[Demand of diagnosis and treatment for work-related psycho-social discomfort: trend of phenomenon]. / Domanda di diagnosi e cura per disadattamento lavorativo: andamento del fenomeno.

This study is aimed at updating the knowledge on case records of workers examined at the "Center for Occupational Stress and Harassment" of the "Clinica del Lavoro Luigi Devoto" in Milan. A sample of patients examined between 2009 and 2011 (n = 198) was compared with a sample examined in 2003 (n = 226). Compared to the past case records, the latter sample included a significantly higher number of graduates (chi2 = 6.6; p < 0.05) and managers (chi2 = 21.5; p < 0.01), employees from the private sector (chi2 = 11.3; p < 0.01), trade (chi2 =22.6; p < 0.01) and micro/small enterprises (chi2 = 41.9; p < 0.001). Company changes and organizational conflicts were the main antecedents for workplace bullying.

[Clinical approach to workers occupationally exposed to negative stress by the occupational health physician]. / L'approccio clinico del medico competente al lavoratore esposto a stress occupazionale.

Following the activation of new norms requiring that all occupational risks including psychosocial risks be evaluated and prevention programs activated, the occupational physician is now faced with new tasks and is expected to modify his role and function. Care and monitoring of stressed workers demand a higher participation in and an adaptation to the different ways in which stress shows up and has consequences on workers health and wellbeing. A subjects suffering of a stress-related disorder asks for a prompt solution be it medical or a job reorganization intervention in order to guarantee the prosecution of his job while the burnout affected subject rather points to leave the situation, to move to another responsibility or no responsibility even when this means abandoning a life choice. The subject suffering for a mobbing situation asks for justice, an intervention to stop the devastating mechanism and the recognition of the actors of his suffering. The three situations ask for differentiated interventions on the part of the occupational physician but all three require attention, participation, time and change from only medical assistance to a caring attitude and an active participation lasting in time.

[Prevention of psychosocial issues and drug addiction in workers employed in building great infrastructures: first outcomes of an experience in the Florence area]. / La prevenzione del disagio psicosociale lavorativo e delle dipendenze negli addetti alla realizzazione delle grandi opere infrastrutturali: primi risultati di uno esperienza in territorio fiorentino.

The research on stress, mobbing, and substance dependence in workers employed in the building of the great infrastructures is part of the project Euridice-Ten. The 75% of the workers employed took part in the research through an anonymous and structured questionnaire. The Clinica del Lavoro of the University of Milan elaborated the data. They point out a high risk of stress, a low level of control, a marked risk of mobbing, a high chronic fatigue in the most exhausting jobs, sleep disorders, problems in the social life as well as at home, in nourishment and at work. Many workers drink too much alcohol and the 9% of the workers know workers who use cocaine.

[Modality of individual response to stress ]. / Modalità di risposta individuale allo stress.

"Stress is a state which is accompanied by physical, psychological or social complaints or dysfunctions and which results from individuals feeling unable to bridge the gap with the requirements or expectations placed on them......stress is not a disease but prolonged exposure to it may reduce effectiveness at work and may cause ill health". This is the stress definition reported by the EU Framework Agreement on Work Related Stress signed 8 October '04 by four workers and employers signatory parties. In order to describe this state of distress, four observation levels can be used, namely data from literature, the subjective symptoms, the related or observed behaviour dysfunctions and the occupational, social performance dysfunctions. Analysis of and interrelations among these four areas can help a better identification of the stress effects and characterize the most frequently observed aspects.

[Updating in occupational health for health care workers]. / Aggiornamenti in tema di tutela della salute occupazionale dei lavoratori della sanità.

The board of the Thematic Section on Preventive Medicine for Health Care Workers of the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII) programmed a national conference on occupational risks of health care workers to be held in late 2009. Main topics will be: a) biohazards; b) biomechanical risk; c) psychosocial factors. Three different working groups were established to tackle critical aspects and suggest practical recommendations to occupational health professionals. Preliminary issues are presented while final results will be presented at the conference on September 2009.

[Risk assessment method for psychosocial factors at workplace: a North-West Tuscany area project]. / Metodologia di valutazione dei rischi psicosociali in ambiente di lavoro: un progetto toscano di area vasta.

The rising awareness of psychosocial risks at workplace means that it is ever more important to prepare methods to assess psychosocial factors in occupational environment. This project of north west tuscany area has the aim to realize an instrument for a gradual risk assessment for this kind of factors without the support of specialists. A decisional flow chart helps to approach the risk assessment step by step on the basis of company features, management and organization problems and company symptoms of stress. The final assessment combines the evaluation of perceived risks with job analysis realizing a matrix containing 5 risk levels, which suggests the priority of preventive measures. The intermediate level (level three) represents the activation level for the medical surveillance. This experience means a proposal for a quantitative assessment of psychosocial risks at workplace.

Emerging aspects of psychosocial risks: violence and harassment at work.

In the last twenty years, psychosocial risks have become crucial in Occupational Health. Particularly, there is an increasing interest about psychological and physical violence at the workplaces. Psychological violence (mobbing or workplace bullying) is described as a situation in which the person has been the victim of negative acts directed to the person and work, with offences, discriminations and isolation. Physical violence at work, still underestimated in many parts of the world, is becoming a topical subject both for its frequency and its pathogenic potential and consist of violence among workers (internal violence) and between workers and external persons (external violence). Examples of external violence are bank robberies, which are prevalent in many European countries, particulary in Italy. The costs of psychological and physical workplace violence are very high at all levels; individual, for the implication of violence for health and quality of life as well as organizational, for the increase of absenteeism, turnover and health care demands and claims. The Medical Centre for Occupational Stress and Harassment (CDL) of the "Clinica de Lavoro Luigi Devoto" was set up in 1996 with a day-hospital service for the diagnosis, rehabilitation and prevention of work related psychological diseases. From its opening, about 5000 patients have been examined.

[Questionnaire for the mobbing risk: CDL2.0]. / Uno strumento per la valutazione del rischio mobbing: CDL2.0.

The aim of the study is to develop and validate a questionnaire able to evaluate the risk of mobbing at the workplace. A multiple-choice questionnaire has been developed which contains, among the different items, only one revealing a mobbing situation. The questionnaire has been administered to two groups (group A--243 subjects in a mobbing situation and group B--63 subjects without exposure to mobbing) and the differences in the scores obtained have been analysed. The questionnaire has proved to be valid and reliable. The results show that the presence of five mobbing actions is sufficient to define the workplace situation as potentially at risk for mobbing. The study reveals some limits in the selection of the two samples thus needing some adjustment. However, the questionnaire, also in the present form, can be considered a tool able to detect the mobbing situations.

[Mobbing in the workplace: new aspects of an old phenomenon]. / Molestie morali nei luoghi di lavoro: nuovi aspetti di un vecchio fenomeno.

In the last ten years there has been increasing concern about the well known old practice of victimization at work, which in recent years has emerged with new characteristics, aims and consequences and is now generally referred to as mobbing behavior. This increased attention seems to be due to increased awareness of individual rights and respect for the dignity of self and others, and to the new economy emphasis on flexibility and reorganizational needs. Moral violence should not be confused with the normal competition and conflicts encountered in work place. Mobbing can be originated by traditional causes such as eliminating an undesired individual or by a precise corporate strategy aimed at reducing the workforce organizations. Mobbing has been recognized as a significant source of individual discomfort and subsequently illness. Lacking specific diagnostic criteria, Post-traumatic Stress Disorder and Adjustment Disorder have been adopted from the international classification of mental diseases (DSM). However, interviews and personality screening highlight specific differences compared with other psychic disorders, not in symptom severity but in the induced loss of parameters which guarantee individual consistency in life, namely self-esteem, event intelligibility, cause-effect relationship, confidence in others, which lead to role and status depletion and eventually acquisition of an invalid personality. The human and economic cost of antisocial behavior at work, with illness, absenteeism and finally unemployment is extremely high for the victims and their families, employers and society. Mobbing control is not only a prevention target but a moral obligation. It should be recognized that interpersonal correctness, respect of individual skills and dignity do not interfere with group efficiency, reorganization, staff reduction and relocation and that these aims can be reached without destroying an individual.

Mapping to distal Xq28 of nonspecific X-linked mental retardation MRX72: linkage analysis and clinical findings in a three-generation Sardinian family.

Families with mentally retarded males found to be negative for FRAXA and FRAXE mutations are useful in understanding the genetic basis of X-linked mental retardation. According to the most recent data (updated to 1999), 69 MRX loci have been mapped and 6 genes cloned. Here we report on a linkage study performed on 20 subjects from a 4-generation Sardinian family segregating a non-specific X-linked recessive mental retardation (XLMR)(MRX72) associated with global delay of all psychomotor development. Five of 8 affected males have been tested for mental age, verbal and performance skills and behavioral anomalies; mental impairment ranged from mild to severe. Only minor anomalies were present in the affected subjects. Two-point linkage analysis based on 28 informative microsatellites spanning the whole X chromosome demonstrated linkage between the disorder and markers DXS1073 and F8c in Xq28 (maximum Lod score of 2. 71 at straight theta = 0.00). Multipoint linkage analysis confirmed the linkage with a Z(max) of 3.0 at straight theta = 0.00 at DXS1073 and F8c. Recombination in an affected male at DXS1073 and F8c allowed us to delimit centromerically and telomerically the region containing the putative candidate gene. The region, where MRX72 maps, overlaps that of another MRX families previously mapped to Xq28, two of which harbored mutations in GDI. Involvement of this gene was excluded in our family, suggesting another MRX might reside in Xq28.

An international questionnaire to explore neurotoxic symptoms.

EURONEST (European Neurotoxic Solvents Toxicity) is a concerted action within the European Communities to use standardized methods available in all countries. The product of this effort is a new symptom questionnaire, EUROQUEST (European Questionnaire). The original version was developed in English. To obtain transcultural reliability, the translation of questionnaires into other languages must be validated. We adopted a procedure with translation, back translation, and agreement between translators. Ten other European countries also followed the same translation procedure for EUROQUEST.

Neurobehavioral functions in operating theatre personnel: a multicenter study.

The study was conducted to evaluate neuropsychological symptoms, subjective stress and response speed functions in subjects occupationally exposed to low levels of anesthetic gases. A group of 112 operating theatre personnel exposed to anesthetic gases (nitrous oxide and isoflurane), and 135 non exposed hospital workers from 10 hospitals in Northern Italy were examined before and after the shift on the first and the last day of the working week. Three different tasks were administered: a complex reaction time test (the Stroop Color Word); a questionnaire for neuropsychological symptoms (EURO-QUEST); the block design subtest (WAIS). Biological and atmospheric indicators of exposure were measured. In the exposed group, the geometric mean of urinary nitrous oxide at the end of the shift was 7.1 micrograms/l (95th percentile 12.4, range 1.5-43) on the first and 7.8 micrograms/l (95th percentile 21.5, range 1.0-73.3) on the last day of the working week. On the same days, end of shift urinary isoflurane was 0.7 microgram/l (95th percentile 2.6, range 0-4.7) on the first day and 0.8 microgram/l (95th percentile 2.0, range 0-5.6) on the last. The exposed and control subjects were comparable for both basic intellectual abilities and subjective stress levels. No statistical differences were observed between exposed and control subjects for neuropsychological tests and symptoms. No dose-effect relationships were observed between the exposure indicators and the test results. In conclusion, no early behavioral effect on the central nervous system was detectable at the exposure levels measured. The biological exposure limits of 13 micrograms/l for nitrous oxide and 1.8 micrograms/l for isoflurane corresponding respectively to the atmospheric concentrations of 25 ppm and 0.5 ppm seem to be adequately protective for the integrity of workers' neurobehavioral functions, as measured with the tests used.

Carbon disulfide and the central nervous system: a 15-year neurobehavioral surveillance of an exposed population.

Carbon disulfide-induced neurobehavioral effects are well known and do not need further evidence. Carbon disulfide vasculopathy and the syndromic complex resulting in depression, loss of memory and concentration, and behavior disturbances have been widely demonstrated. Less known is the evolution of the symptomatology when the environmental conditions are consistently improved, that is, the reversibility or the progression of the dysfunctions observed. This paper reports on a neurobehavioral follow-up in a viscose rayon factory carried out, in intervals, from 1974 to 1990. Several successive improvements were implemented in the plant through the years, until finally, the most radical changes were made at the end of the Seventies and these resulted in exposure levels far below the current Threshold Limit Values. A total of 493 subjects were examined and some of them were reexamined up to six times. The last examination was completed in September, 1990. In this paper, studies by our group over the 15 years of monitoring are discussed. The results show that the general mental state, as measured by neurobehavioral methods, reflects past and current exposure. This point was explored by dividing the subjects into six groups on the basis of their length of exposure and year of examination and by comparing their performances. The results show that even exposure to levels of carbon disulfide not exceeding 8 mg/m3 may induce absentmindedness and difficulties in perceptive abilities.

Comparison of performance from three continents on the WHO-Recommended Neurobehavioral Core Test Battery.

To address the need for standardized test batteries, an expert group convened by the World Health Organization (WHO) and the U.S. National Institute for Occupational Safety and Health during 1983 proposed the Neurobehavioral Core Test Battery (NCTB) to identify nervous system effects of chemical exposures in human populations worldwide. To determine the feasibility of using the NCTB in varied cultures, a cross-cultural assessment was conducted under WHO auspices. Data were collected in 10 countries of Europe, North and Central America, and Asia from over 2300 males and females who were not exposed to chemicals at work, within five age ranges between 16 and 65. Results suggest that performance on two NCTB tests (Simple Reaction Time, Benton Visual Retention) is very similar in a broad range of countries and that performance on four other NCTB tests (Santa Ana, Digit Symbol, Digit Span, Aiming) is relatively more variable from country to country, in both males and females. However, data collected from very poorly educated males in one country revealed very low performance levels suggesting that the NCTB may not provide an adequate reference group for identifying (behavioral) neurotoxic effects in such populations. More research is thus needed on evaluating neurotoxicity in poorly educated subjects.

Prevalence of abnormal neurobehavioral scores in populations exposed to different industrial chemicals.

The aim of the study is to establish the prevalence of neurobehavioral scores of occupationally exposed subjects below the 10th percentile rank of normalized curves obtained on a referent population. The Milan Automated Neurobehavioral System (MANS) was administered to 400 drivers from public and private firms; their data were distributed on the basis of age and years of school attendance and were normalized by determining percentile rank equivalence. The exposed population is made up of 20 lead- and zinc-exposed subjects, 18 welders exposed to aluminum for less than 1 year, 150 exposed to different metals in the ferromanganese production, 73 lithographic operators exposed to gasoline and petroleum, 197 exposed to solvents mixtures in the paint manufacture, and 23 dropouts of the same firm. The percentages of scores below 10th percentile rank were calculated in the different exposure groups and in the different age-school attendance ranges. The prevalence of results below the 10th percentile rank was found to be related to the intensity of the exposures and to the low levels of school attendance. In the 20-29 and the 30-39 age ranges, there was a prevalence of POMS scale scores below 10th percentile rank, in the 50-59 age range, the percentages were high for the Digit Symbol, the mean value of Simple Reaction Time, Serial Digit Learning, and Benton Visual Recognition.

Individual-administered human behavioral test batteries to identify neurotoxic chemicals.

Most research demonstrating behavioral effects of occupational chemical exposures is produced in established laboratories using a consistent set or battery of tests. Exemplifying this tradition are batteries developed at Finland's Institute of Occupational Health, Milan's Institute of Occupational Health, Sweden's National Institute of Occupational Health, Australia's National Institute of Occupational Safety and Health, and at universities in the United States and other countries. In 1983, under the World Health Organization (WHO) aegis, experienced human occupational researchers recommended the Neurobehavioral Core Test Battery (NCTB) as a screening instrument to be administered by an individual to subjects exposed to chemicals believed to be neurotoxic. Health professionals from 50 cities in 27 countries distributed on every large continent have been trained to administer the NCTB according to its Operational Guide. Six issues need to be addressed regarding human-administered test batteries: (a) The critical role of individual-administered batteries to screen chemically exposed populations in a field increasingly dominated by computer-administered batteries; (b) selection criteria for tests to assess known and unknown chemicals; (c) utility of baseline data for study analysis and interpretation; (d) test battery validation; (e) availability and cost of inexpensive test batteries; and (f) equivalence of computer- and human-administered variants of the same tests.

[Neurobehavioral effects of inhalation anesthetics used occupationally: a critical analysis]. / Effetti neurocomportamentali da anestetici per inalazione di uso professionale: un'analisi critica.

Unlike other apparatuses, the potential effects on the nervous system of occupational exposure to anaesthetic gases have not been exhaustively reviewed. Because of the relevance of these effects, their significance of the quality of life of the exposed subjects and of the increased risk inherent in their delicate work tasks, these themes deserve the greatest attention. This paper briefly examines the data from the international literature as well as the neurobehavioral methods employed, underlines the existing gaps of knowledge and eventually proposes strategies aimed at filling these gaps of knowledge.

[Neurobehavioral effects of exposure to anesthetic gases]. / Effetti neurocomportamentali dell'esposizione a gas anestetici.

Neurobehavioral studies on operating room personnel exposed to anaesthetic gases in hospitals of the Region Lombardia have confirmed findings already reported in the literature. There was high subjective symptomatology and reduced efficiency at psychologic testing among exposed people with protracted exposure. In this group, reaction time was worse at the end of the workshift with respect to the beginning. These changes were reversible after removal from exposure. It was impossible to establish a clear dose/response relationship due to the difficulty to control an important confounding factor, such as stress, in field studies.

Experiences with the Milan Automated Neurobehavioral System (MANS) in occupational neurotoxic exposure.

It is known that in neurobehavioral toxicology, the data obtained by means of psychological testing can acquire sense only when testing conditions and procedures, among others, are kept under rigorous control. This demand, together with the diffusion of multicentered studies aimed at finding mutual agreement on the parameters to be measured and the interpretation criteria to be adopted, has determined our decision to convert six out of the seven tests of the WHO-NCTB into a computer-aided system (MANS). The choice of one of the two systems depends on the characteristics of the testing situation and on the different requirements of clinical, epidemiological and experimental studies. The validation of MANS, as to its reliability and sensitivity, is ongoing but some data have already been collected which show a high correlation of the computer-administered test results with the paper and pencil form as well as a good degree of discriminating power in different testing situations. The experience, made in the past three years, seems to show that the goal of having a simple, easy to handle and reliable instrument to be used and, if necessary easily adapted to a variety of situations and cultures, has been met. Further work is to be carried out to confirm its validity in the early detection of neurobehavioral impairments due to neurotoxic agents.