposure to metals in the production and processing of copper alloys].

A study was carried out in 3 copper alloy industries: a foundry for scrap of various origin producing brass and bronze alloys (foundry A) and 2 foundries that used these same alloys (foundries B and C). An environmental investigation and biological monitoring of the employees for Pb, ZPP, Cu, Zn, Be, Sb, Mn, Ni and Cr were performed in each foundry. The results of biological and environmental monitoring showed that the Pb exposure levels were distinctly higher than those of the other metals in all 3 foundries. The highest levels of PbA and PbB were observed in foundry A, especially during scrap grinding operations, where the limit values were exceeded. The environmental concentrations and the levels of the biological indicators for all other metals, except Pb, were within reasonable limits. Therefore, in the investigated working situations and for the metals under study, except Pb, it would appear that a situation exists of exposure to "microdoses" which, even though not implying a risk of appearance of the classic signs and symptoms of intoxication, raises the problem of the possibility of identifying early effects and interpreting the biological indicators. Biological monitoring of exposed subjects has shown that the levels of the indicators for Cu, Ni and Cr are markedly different from the reference values on a group basis, whereas in individual workers the values are generally below the "upper limits". A comparison with the "limit values'' was only possible for the biological indicators of Pb; for the others, although differences were observed indicating that absorption had taken place, no univocal interpretation criteria exist, considering also the relatively low mean increases observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Alloys↗
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[Effects on hearing in exposure to impulsive and high frequency noise].

Audiometric tests performed on 41 workers at a metal engineering factory producing tools for the wood manufacturing industry showed hearing loss at 6 kHz in 45.9% of the cases. A study was therefore carried out to check carefully the physical characteristics of the noise via statistical analysis and octave frequencies band analysis in real time. The measurements revealed higher noise levels at the high and medium high frequencies (3.15-6.3 Hz) both for impulsive and continuous noise. The results of the audiometric tests differed from those of a group of 50 workers employed in two different metal engineering factories, where the noise levels were similar but at medium-low frequencies, with no pure tones. In this group of subjects, hearing loss occurred at 6 kHz in 28% of the cases; the differences thus seemed to be related the particular physical characteristics of the noise levels measured in the first factory. The data are discussed against findings already reported in the literature, in relation to their prevention-related aspects and a more correct interpretation of the audiograms.

Adult↗
PubMedDate not supplied

[What are the prospects of metal toxicology studies?].

Although we still have to be careful about situations where there is still a risk of high levels of absorption of the most commonly known metals or where there is exposure to rare metals but with known toxicity, in the current transition phase from macro- to micro-doses of industrial toxics and metals in particular, it seems appropriate to encourage the development of study criteria and methods for this special field of occupational medicine. A number of aspects of the analytical techniques (ICP MS, in vivo measurements) are therefore discussed which should make for a better evaluation of doses; reference values for toxic metals intended as indispensable terms of evaluation of abnormal exposure to be related with any response by the human organism; identification and quantification of certain early effects that are of significant theoretical and practical interest, such as effects on the functional reserve and immunotoxic effects. Occupational medicine should take renewed interest in toxicological problems which, in the authors' view, have wrongly been considered outdated by the evolution of work-related diseases. On the contrary, this evolution calls for fresh and more in-depth interest also in occupational toxicology research.

Air Pollutants, Occupational↗
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[The evaluation of occupational exposure to carcinogenic substances: limit values and risk assessments].

Considering that nowadays there is no unanimity about the possibility of adopting environmental and/or biological limit values in occupational exposure to carcinogens, some aspects are discussed about the mechanism of action of carcinogens, their metabolism and problems deriving from the possible multiple exposures, interactions and speciation of the different compounds. After the analysis of the results obtained by means of two different approaches by the American Conference of Governmental Industrial Hygienist and the Environmental Protection Agency of the United States, the authors examine some aspects of the qualitative and as far as possible quantitative comparison for the 16 substances included in both lists and they discuss how the mathematical models are used in the process of carcinogenic risk evaluation. Finally, it is considered the possible application even in occupational carcinogenesis of a model such as the one of the EPA.

Carcinogens↗
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[Validity of some urinary tests considered singly or in combination in the study of renal effects of cadmium].

A number of indicators of renal effect (N-acetyl-glucosaminidase, retinol binding protein, beta-2-microglobulin, albuminuria) were measured in 42 cadmium-exposed workers divided into 3 subgroups on the basis of the results of the last 10 years' biological monitoring (less than 3, 3-10, greater than 10 micrograms/l). An increase in the first three indicators was observed, particularly in the third subgroup, which, however, due to the wide dispersion of the values, was not statistically significant by the Kruskal-Wallis test. Taking the indicators singly, the marked increase in RBP and beta-2-microglobulin in the heavily exposed subjects was confirmed, along with an increasing sensitivity for NAG, while albuminuria levels were unchanged. Assessment of the "degree of association" of the altered tests demonstrated that the number and type of "association" varies between the subgroups in relation to the exposure conditions: in the first group there were no associations between the altered tests, whereas there were 2 duplicates in the second and 2 duplicates, 2 triplicates and 3 quadruplicates in the heavily exposed group. In the study of the renal effects of cadmium, it is therefore advisable to use several indicators and assess their behaviour both singly and combined, and also analyse the altered tests on the basis of the number and type of "association".

Adult↗
PubMedDate not supplied

Behaviour of biological indicators of internal dose and some neuro-endocrine tests in aluminium workers.

The authors present the results of toxicological studies on aluminium from 1983 to 1988. In order to obtain reference values for serum and urine aluminium, 506 healthy adults, not occupationally exposed to the metal, residing in the Brescia area were studied. The following values were obtained: AlS = 5.8 +/- 2.9 micrograms/l; AlU 11.9 +/- 4.3 micrograms/l. The AlU and AlS values did not differ in relation to age, sex, alcohol consumption, smoking habits and residence, contrary to what has been found for some metals determined in the urine and/or blood of the same subjects. In a group of 227 subjects with occupational exposure to aluminium within the range 0.1-1.0 mg/m3, the mean levels of AlU were higher than that of the reference population; however the AlU of the workers were generally lower than 20 micrograms/l which is the upper limit for the reference population; 4 workers who were under treatment with antiacid preparations showed AlU values higher than 150 micrograms/l. Seven workers exposed to atmospheric aluminium concentrations around the TLV-TWA had higher AlU values at the end of their shift on all working days and on Friday morning the values where higher than those encountered on Monday morning. On the other hand no daily and weekly fluctuations were evident for AlS. For 14 workers the relationship between AlU and AlS values were examined in three subsequent periods after the start of working activity. Considering the same values of AlU, it was observed that the AlS increased with the duration of exposure. These results seem to indicate that AlU could be considered as indicator of current exposure and AlS as an indicator of cumulative exposure. Neuroendocrine tests were performed every 6 months in 21 workers after they had been hired. PRL and TSH values were reduced after 1 year of work and were still reduced 6 months later. Further analyses showed a different behaviour: in fact the levels of the two hormones rose above the reference values, while the HGH and other gonadotropins showed no alterations. These results seem to indicate that at the start of exposure to aluminium concentrations below TLV-TWA there is an effect on the hypothalamus-pituitary axis. This phenomenon is probably transient perhaps because of an adaptation mechanism. Further studies are however necessary to verify these results.

Aluminum↗