[Health surveillance of workers exposed in a hadrontherapy center]. / La sorveglianza sanitaria degli esposti in un centro di adroterapia.

SUMMARY: The Centro Nazionale di Adroterapia Oncologica (CNAO) of Pavia is the only Italian structure capable of administering therapeutic radiotherapy treatments with heavy particles (carbon ions, protons) accelerated; in addition to this, it hosts significant research activity, both as basic research and for health-related applications. From the perspective of radioprotection, the most significant risk profile is that linked to external irradiation, from three categories of sources: accelerated external beams (in addition to the treatment beams there are conventional linear accelerators), materials activated following irradiation during treatment or during research activities, unstable isotopes used for diagnostic purposes. The CNAO building has been designed and built to guarantee maximum safety both to the operator and to the patient or visitor, with widely redundant systems in order to exclude the occurrence of accidental irradiation, and to minimize the risk of exposure to activated materials. The cohort of workers shows "atypical" characteristics for healthcare safacilities due to the absolute disproportion between classified and unclassified personnel, the homogeneity of training paths, and demographic characteristics. The health surveillance of the exposed, all classified in category B pursuant to Legislative Decree 230/95, is based on the adoption of the AIRM Protocol, tempered on the specific characteristics of the work process. The main critical issues related to the health surveillance of the exposed CNAO workers come from the energies used, with significant activation capacity, and from the presence of personnel in training.

[Work on a building site at high altitude: physiopathological features and entailments for the occupational medicine]. / Il lavoro in un cantiere in alta quota: generalità fisiopatologiche e analisi di una casistica occupazionale.

SUMMARY: Introduction. From a physiological perspective the high altitude is defined by altitudes higher than 3000 meters above sea level: at this altitude the atmospheric pressure is reduced to 525 mmHg and the partial pressure of Oxygen drops to 110 mmHg in the ambient air follows and 60 mmHg in the alveolar air. To stay at altitudes above 3000 m s.l.m. therefore places the human organism in front of a notable reduction of the functional respiratory reserve already in conditions of rest, leading to inevitable repercussions on the ability to sustain physical effort. Materials and methods. A population of 39 workers employed in the construction sector at a high altitude construction site (2200-3480 m) was examined. Data relating to sex, age, body mass index, smoking, residence altitude, mountaineering history (maximum altitude reached over a lifetime, frequency of ascents, time spent at high altitude, both for pleasure and for work) and sport practice were collected. Among them, for 25 workers the data of the ergometric tests in normobaric hypoxia (pO2, desaturation and peak values of heart rate, respiratory frequency, ventilation) conducted with simplified mode were collected. Purpose. The study aims to analyze the health of a group of workers exposed to the risk related to staying at high altitude in light of the indications of the scientific literature on health surveillance. Results. The data relating to the group of workers studied with regard to anamnestic data and to the results of ergospirometric examinations in hypoxic conditions are described. Conclusions. In working conditions at high altitude it is necessary to consider both the effect of high altitude in itself, similar to a sort of substantially unchangeable "background risk", and the ways in which high altitude interacts with other risk factors characteristic of the work site activity (which are the same as for any construction site activity that takes place at sea level), considering also the pathophysiological or frankly pathological conditions of which the worker is a carrier. This evaluation can be articulated on two levels: a first level concerning the suitability of the individual for access and the simple prolonged stay in altitude where the work activity will be performed; a second level regarding the suitability of the worker to carry out the work tasks required by the specific task in the particular environmental conditions.

[Not Available]. / Cefalee primarie e lavoro a turni: sudio dell' associazione in una popolazione di lavoratori esposti al rischio.

Primary headaches are characterized by an high prevalence, especially among workers. This issue entails remarkable costs, both direct and indirect. For a great amount, the latter consist in the loss of work days for this disease and in a decrease of occupational efficiency among these patients. Moreover, workers suffering from headache could be at high risk for occupational injuries, due to a reduction in attention and to the possible onset of adverse drug effects of their therapies. Thus, primary headache should not be no longe overlooked as an important occupational disease. Among putative risks factors that could increase the rate of headache's onset in the occupational environment, shift work is of great interest. We studied 97 workers (93 males and 4 females) of a single, chemical plant located in Lombardy (Italy). Considering only male workers, the prevalence of primary headache was found to be significantly high among shift workers compared to workers occupied only during the day (40.4% vs. 21.9%, p=0.043). Our results, although observed on a little population, seem to add some evidence, suggesting a role for shift work to increase the prevalence of headache among workers.

[The occupational medicine specialist advice in support of the competent physician in the elaboration of the judgement of suitability to the job specification: evaluation method and analysis of case studies]. / La consulenza specialistica di Medicina del Lavoro a supporto del Medico Competente nella elaborazione del giudizio di idoneità alla mansione specifica: metodo di valutazione e analisi di una casistica.

INTRODUCTION: Still today, one of the most problematic, qualified and awkward assignments for the occupational physician, also for its ethical and socio-economic involvements, is to provide for each worker a fitness judgment to a specific work task. AIM: The aim of this study is to describe and to support results and effectiveness of a "second level" expert advice in occupational medicine, among workers with a "problematic" judgment of fitness to work. MATERIALS AND METHODS: We considered 80 requests for a "second level" advice. They were all requested, during 6 years, to the same Occupational Medicine Unit (UOOML) of a single hospital in north of Italy by a single large metalwork company, following the art. 39 of the 81/2008 legislative decree. RESULTS: The study underlined the effectiveness of "second level" advices in evaluating the adequacy of worker's health conditions related to the specific occupational task. Moreover, this study contributed to develop all operative protocol to carry out a systematic and effective process when "second level" advices are addressed to an Occupational Medicine Unit (UOOML). In particular, our operative proposal suggests, as a key point in the assessment process, a careful visit to the occupational environment, to directly study each single task and to deepen the needs of each single occupational emplacement.

[Judgment of fitness for work in employees with a history of malignant neoplastic disease and exposed to ionizing radiations: evaluation criteria and their application in a case-series study]. / Il giudizio di idoneità al rischio da esposizione a radiazioni ionizzanti nei lavoratori con pregressa patologia neoplastica: criteri di valutazione e analisi di una casistica.

INTRODUCTION: The increase in working age has many epidemiological consequences, one of which is an increased incidence of neoplastic diseases among the working population. Therefore it is more frequent than in the past that the Approved Physician ("Autorizzato" according to Italian legislation) have to judge working fitness in employees suffering from cancer and at the same time exposed to ionizing sources. AIMS: In this study we give suggestions for the decision if a worker, who have previously suffered from malignant tumors, is ready to go or not to go back to work. METHODS: Though we believe in the preventive theory of the linear correlation without threshold for stochastic effects ("Linear No Threshold" LNT), we considered data from the literature that highlight how very low doses of radiation exposure do not increase the risk of stochastic effects and how the potential occupational exposure to low doses does not introduce a significant additional risk of cancer in subjects with a history of malignant tumor. RESULTS: We identify "objective" elements of judgment related to the neoplastic disease of the worker and his activity, but we emphasize the importance of the psychological condition of the worker, as well as his professional interest and his career opportunities. CONCLUSIONS: The criteria we recommend were applied to a group of workers suffering from cancer and with different working activities at risk of exposure to ionizing radiations. The evaluation process is a first rational approach to the assessment of their suitability in worker suffering from neoplastic disease, with the need for custom handling for each individual.

[Primary headache and work: concepts of pathophysiology, occupational risk factors, health monitoring and criteria for judging causation]. / Cefalea primaria e lavoro: nozioni di fisiopatologia, fattori occupazionali di rischio, sorveglianza sanitaria e criteri per la formulazione del giudizio di idoneità.

Primary headaches account for 90% of all the forms of headache. The disease is characterized by high occurrence in the working-age population and by significant impact in countries with high economic and social development. These two epidemiological aspects carry significant economic costs that can be estimated calculating loss of working days due to illness and appreciable loss of labour productivity. In an occupational setting several circumstances are known to cause the onset of attacks in workers who already suffer from primary headache. In this sense, the following factors have an important role: interruption of the circadian sleep-wake rhythm, sleep deprivation, physical/mental distress, not ergonomic postures (mainly those involving the cervical-brachial district), prolonged use of display screen, acoustic discomfort. Among chemicals, in the current conditions of exposure, the olfactory characteristics seem of primary importance rather than the more "conventional" mechanism of toxicity. The main aim of this study is to provide useful information to occupational physicians on the management of workers suffering from primary headache, with regard either to the formulation of the judgement of suitability, or to their auxiliary role in the planning and organization of work. A second aim involves the identification of specific preventive measures in order to reduce the probability of occurrence of a headache attack. This also minimizes the risk of accidents and injuries and ensures workers' efficiency. After these considerations, we suggest guidelines for a flow chart (aimed to understand worker's suitability for his/her specific task). This guarantees not only safety and health of workers who suffer from the illness, but also safeguards any third worker from a possible consequence due to less working capacity and reduction of attention of employees working with a headache attack. In conclusion we also identify three critical factors: the diagnosis of the form of primary headache, the characteristics of the work and the effects due to pharmacological therapy. The study and characterization of these elements are a crucial step for a proper formulation of the judgement of suitability to work. We report a decision process for judgement formulation at the end of this article. It is organized with a hierarchical model, the first steps are the clinical examination and history, the last step, if necessary or advisable, is the neurological visit and a periodic verification of the adherence to treatment prescribed and the follow-up.