[The role of professional activity in arterial hypertension]. / Il ruolo svolto dall'attività lavorativa sull'ipertensione arteriosa.

BACKGROUND: Arterial blood pressure, both systolic (SAP) or diastolic (DAP), has been widely investigated and some studies have shown an association between an increase in these parameters and mortality. The most frequently studied risk factors of arterial hypertension are use of alcohol, smoking and ethnic origin referred to both genetic differences and nutritional habits, while professional factors have been rarely and less deeply considered although significant differences have been found in mean arterial pressure in subjects conducting different professional activities. It seems in fact that "blue collar" workers are more at risk that "white collar" ones. OBJECTIVES: Our aim is to evaluate if work conditions or job strain related to professional activity or to life styles represent a risk factor for arterial hypertension and whether this effect of hypertension is independent of age. In fact, specific factors that may explain this connection have still not been clearly defined. METHODS: Our research method was similar to french inquiries ESTEV (Derriennic, Touranchet, Volkoff) and VISAT (Marquie, Jansou) applied in 6 Italian Regions and involved workers employed in different productive sectors and belonging to 5 age cohorts: 32, 37, 42, 47, 52 years. Information were obtained by occupational health physicians, using 3 questionnaires:--working conditions (exposure to certain risks or job strain);--life styles and self evaluation of health (Nottingham Health Profile);--objective information on health status. The present work consider only parameters that in other studies have been found associated with CVD morbidity, including: (1) working conditions, (2) subjective assessment of work, (3) specific job strain perceived Hypertension was considered as SAP > or =160 mm/Hg and/or DAP > or =90 mm/Hg, or current antihypertensive treatment. RESULTS: The results refer to 1104 workers, 76% men and 24% women. Prevalence of hypertension was found to be higher among the men than women (33% Vs 22%) and was higher with advancing age. Risk estimation showed a statistically significant association with certain work-related factors such as: shift work (O.R. 1.33), awkward posture (O.R. 1.71), exposure heat (O.R. 1.43), sitting work (O.R. 1.48), doing several tasks simultaneous (O.R. 1.41), being interrupted at work (O.R. 1.35), not being able to take eyes off work (O.R. 1.61). The multivariate analysis by logistic regression showed that the variables referred to cognitive aspects and work organization tended to be associated to arterial hypertension even when exposure ceased. CONCLUSIONS: We observed that both some physical aspects of work and cognitive organisation aspects, are strongly associated with arterial hypertension. An important element was found to be the subjective assessment that workers give to their work. From an intervention point of view, this aspects should be considered as possible reducible risk factor.

[The main illnesses causing absence from work. Analysis of the INPS data bank]. / Le principali patologie causa di assenza dal lavoro. Analisi della banca dati INPS.

UNLABELLED: Understanding the reasons which underlie absence from work due to illness can allow us to prevent harmful events, either in private life or professional activity, which represent a risk for the health of workers and can reduce their personal and professional capacities. OBJECTIVES: To describe the frequency of illness in a population of workers employed by the Marche region, showing: the most common pathological events, their length and the differences in occurrence linked to gender and age of the workers. MATERIALS AND METHODS: We analyzed the Marche Region INPS data bank regarding medical certificates presented by workers for the years 1999 and 2000. These medical certificates were registered by the Institute according to the nosological code (ICD-9-CM classification), length of illness, gender and age of workers. RESULTS: The incidence of illness in the specified two years decreases in the second year of observation passing from 0.67 to 0.64. The number of certificates for the two years is similar for males but increases significantly for females ((p < 0.001). In general the most frequent illnesses were infectious or parasitical ones (31%), followed by those affecting the respiratory apparatus (17%). Compared to women, men presented a higher risk for: burns, traumas and poisoning (OR 1.92 IC 1.81-2.03) and diseases of the cardio-circulatory apparatus (OR 1.75 IC 1.55-1.97). Regarding length of absence, the most common was between 4 and 7 days, even though a reversal of tendency was registered in 2000 with a decrease in short and very short absences from work in favour of average and long ones. The older workers, those over 40 years of age, tend to produce fewer certificates compared to their younger colleagues, but of longer absence. The highest number of days off work can be found among the older workers. CONCLUSIONS: According to the data we analyzed, absence from work due to illness is a complex phenomenon regarding not only gender differences but also the age of workers and the kind of work they perform.

Resistance of Yersinia enterocolitica, Escherichia coli O157:H7 and natural microflora against acidic conditions and freezing-thawing in fresh sausages.

The resistance of Yersinia enterocolitica O:9, Escherichia coli O157:H7 and natural microflora against lactic acid (LA), ascorbic acid (AA), and freezing-thawing in noninoculated and inoculated fresh sausages was studied. Samples were stored at -18 degrees C for 28 days and thawed in microwave (MW), at room temperature (RT), in refrigerator (R) and under flowing of tap water (F) on days 7, 14, 21 and 28. Plate Count Agar (PCA), Sorbitol Mac Conkey agar (SMC) and Mac Conkey agar (MC) were used for microbial counts. A maximal reduction of 1.57 log in mesophilic aerobes and no significant changes in total and fecal coliform levels with respect to the initial counts in natural microflora were observed along storage. In inoculated fresh sausages, reductions of 1.37 log on PCA and 2.17 log on SMC were obtained in E. coli O157:H7 populations as compared to the control groups on day 0. Similarly, reductions of 1.69 log on PCA and 2.79 log on MC as compared to the initial level were observed in counts of Y. enterocolitica inoculated samples. Salmonella Anatum, P. aeruginosa, Y. enterocolitica B1A O:7,8-8-8,19 and E. coli non O157:H7 strains were recovered from the natural microflora by enrichment techniques. Thawing in refrigerator was more frequently related to the best reductions of total mesophilic aerobe, E. coli O157:H7 and Y. enterocolitica O:9 counts than the other thawing methods. Reductions of microbial populations observed in LA treated samples were similar to those observed in AA treated samples. Although the acidic and freezing treatments might reduce the microbial levels in natural microflora of fresh sausages, they appeared to be ineffective in the total elimination of high inocula of pathogens like E. coli O157:H7 and Y. enterocolitica O:9.

[Aging of health workers and multiple musculoskeletal complaints]. / Invecchiamento degli operatori sanitari e plurilocalizzazioni dolorose all'apparato osteoarticolare.

OBJECTIVES: The problem of ageing of health women workers and musculoskeletal disorders (MSD) associated working activity is faced by studying the presence of two or more complaints in the back, upper limbs and lower limbs. METHODS: A survey, using a questionnaire (the shortened Italian version of the ESTEV-VISAT), was carried out in several wards of the geriatric hospital to determine the prevalence of MSD in a sample of health workers (nurses and physiotherapists). Several working conditions were considered: physical variables (awkward postures, heavy loads, rapid and frequent walking, etc), organisational (time pressure, to be interrupted at work, etc) and psychosocial (appreciation and recognition). Using both simple and multiple linear regression, the association between the presence of two or more complaints and cumulative index of exposure to 2 or more risks at work was evaluated. The importance of the age factor was also analysed. Ergonomic study was also carried out by observing whole work shifts. RESULTS AND DISCUSSION: The distribution of pain is mainly concentrated in the back (81% of the sample) but can also be consistently found in the upper limbs (39%) and lower ones (54%). More than 50% of the workers reported 2 or more complaints in different muscoloskeletal regions. In nurses these problems already appear before the age of 40, suggesting, for this professional category, a possible risk of pathological ageing of the muscoloskeletal apparatus. The presence of 2 or more complaints was found to be associated with physical cumulative index for physiotherapists and with organisational cumulative index for nurses. Ergonomic work analysis showed that caregiving determines the maintenance of awkward postures, such as stooping more than 45 degrees and bending and twisting the trunk for prolonged lengths of time (up to 5 hours consecutively), which represents a physical risk. Besides, the fact that the MSD are mainly associated with organisational characteristics of work, and especially with work pressure, suggests that greater attention must be given to work organisation.

[ESTEV study on relationship between health, work and aging in Italy]. / L'indagine ESTEV sulle relazioni salute, lavoro e invecchiamento in Italia.

A longitudinal epidemiological study into the relationships between age/health/work is currently under way in different geographical areas throughout Italy. The research is co-ordinated by INRCA (Italian National Research Centres on Aging) in Ancona with the collaboration of the Universities of Ancona, Verona and Bari. This study concerns a population of approximately 2,000 employees from a variety of production sectors. The sample is made up of 5 groups of workers selected according to the year they were born and aged: 32, 37, 42, 47 and 52 years. The chosen research tool is modelled on ESTEV and VISAT researches, the former conducted on a sample of 20,000 French workers, the latter on approximately 3,000 workers and still under way. It involves a set of three questionnaires which allow for a number of variables to be taken into consideration: the first questionnaire concentrates on information regarding the occupation, both past and present; the second on the life style and self-assessed health according to the Nottingham Health Profile (NHP); the third, completed by the occupational physician, contains information on current and previous illnesses, the presence of disorders of the musculo-skeletal apparatus, the taking of any drugs and some anthropometrical and clinical-instrumental parameters (Respiratory Functionality Test, Visiotest and Audiogram). The study with be carried out in two phases: a first survey (under way) and a second one five years later on the same subjects. The results of the analysis will be compared with those of other European countries.

[Psychologic reactions of patients undergoing magnetic resonance imaging. Preliminary study]. / Reazioni psicologiche di pazienti sottoposti a imaging con risonanza magnetica. Studio preliminare.

MR imaging, like other imaging techniques, can cause emotional and psychological reactions in the patients. Although reversible, these reactions sometimes lead the patient to absolutely refuse the examination or to make it impossible to carry it through. To investigate the patients' emotional distress, a study group of 28 subjects was examined. They were heterogeneous in sex, age, and pathologic condition. The main psychological reactions were analyzed, and anxiety--both of state and of trait. The anxiety parameter was evaluated as a specific index in the psycho-behavioral modifications induced by MR examination. The influence was also considered of the "fantasies" related to examination results on the patients' psyche. Talks and STAI X1 and STAI X2 were employed to this purpose, to identify possible disturbing elements related to both patients' character and examination situations. Our results point to anxiety as the major reaction observed in the subjects undergoing MR examination; it seems to be related to different parameters, which are difficult to identify. Claustrophobia, pathofobia, and the fear of an unknown examination play a major role. Talking to the patients and informing them of the characteristics of the examination proved useful to significantly reduce their emotional distress.

[Radical reconstructive hemorrhoidectomy. Apropos of a new technic]. / L'emorroidectomia radicale ricostruttiva (ERR). A proposito di una nuova tecnica.

On the basis of personal experience of the surgical treatment of hemorrhoidal lesions of the third stage, the Authors describe a new technique for radical hemorrhoidectomy. Sixty-one patients (67% males and 33% females) affected by hemorrhoidal lesions of the third (96%) and second (2%) stage were treated using this method at the INRCA Surgical Centre in Ancona. 19% of patients also suffered from chronic anal fissure which were treated by internal lateral sphincterotomy. No major complications were observed, although minimum postoperative bleeding (17%) and a congestive edematous suffusion (20%) were observed, as was the partial leakage of the mucous-cutaneous suture in 7% of cases. The follow-up after 24 months of 50 patients revealed only one relapse (2%) and persistent soiling for approximately 90 days in 22% of cases.