[Alcohol consumption risk among health care workers of the Santa Croce e Carle Hospital of Cuneo: index of prevalence, predictors and enforcement actions to dissuade alcohol consumption]. / Consumo di alcol a rischio fra gli operatori dell'Azienda Ospedaliera Santa Croce e Carle di Cuneo: indici di prevalenza, predittori e interventi di contrasto all'assunzione di alcol.

OBJECTIVES: 1691 workers of a hospital in Northern Italy underwent medical examinations in order to identij the prevalence index of alcohol consumption posing a risk, to assess the ability of some bio-anthropometric variables to predict the condition of a risk drinker, and to assess the results of a programme designed to reduce alcohol intake. METHODS: Certain blood parameters were examined and two basic alcohol consumption questionnaires were administered to identify drinkers at risk. Subjects showing a high CDT ratio were given an in-depth interview to assess alcohol intake. Drinkers at risk were enrolled in an alcohol dissuasion programme consisting of brief interventions andfollow-up assessments repeated every three months for a year. RESULTS: 63 subjects (3.7% of the total) were classified as drinkers at risk. By means of a logistic regression test the variables male gender and smoking showed a statistically significant association with the condition of drinkers at risk, while working in inpatient wards showed only a trend towards risk (p=0.06). After a year 42 (70%) of the 60 subjects who completed the alcohol consumption dissuasion programme had reduced alcohol consumption and 18 (30%) had not changed their habits. CONCLUSIONS: The prevalence of alcohol consumption posing a risk among hospital workers was low; blood parameters and alcohol consumption questionnaires routinely used to determine alcohol intake showed low ability to identif a risk condition, bio-anthropometric variables were statistically associated with a higher probability of alcohol consumption posing a risk, programmes to reduce alcohol intake among health workers proved to be effective.

[Identification of risk factors for work-related stress in a hospital: a qualitative and quantitative approach]. / L'identificazione dei fattori di rischio stress lavoro-correlato in un'Azienda Sanitaria Ospedaliera: un approccio quali-quantitativo.

BACKGROUND: Italian legislation establishes the obligation for the employer to assess any risks to the safety and health of workers, including those relating to work-related stress (WRS). Several studies have proved the existence of a link between WRS and both individual diseases and organizational results. OBJECTIVE: The research aimed at detecting WRS risk factors in a hospital consisting of 53 departments employing 2334 workers. METHODS: A qualitative and quantitative approach was adopted divided into six steps: 1) analysis of the hospital indicators; 2) semistructured interviews of the 53 department heads; 3) preparation of a checklist including 42 WRS risk indicators; 4) observation by shadowing of the 53 departments; 5) setting up of 53 focus groups with staff from each department; 6) distribution of the check-list to a representative sample of 747 employees. RESULTS: Data analysis showed a "low" level of WRS risk regarding the hospital as a whole, a "medium" level regarding six transversal indicators and eight departments. Three indicators considered particularly significant were examined in detail: "workplace and ergonomic conditions", "shift work", "interruptions in work flow". CONCLUSIONS: The results helped to identifj a series of best practices aimed at reducing WRS risk that are applicable to other health care settings. The qualitative and quantitative approach produced a keen involvement of the employees of the hospital which will positively encourage the real efficacy of the measures taken.

[Prevalence of job fitness restrictions in the period 2007-2009 and analysis of predictors of restrictions among hospital health care workers]. / Prevalenza dei giudizi di limitazione dell'idoneità alla mansione nel triennio 2007-2009 e analisi dei predittori delle limitazioni fra gli operatori sanitari di un'azienda ospedaliera.

BACKGROUND: Little is known about the prevalence rates of job fitness restrictions (JFR) and the impact of demographics on JFR among Italian health care workers (HCW). OBJECTIVE: To examine the prevalence rates of JFR among HCW of an Italian hospital in the years 2007-2009 and to estimate ability of demographic variables to predict JFR. METHODS: The number of HCW with JFR was divided by the number of HCW in service at the end of each year from 2007 to 2009 to calculate prevalence of JFR. The variables age, gender, employment, type of contract, and place of birth of the HCW in service at the end of 2009 were compared to JFR, by univariate and multivariate analysis. RESULTS: Prevalence rates of JFR were 15.2% in 2007, 15.6% in 2008, and 13.8% in 2009. The most frequent JFR were related to manual load handling (177 in 2007, 185 in 2008, and 155 in 2009). HCW of the female gender (OR: 1.69; CI: 1.17-2.43), aged > 42 years (OR: 1.66; CI: 1.30-2.13), health professionals (OR: 2.46; CI: 1.61-3.78), part-time (OR: 1.34; CI: 1.00-1.80), from other Italian regions (OR: 1.79; CI: 1.30-2.46), or other countries (OR: 2.37; CI: 1.46-5.12), showed statistically significant increases in JFR. Only a few demographic variables were associated with greater likelihood of JFR for exposure to manual handling, hazardous substances and organizational constraints. CONCLUSIONS: These data should be used to plan interventions to support the subgroups of HCW at increased risk of JFR

[Association between demographic characteristics and psychosocial factors of job stress in a sample of health care workers employed in two Italian hospitals]. / Correlazioni tra variabili demografiche e fattori psicosociali di stress occupazionale in un campione di operatori sanitari di due aziende ospedaliere.

BACKGROUND: Job stress has negative effects on both health care work ers' (HCW) health and on work organization. OBJECTIVES: To assess whether the presence of stressful conditions, individually considered, or combined in the iso-strain model, is significantly associated with specific socio-demographic characteristics, also with the aim of providing organizational tools for management to reduce stress in the working environment according to Italian law 81/2008. METHODS: The extended version of the Job Content Questionnaire was administered to 265 healthy HCW in seven paired wards of two hospitals. The five psychosocial scales Job Demand (JD), Job Control (JC), Social Support (SS), Skill Underutilization (SuS), and Job Insecurity (JI) were calculated. The factors JD, JC, and SS were combined together to separate a group of 33 HCW in iso-strain conditions from another group of 232 HCW not in iso-strain conditions. Several socio-demographic variables were collected. RESULTS: Statistically significant associations were found between socio-demographic characteristics and psychosocial factors, whereas the iso-strain conditions were not related to any socio-demographic parameter. CONCLUSIONS: Data suggest the need for alternative policies to reduce job stress: for example, actions addressed to operative units or HCW with specific socio-demographic characteristics could be effective in improving individual psychosocial factors; however, integrated actions aimed at reorganizing the working environment as a whole should be implemented to correct iso-strain conditions.

[Relationship between musculoskeletal disorders and work-related awkward postures among a group of health care workers in a hospital]. / Correlazione tra disturbi muscolo-scheletrici e posture disergonomiche in un gruppo di operatori sanitari di un'azienda ospedaliera.

BACKGROUND: There are few studies in the Italian literature on musculoskeletal disorders (MSD) among health care workers (HCW) keeping and holding awkward postures during their job. OBJECTIVES: The aims of this study were to determine the prevalence of low-back, neck and upper limb complaints and the association between risk factors and MSD in HCW working in 15 wards of the Hospital of Cuneo. METHODS: A questionnaire was submitted to 113 HCW. Information about demographic and occupational factors, and MSD characteristics were collected to be statistically elaborated. RESULTS: The prevalence of complaints regarding at least one of the 3 body regions was 71% in the whole sample (80 subjects). Low back, neck and upper limb were interested, respectively, in 58.4%, 50.4% and 25.7% of the cases. Logistic regression showed a significant association of MSD with score > 7 on the Borg scale (OR = 9.70; CI: 2.01-46.9; p < 0.01), positive musculoskeletal clinical history (OR = 3.67; CI: 1.24-10.88; p < 0.05), and visual defects (OR = 2.88; CI: 1.07-7.81; p < 0.05). Based on the answers from the questionnaire, the onset of MSD was attributed in 41 cases to organizational problems, and in 14 cases to the ergonomic characteristics of the job. CONCLUSIONS: The index of prevalence of MSD associated to work-related awkward postures (71%) is very high, greater than that observed among HCW exposed to manual lifting of weights (21%) in the hospital. Thereafter, assessment of exposure and containment of such occupational risk must be considered useful.

[Results and significance of a baseline tuberculin skin test programme among health care workers in a hospital setting]. / Risultati e significato della sorveglianza tubercolinica di base fra i lavoratori di un'azienda sanitaria ospedaliera esposti a rischio professionale.

BACKGROUND: Due to the resurgence of tuberculosis (Tb), health care workers (HCW) are considered at increased risk for Latent Tuberculosis Infection (LTI). According to the national guidelines health care facilities are required both to perform tuberculin skin tests (TsT) on all employees with potential occupational exposure to Tb and to analyze the results obtained. However, only a limited number of studies can be found in the literature reporting data of Tb prevalence in Italian hospitals. OBJECTIVES: The aim of this study was to determine the prevalence of and the relative risks for positive TsT among employees of the Hospital of Cuneo. METHODS: After informed consent, a questionnaire and a TsT according to the Mantoux technique were administered to the 2368 employees of the hospital exposed to occupational risk for Tb. The variables considered for the univariate and multivariate analysis included several anthropometric, occupational and clinical factors RESULTS: 274 of the 2210 employees who completed the screening programme had positive TsT (12.4%). Only one subject had been treated for active Tb. Factors significantly associated with a positive TsT were duration of employment (odds ratio [OR]:4.90, CI: 2.25-10.66, for length of employment 10-17 years; and OR: 8.77, CI: 3.53-21.81, for length >17 years; p < 0.001); working in a Tb high-risk occupational setting (OR 4.26, CI: 1.90-9.57for level of "limited" risk and OR: 5.68, CI: 2.47-13.07 for level of "medium" risk; p < 0.001); belonging to nurse or assistant nurse job categories (OR: 2.80, CI: 1.09-7.19; p < 0.05); history of active or latent Tb infection (OR: 11.54, CI: 5.54-24.06; p < 0.001); birth in a foreign country (OR: 4.40, CI: 1.30-14.85; p = 0.01); and BCG immunization (OR: 2.51, CI: 1.68-3.75; p < 0.001). Seventeen subjects had a positive reaction after a two-step test (0.8%). Boosting occurred among elderly employees (mean age: 48, 3 +/- 8.0 yrs), with long duration of employment (22, 2 +/- 10.5 yrs), vaccinated with BCG (17/17). CONCLUSIONS: Our data suggest that a baseline survey based on TsT is useful to assess the prevalence of and risk factors for TLI in a health care setting. The high rate of participation in the survey (93.3%) was probably due to the training and awareness efforts aimed specifically at exposed HCW.

[Implementation and application of an index method for assessment of occupational biological risk in a hospital setting]. / Implementazione ed applicazione di un metodo ad indici per la valutazione del rischio da esposizione occupazionale ad agenti biologici in ambito ospedaliero.

BACKGROUND: Over the last years several mathematical methods have been proposed by The Italian Society for Occupational Health and Industrial Hygiene (SIMLII) with the aim of assessing exposure to occupational risks. The current way of assessing biological risk is based on the widely used but poorly accurate formula R = P x D. Use of more complex methods of assessment of exposure involves many problems due to: complexity and poor standardisation of micro-organisms concentration, ubiquitary diffusion of biological agents in the working environment, lack of dose-response curves, uncertainty about the existence of an effective infection threshold for many micro-organisms, etc. OBJECTIVES: In order to assess occupational exposure to biological risk in health care settings an index method was developed according to the Guidelines for health surveillance of health care workers drawn up by SIMLII. METHODS: A check-list containing the features of the two main modes of transmission of infectious diseases (blood-borne and air-borne) was applied to the wards of Cuneo Hospital. The selected variables were combined, according to the different transmission modalities, into two mathematical models producing, for each of them, a numeric value of the degree of the risk. RESULTS AND CONCLUSIONS: The cut-off values chosen to separate both the final degrees of exposure by blood-borne (mild, medium and high) or by air-borne transmission (very low, very limited, limited, medium) were statistically different (P < 0.001). The most important determinants of the differences found in the comparison between different exposure levels were: frequency of work manoeuvres at high risk of exposure and/or frequency of performance, building deficiencies, extent of application of the work and behaviour procedures, degree of training, number of occupational injuries, the occupation of physician, and, for the nursing category, duty in a medical ward. This index method seems to assure better results, both in terms of efficacy and appropriateness, compared to the methods previously used to assess biological exposure. The results justify the need for further investigation.