Total quality strategy in the formative process of the occupational physician.

Interest in applying the concepts of total quality management to the fields of health care and medical education is growing. This paper analyzes the field of education in occupational medicine to explore the relationships between teaching and the deliverance of a product or a service. Issues such as defining teaching customers, addressing customer needs, teaching processes, and assessing and improving quality teaching are described. The occupational physician is requested to act according to particular competencies. This demand implies the need to meet specific requirements. To assure the achievement of these goals, the implementation of a teaching process must include (i) targeting the learning objectives (the knowledge, skills, and attitudes the specialist should have), (ii) planning the evaluation system (ability of the course to assure the achievement of the objective), (iii) evaluating the curriculum (compliance of the acquired competencies to the needs).

[Health surveillance program for the prevention of Mycobacterium tuberculosis infection risk among health personnel of the Polyclinic and the University of Modena]. / Protocollo di sorveglianza sanitaria per la prevenzione del rischio da Mycobacterium tuberculosis negli operatori dell'Azienda Policlinico e dell'Università di Modena.

Surveillance programme for the prevention of Mycobacterium tuberculosis risk infection among health care workers at Azienda Policlinico and Università di Modena. Increase in tuberculosis (TB) morbidity and mortality in the last decade even in highly industrialized countries represents a major public health problem. Health care workers (HCWs) are one of the high-risk group for TB infection in the population. Several international guidelines for the prevention and control of TB infection among HCWs have been proposed, also including expensive and not easily applicable interventions. A surveillance programme has been set up at the Servizio di Sorveglianza Sanitaria in the Azienda Policlinico di Modena aimed to the early identification of hospital workers with recently-acquired latent TB infection, B.C.G. vaccination of PPD skin negative subjects working in intermediate-high TB risk workplaces, periodic evaluation of PPD skin conversion rates among personnel of each working area. This programme, whose feasibility depends on the availability of adequate resources, is considered as a tool suitable for the individual risk assessment and should be performed together with technical and structural interventions to carry out an effective primary prevention of TB infection among HCWs.

[Organization of the activities of health services according to UNI EN ISO 9000 standards]. / Organizzazione dell'attività di sorveglianza sanitaria secondo la norma UNI EN ISO 9000.

Implementation of a Quality System in accordance with the ISO 9000 standard with an Occupational Health Service. Following the lead of the industrial sector, Quality Systems (QS), in accordance with the principles of the ISO 9000 standards, have been implemented in many health care organizations. The purpose is to improve the health care delivered to the patient in a systematic way improving the system efficacy and effectiveness. Our aim is to describe a practical approach for the implementation of a QS in accordance with the ISO 9000 standard within an Occupational Health Service (OHS) in a middle-sized hospital. The purpose of the system is to ensure that everyone at the OHS is aware of the common quality objectives and knows how to act in order to achieve them. The implementation of the QS has entailed 2 phases: (i) a conformity assessment to verify that the organization and services delivered measure up to ISO standards; (ii) the development of a deployment plan to support the activities and action implementation for achieving the QS requirement of ISO 9000. An early conformity assessment highlighted the need for management and control in order to assure quality. The Service did not have a documented QS, a documented management review and a documented procedure for corrective and preventive actions for ensuring QS implementation and its effectiveness. A strategic quality plan, focused upon the major areas for improvement, was developed. This practical approach shows encouraging results because it allows to build up the basic quality and to motivate the OHS personnel.

[Use of the Total Quality strategy in the educational process of the occupational medicine specialist]. / Applicazione della strategia della Qualità Totale nel processo formativo dello specialista in Medicina del Lavoro.

The formative process of the Occupational physician: a Total Quality approach. There is a growing interest in applying the concepts of Total Quality Management to the fields of health care and medical education. This paper analyses the field of occupational medicine education to explore the relationships of teaching and delivering a product or a service. Issues such as defining teaching customers, addressing customer's needs, teaching processes, assessing and improving quality teaching are described. The occupational physician is requested to act according to particular competencies. This implies the need to meet specific requirements. To assure the achievement of these goals, the implementation of a teaching process must include: (i) targeting the learning objectives (knowledge, skills and attitudes the specialist should have), (ii) planning the evaluation system (ability of the course to assure the objective achievement), (iii) evaluating the curriculum (compliance of the acquired competencies to the needs).

[The educational process of the "competent physician": quality exigencies]. / Il processo formativo del "medico competente": esigenza di qualità.

The spread of Quality concepts and process control in industries and services has meant that the educational field has become increasingly affected by the concepts of activities optimization and quality assurance. Teaching is comparable to any other service supplied in terms of program quality, quality control, quality assurance, and quality management. Teaching is a service that can be supplied through a number of phases: planning, execution and evaluation or control. This paper aims to describe an application of the Quality concept according to ISO 9000 rules in order to assure quality of teaching and training of the occupational physician. The occupational physician is requested to act according to particular competencies. This implies the need to meet specific requirements (competence-based educational goals). To assure the achievement of these goals, the implementation of a teaching Quality system must include: targeting the learning objectives (knowledge, skills and attitudes the specialist should have); planning the evaluation system (ability of the course to assure the objectives are achieved); evaluating the curriculum (relating the acquired competencies to the needs). From the integration between Quality concepts and education, new rules are arising to comply with the quality needs in teaching, where the quality of the teaching program is considered as the suitability of the program to satisfy the occupational physician competency needs.

[Study of a matrix for the evaluation and prediction of occupational benzene exposure]. / Studio di una matrice per la valutazione e la previsione dell'esposizione occupazionale a benzene.

Aim of the study was to assess the occupational exposure to benzene by mean of a job-exposure matrix, which classified job titles according to the level of exposure to benzene. This study consisted of 3 parts: (i) the analysis of the literature which takes into account the biological and environmental monitoring studies of workers exposed to benzene, (ii) the statistical analysis (cluster join-analysis) of biological monitoring data leading to the development of the job-exposure matrix, (iii) the validation of the matrix. The job-exposure matrix allows the estimate of the exposure to benzene according to job and is suggested as a tool to be used when environmental monitoring data are not available.

[An anamnestic-observational estimation of the postural-energy-motor commitment of occupational activities via a questionnaire]. / Stima anamnestico-osservazionale dell'impegno posturale-energetico-motorio di attività occupazionali mediante questionario.

A simple questionnaire for the quali-quantitative clinical assessment of the physical requirements in habitual occupational activities has been fixed. The assessment goes through the classification of qualitative, dimensional, temporal parameters referred by the patient as characteristic of the occupational activity. As a result the risk factors related to postures and movements are highlighted, and an esteem of the energy expenditure is obtained from a predictive equation which has been formulated on the basis of some important references. The energy expenditure of three homogeneous occupational phases was estimated through the equation, and then measured during a simulation of the same activities performed in a laboratory by 7 subjects. The estimated and the measured values were compared also with the esteems obtained from validated predictive equations (Garg et al, 1978). The predictivity of our equation was measured. As an on-site assessment, detailed written reports of 18 occupational phases were submitted to 6 differently trained observers and were analyzed through the questionnaire; the variability inter-observer was studied.

[Role of the occupational physician in risk communication]. / Ruolo del medico competente nella comunicazione del rischio.

Risk can be defined as the probability of suffering a loss or an effect because of some event. Communication can be defined as an exchange of information. Risk communication can be defined as the exchange of information among interested parties about the nature, magnitude, significance, or control of a risk. Although effective risk communication is difficult for several reasons, depending on the source, channel and receiver, communication plays a key role in occupational and environmental medicine. Risk communication is a "two-way process" involving an interactive exchange between occupational physician and workers. How risk estimates are communicated depends on who is talking, who is listening and what is being said. One of the most important findings to emerge from risk communication research is that occupational (and environmental medicine) physicians are among the most trusted and credible sources of information on occupational (and environmental) health issues. Trust and credibility are key issues in risk communication. The ability to establish useful and constructive channels of communication depends on whether the physician is perceived as trustworthy. Empathy-caring, competence-expertise, honesty-openess and dedication-commitment are considered as the most important factors in determining trust and credibility. Effective risk communication is a complex art and skill that requires substantial knowledge, training and practice: communication structure is important, as much as content.

Evaluation of an occupational health course. Developed for nursing education programs in Italy.

1. Italian schools of nursing are now required to have a standardized curriculum. Part of the standardized curriculum is an occupational health course. The course is divided into two main units including occupational health (18 topics) and occupational health in the hospital (25 topics). 2. In an effort to identify relevant course topics from the two modules, an external evaluation using an audit approach was performed. 3. Items identified as most relevant (with a percentage of the theoretical maximum level > 78%) included both the basic concepts in occupational health and occupational health in the hospital. 4. The audit process revealed that a number of topics should be considered compulsory, whereas others could be omitted because of their lower relevance for nursing education curricula.

[Perception of the Occupational Medicine discipline by graduate medical students of the University of Modena before and after taking the course during the academic year 1994-1995]. / Percezione della disciplina "medicina del lavoro" da parte degli studenti del corso di laurea in medicina dell'Universita' di Modena prima e dopo la frequenza del corso nell'anno accademico 1994-95.

Until recently, the course in Occupational Medicine was not compulsory for medical students. The introduction of Occupational Medicine in the curriculum as a mandatory course may have caused uncertainty among the students in clearly and correctly identifying the discipline and its role in professional training. The aim of the study was to investigate how the students attending the course in Occupational Medicine at the Medical School of the University of Modena in the academic year 1995-95 perceived this discipline. Fifty-eight 5th year students (out of 76) were administered a questionnaire, before and after the course, in order to check their awareness of the relationship between work, environment and health, their knowledge about the functions of the occupational health specialist, their opinion about the cultural and professional link of Occupational Medicine with other disciplines. The results showed that: (i) students were fully aware of the relationship between working conditions and health, knowledge of which is considered important in the training of the general practitioner; (ii) students correctly indicated the main functions of the occupational health physician which were better defined after attendance of the course; (iii) after the course, students emphasized the cultural and professional links of the discipline with epidemiology, hygiene, forensic medicine, internal medicine and pneumology; (iv) students' expectations of the curriculum mainly regarded occupational diseases and their prevention, and the study of the relationship between health and work; (v) students suggested overlapping of subjects and they believed it was correct for the course to be taken in the 5th year.

Drinking habits and occupational exposure to xenobiotics: a review.

The evaluation of health status of workers exposed to a variety of chemicals is usually performed by means of several laboratory indices. Our aim is to review literature data in order to evaluate the influence of some lifestyle characteristics (alcohol intake) on these parameters. Since alcohol intake is responsible for a modification of some laboratory parameters in healthy workers, the medical surveillance of workers exposed to chemicals should include a careful evaluation of alcohol intake.

[Course on industrial medicine in graduate education of medicine and surgery at the University of Modena. Critical analysis of the judgment of students of the academic year 1993-1994]. / Il corso integrato di "Medicina del Lavoro" nel corso di laurea in Medicina e Chirurgia dell'Università di Modena. Analisi critica del giudizio degli studenti dell'anno accademico 1993-1994.

Assessment of teaching activity based on the judgment of students can provide useful information which can be used to revise and improve the courses. In the academic year 1993-1994 the course of "Occupational Medicine" was assessed in the Medical School of the University of Modena. Fifty-six out of 62 medical students participated in the study. An anonymous questionnaire was administered to obtain information on usefulness, clarity (presentation and visual aids quality), cultural and professional interest. Each student was requested to assess these aspects on a 5-point scale ranging from 1 (poor) to 5 (very good). The results show that some lectures ("Occupational History", "Allergic respiratory diseases") were considered more useful and more interesting from a professional point of view. No difference was found among the lectures with respect to clarity, which was considered as "good". Clarity depends mostly on the quality of the visual aids. The students suggested that 80% of the program should be covered during the course.

[Life style as a confounding factor in the study of biological effects of the occupational exposure to chemical substances]. / Lo stile di vita come fattore di confondimento nello studio degli effetti biologici derivati dall'esposizione professionale a sostanze chimiche.

The evaluation of health status of workers exposed to a variety of chemicals is usually performed by means of several laboratory indices. Our aim was to assess the influence of some lifestyle characteristics (alcohol intake and cigarettes smoking) on these parameters. 103 subjects occupationally exposed to chemicals and 146 non occupationally exposed subject were studied. A significant increase in gamma-GT, MCV e UDGA was observed among drinkers (> or = 5 g alcohol/day) as compared with non drinkers and among cigarette smokers (> or = 5 cigarettes/day) as compared with non smokers. Statistically cigarette smoking and alcohol intake influenced parameters independently from any occupational exposure to chemicals. Among the explored indices, UDGA only was significantly and positively associated to occupationally exposure to chemicals. Alcohol intake and cigarettes smoking are responsible for a modification of some laboratory parameters in healthy workers. The medical surveillance of workers exposed to chemicals should include a careful evaluation of alcohol intake (when gamma-GT and ADGU are measured) and cigarette smoking (when MCV and ADGU are measured).

[Computer program recognition of a cDNA sequence specifying signal peptides]. / Riconoscimento mediante programma computazionale delle sequenze di cDNA che specificano i peptidi segnale.

An application of a computational analysis of cDNA sequences is presented in this paper. The goal is the identification of functional domains on sequence data. The results show the capability of this technique to identify a zone of DNA associated with the signal peptide coding region, whose biological function at DNA or RNA level is still unknown.

Response to Mycobacterium tuberculosis antigens is enhanced by monoclonal antibodies.

T lymphocytes purified from peripheral blood of tuberculosis patients and from healthy skin test PPD-positive subjects show a remarkably increased proliferative response in culture to purified protein derivative (PPD) when three anti-mycobacterial monoclonal antibodies are added together with the antigen. This indicates an important role played by antibodies in the T cell response to the tuberculous infection.

[Metamorphosis of Hyla arborea and of Rana esculenta in conditions of environmental pollution: a biostatistical study]. / Metamorfosi dell'Hyla arborea e della Rana esculenta in condizioni di inquinamento ambientale: studio biostatistico.

An extention to the largest possible numbers of animal species is a basic requirement when damages induced by pollutants are studies with a specific purpose of defining the concentrations of pollutants compatible with the conservation of the biochemical system. Animals should be bred in standard conditions, and the natural habitat is to be reproduced in the laboratory. The studies should also be planned favoring these statistical elaborations which are suitable of application also in case of interruption of the experimental design. The results of two experiments are reported in example, in which the metamorphoses of Rana esculenta and Hyla arborea are compared in standard conditions and during pollution with "fanghi rossi" (containing titanium dioxide).