Systemic sclerosis in an anaesthetist.

INTRODUCTION: Systemic sclerosis is a potentially devastating disease in which the aetiology and pathogenesis has not yet been fully understood. It has been associated with occupational exposure to silica, vinyl chloride, solvents and other chemical agents. CASE SUMMARY: In this paper, we present the case of an anaesthetist who developed scleroderma after an occupational exposure to volatile anaesthetic gases (halothane, sevoflurane, isoflurane and enflurane) in operating theatres with poor scavenging systems and we discuss the possible causal link between occupational exposure and the disease. CONCLUSIONS: The case reported is the second that we are aware of in recent years. Reporting scleroderma cases in workers may be the first step in assessing the causal link between occupational exposure to anaesthetic gases and the disease.

Work-related stress as a cardiovascular risk factor in police officers: a systematic review of evidence.

PURPOSE: Several studies suggest that work-related stress in police officers may be associated with an increased risk of cardiovascular diseases. A systematic review of studies is, however, still lacking. METHOD: According to PRISMA statement, a systematic search of PubMed, ISI Web of Science, Cinahl and PsychInfo electronic databases was undertaken. Studies published in English between 1/1/2000 and 31/12/2016 were included. A studies quality assessment was performed using the Newcastle Ottawa scale (NOS). RESULTS: The preliminary search retrieved 752 records. After selection, 16 studies (total population 17,698) were retrieved. The average quality of studies was low. Exposure to stress in cross-sectional studies was inconstantly associated with hypertension, obesity, dyslipidaemia, and impaired glucose metabolism. In addition, there was a prevalence of positive studies showing an association between stress and cardiovascular disease morbidity. Studies of higher quality, such as longitudinal studies on large sample size, were more supportive of a significant positive association between stress and cardiovascular risk factors. Results were, however, often conflicting and inconsistent with regard to definitions and measurement of stress, features of individual study design, study conduct, and conclusions drawn. CONCLUSIONS: A sound precautionary principle would be to adopt worksite health promotion programs designed to implement stress management strategies in this category of workers.

[Health surveillance of workers in indoor environments. Application of the Italian version of the MM040/IAQ questionnaire]. / Sorveglianza sanitaria dei lavoratori che operano in ambienti confinati. Applicazione della versione italiana del questionario MM040/IAQ.

AIMS: To test the efficacy of the Italian version of a questionnaire used for the health surveillance of workers operating in confined spaces. METHOD: The Italian version of the Swedish MM040/Indoor Air Questionnaire was used to collect information on ailments and symptoms related to the indoor environment of 28 workplaces. 4,029 workers took part in the study. RESULTS: For 23.1% of respondents, the most frequent environmental problem concerned fluctuations in temperature. For 12.7% of respondents, the commonest work-related symptom was fatigue. Women reported indoor air problems and work-related symptoms more often than men. Allergic subjects reported environmental problems and work-related symptoms more often than non-allergic workers. A significant correlation was found between environmental discomfort and the presence of symptoms. CONCLUSIONS: Ailments and work-related symptoms were common in indoor workers, regardless of the presence of collective disorders such as the "sick building syndrome" (SBS). The questionnaire used in this study proved valuable in helping the occupational health physician to monitor the health of indoor workers. The data collected can provide a reference point for the medical surveillance of workers operating in confined spaces.

Personality traits of the Five-Factor Model are associated with work-related stress in special force police officers.

PURPOSE: The police work is particularly stressful. The aim of this work was to clarify whether the personality factors are associated with perceived stress levels or reactivity to environmental stressors in a special body of police. METHODS: The police officers in charge of guaranteeing public order at the L'Aquila G8 meeting were subjected to a control of their levels of work-related stress in anticipation of the event. Personality was assessed by the Italian version of the Five-Factor Model questionnaire, while stress was measured three times (during routine work in January 2009, preparation and imminence of the event, in April and July 2009, respectively) with the demand/control/support model of Karasek and the effort/reward imbalance model of Siegrist. A total of 289 of 294 officers took part in the survey. RESULTS: Some personality traits of the Five-Factor Model were associated with stress levels and stress reactivity. Neuroticism (low emotional stability) showed the strongest associations with job strain (demand/control ratio) (ß = 0.115, p < 0.05) and effort/reward imbalance (ß = 0.270, p < 0.001) and was associated with most of the stress variables. High agreeableness was associated with low effort/reward imbalance (ß = -0.157, p < 0.01). CONCLUSIONS: Personality factors may mitigate or increase the strain induced by environmental stressors.

Association of work-related stress with depression and anxiety in radiologists.

PURPOSE: Since radiologists and radiotherapists can be occupationally exposed to significant psychosocial risk factors, some may find themselves in a state of distress. The aim of this study was to investigate the association of work-related stress with the presence of symptoms of anxiety, depression and psychological malaise and to evaluate the risk of psychic disorder in radiologists suffering from work-related stress. METHODS: A total of 654 radiologists responded to our invitation to complete a questionnaire designed to evaluate work-related stress and associated medical conditions: the General Health Questionnaire and Goldberg's Anxiety and Depression scales. RESULTS: Scores on the anxiety, depression and psychological malaise scales rise with an increase in effort and over-commitment, while control and support exert a protective effect. In radiologists who are aware of an effort/reward imbalance, there is a marked increase in the risk of anxiety [odds ratio (OR) 14.14, 95 % CI 9.15-21.86], depression (OR 7.00, 95 % CI 4.76-10.30) and psychic disorders (OR 3.95, 95 % CI 2.62-9.57). Radiologists who perceive demand as excessive in relation to their power of control also have an increased risk of being anxious (OR 2.98, 95 % CI 2.05-4.31), depressed (OR 1.73, 95 % CI 1.21-2.48) and affected by psychic disorders (OR 2.26, 95 % CI 1.48-3.45) compared to fellow workers who are not in a state of distress. CONCLUSIONS: Outstanding technical progress has been made in the field of radiology which today plays an invaluable role in public health. Now a major effort must also be made to improve the mental wellbeing of radiologists, both in the interests of the workers themselves, and also in those of their patients and the quality of the treatment they have the right to receive.

[Sleep disorders and work: guidelines for health surveillance, risk management and prevention]. / I disturbi del sonno in ambito lavorativo: indirizzi di sorveglianza sanitaria, prevenzione e gestione del rischio.

Sleep disorders and related diseases are becoming increasingly relevant for the health and wellbeing of the general and working populations. Sleep disorders affect all aspects of health, showing a bi-directionality with health conditions and comorbidity with several diseases. Consequently, sleep disorders may have severe negative consequences both for the individual and the enterprise, as well as for society on the whole, in terms of health, productivity and social costs. When considering the disturbances of the sleep/wake cycle, it is important to distinguish between those connected with endogenous biological factors from those related to socio-environmental conditions, including work, and those associated with mental and physical diseases, that are often associated and interact with each other. Many sleep disorders are still underestimated and under-valued in clinical practice and, to a much greater extent, in workers' health surveillance. The present paper is aimed at drawing the attention of the occupational health physician to some key issues, particularly regarding excessive daytime sleepiness, obstructive sleep apnea syndrome and shift and night work, as well as their implications in terms of health and occupational consequences. Information on the main aspects of clinical diagnosis and health surveillance, as well as risk management and prevention at the workplace, are provided.

Inadequate access to diagnostic resources: a case of unrecognised hypersensitivity pneumonitis.

OBJECTIVE: Hypersensitivity pneumonitis (HP) often goes unrecognized because of its relatively low incidence in the general population and it is frequently misdiagnosed as a respiratory infection or idiopathic interstitial lung disease. METHODS: Through the analysis of a paradigmatic case of hypersensitivity pneumonitis, in which only symptomatic diagnosis and treatment were proposed, we argue that limiting the clinical process to generic diagnosis, without detection of the etiologic agent, makes it impossible to avoid exposure, hinders compensation and severely worsens the evolution of the disease. RESULTS: In 1981, a previously healthy, 28-year-old female clerk developed respiratory symptoms. She was diagnosed as suffering from extrinsic bronchial asthma and was treated with steroids and broncho-dilators. Neither immunologic tests nor any environmental pathogen research were proposed until 2008, when precipitins analysis showed positivity to Thermoactynomyces vulgaris, which had presumably contaminated the centralized air-conditioning system. CONCLUSIONS: The diagnosis of HP is unlikely to be missed if in all clinical settings, occupational or environmental causes are routinely considered in the differential diagnosis of any patient with a respiratory problem. This approach could provide a better clinical management of the disease and more effective programmes of primary prevention. Implicit rationing of healthcare resources by limiting diagnostic tests that are not readily accessible reduces patient autonomy and the benefits of medical care.

Malpractice claims in interventional radiology: frequency, characteristics and protective measures.

PURPOSE: The use of interventional radiology procedures has considerably increased in recent years, as has the number of related medicolegal litigations. This study aimed to highlight the problems underlying malpractice claims in interventional radiology and to assess the importance of the informed consent process. MATERIALS AND METHODS: The authors examined all insurance claims relating to presumed errors in interventional radiology filed by radiologists over a period of 14 years after isolating them from the insurance database of all radiologists registered with the Italian Society of Medical Radiology (SIRM) between 1 January1993 and 31 December 2006. RESULTS: In the period considered, 98 malpractice claims were filed against radiologists who had performed interventional radiology procedures. In 21 cases (21.4%), the event had caused the patient's death. In >80% of cases, the event occurred in a public facility. The risk of a malpractice claim for a radiologist practising interventional procedures is 47 per 1,000, which corresponds to one malpractice claim for each 231 years of activity. DISCUSSION: Interventional radiology, a discipline with a biological risk profile similar to that of surgery, exposes practitioners to a high risk of medicolegal litigation both because of problems intrinsic to the techniques used and because of the need to operate on severely ill patients with compromised clinical status. CONCLUSIONS: Litigation prevention largely depends on both reducing the rate of medical error and providing the patient with correct and coherent information. Adopting good radiological practices, scrupulous review of procedures and efficiency of the instruments used and audit of organisational and management processes are all factors that can help reduce the likelihood of error. Improving communication techniques while safeguarding the patient's right to autonomy also implies adopting clear and rigorous processes for obtaining the patient's informed consent to the medical procedure.

Validation of the Italian version of the HSE Indicator Tool.

BACKGROUND: An Italian version of the Health & Safety Executive's (HSE) Management Standards Revised Indicator Tool (MS-RIT) has been used to monitor the working conditions that may lead to stress. AIMS: To initially examine the factor structure of the Italian version of the MS-RIT, in comparison with the original UK tool, and to investigate its validity and reliability; second, to study the association between occupational stress and psychological distress. METHODS: Workers from 17 companies self-completed the MS-RIT and the General Health Questionnaire used to measure the psychological distress while they waited for their periodic examination at the workplace. Factor analysis was employed to ascertain whether the Italian version maintained the original subdivision into seven scales. Odds ratios were calculated to estimate the risk of impairment associated with exposure to stress at the workplace. RESULTS: In total, 748 workers participated; the response rate was 91%. The factor structure of the Italian MS-RIT corresponded partially to the original UK version. The 'demand', 'control', 'role', ' relationship' and 'colleague-support' scales were equivalent to the UK ones. A principal factor, termed ' elasticity', incorporated the UK 'management-support' and 'change' scales. Reliability analysis of the sub-scales revealed Cronbach's alpha values ranging from 0.75 to 0.86. CONCLUSIONS: Our findings confirmed the usefulness of the Italian version of the HSE MS-RIT in stress control.

Violence against radiologists. I: Prevalence and preventive measures.

PURPOSE: Violence in the workplace is a specific risk for healthcare workers. Radiologists, especially when involved in emergency services, share that risk. Very few studies in the literature have researched this topic. This study aimed to evaluate the prevalence of violent behaviour in a large sample of Italian radiologists and analyse the phenomenon and its consequences with a view to proposing preventive measures. MATERIALS AND METHODS: A total of 992 radiologists (61.5% men) taking part in a national radiology congress agreed to respond to a questionnaire on violence that contained the Violent Incident Form by Arnetz for the description of violent incidents in healthcare practice. RESULTS: Some 6.8% of radiologists in public hospitals experienced physical abuse in the previous 12 months, for the most part from patients or their companions. The prevalence of physical abuse is greatest among younger healthcare individuals with less clinical experience, with no differences between sexes. Among younger radiologists, one in five suffered at least one act of physical abuse in a working year. Nonphysical violence is more widespread and throughout radiologists' working lives affects 65.2% of them. In this case, almost half of the violent incidents originate from colleagues. A total of 5.5% of respondents stated that they were victims of abuse at the time of the survey. In most cases, the violent incidents remain unreported. The immediate consequences of violence in the workplace are emotions such as anger, disappointment, humiliation, anxiety, fear, distress, a feeling of helplessness and isolation, occasionally a feeling of guilt or of having done wrong and a desire to take revenge, change behaviour or change workplace. CONCLUSIONS: The extent of the problem calls for the adoption of a series of measures aimed at eliminating the causes of the various forms of workplace violence.

Violence against radiologists. II: Psychosocial factors.

PURPOSE: Violence against radiologists is a growing problem. This study evaluated the psychosocial factors associated with this phenomenon. MATERIALS AND METHODS: A questionnaire was administered to 992 Italian radiologists. RESULTS: Physical violence experienced in the previous 12-month period was associated with the radiologist's poor mental health [odds ratio (OR) 1.11] and overcommitment to work (OR 1.06), whereas radiologists in good physical health (OR 0.64), with job satisfaction (OR 0.96) and with overall happiness (OR 0.67) were less exposed. Nonphysical abuse was equally associated with the radiologist's poor mental health (OR 1.10) and overcommitment (OR 1.14) and negatively associated with physical health (OR 0.54), job satisfaction (OR 0.96), happiness (OR 0.81), organisational justice (OR 0.94) and social support (OR 0.80). CONCLUSIONS: Preventive intervention against violence in the workplace should improve workplace organisation and relationships between workers.

Police job strain during routine activities and a major event.

BACKGROUND: Special police forces are exposed to periods of intense work stress in ensuring public order. AIMS: To explore the relationship between the work context (routine work or special event) of special force policemen and psychological measures of job strain (demand-control) and effort-reward imbalance. METHODS: All policemen assigned to the G8 meeting in L'Aquila, Italy, in July 2009 were invited to complete a questionnaire while engaged in routine work in January 2009 (Time A) and in June 2009 (Time B), while preparing for the special event. RESULTS: Participation rate in the questionnaire study was 292/294 (99%) members of the special police force. Measures of job strain (-0.39, P < 0.001) and effort-reward imbalance (-0.37, P < 0.001) decreased significantly from Time A to Time B. On average, demand decreased from 14.2 ± 1.9 to 12.6 ± 2.7 (P < 0.001), control increased from 11.8 ± 2.5 to 14.4 ± 3.4 (P < 0.001) and social support increased from 17.8 ± 2.9 to 19.0 ± 3.1 (P < 0.001). At the same time, effort decreased from 17.4 ± 3.2 to 11.8 ± 3.8 (P < 0.001), reward grew from 37.6 ± 5.5 to 45.5 ± 7.4 (P < 0.001) and overcommitment dropped from 7.1 ± 2.1 to 6.6 ± 1.7 (P < 0.001). CONCLUSIONS: In special police forces, routine work may be significantly more stressful than a single critical event.

Environmental discomfort and musculoskeletal disorders.

BACKGROUND: Musculoskeletal disorders (MSDs) are the most common occupational disease in Europe, with high prevalence among hospital workers. Both environmental and psychosocial work factors may impact significantly on the development and exacerbation of MSDs. AIMS: To evaluate whether environmental factors at work are associated with MSDs in hospital workers and to investigate potential interactions between environmental and psychosocial risk factors in the workplace that are associated with MSDs. METHODS: A cross-sectional investigation was performed using the Nordic questionnaire to assess MSDs, the IAQ/MM-040 indoor air questionnaire for environmental factors, the demand-control model for job strain and the Goldberg questionnaire for anxiety and depression. The association between environmental factors and MSDs was studied using logistic regression analysis. In addition, the interactions of environmental factors with strain, anxiety and depression for MSDs were examined. RESULTS: Environmental complaints were associated with MSDs. The strongest associations were found between temperature complaints (OR 2.73), noise and light complaints (OR 2.22), other environmental complaints (OR 3.12) and upper limb disorders. A significant interaction between temperature complaints and strain for upper limb disorders (F = 9.52, P < 0.05) was found. CONCLUSIONS: To prevent MSDs, a multi-level approach is needed, including environmental measures and interventions directed to both psychosocial and organizational factors.

[The coping and support activities in the phenomenon of mass immigration in Italy: evaluation of work-related stress in police forces]. / L'attività di accoglienza e sostegno nel fenomeno di immigrazione di massa in Italia: valutazione dello stress lavoro-correlato nelle Forze di Polizia.

UNLABELLED: The recent emergence of new democracies in North Africa results in a massive wave of immigration in Europe with thousands landing in recent months on the coast of southern Italy. This phenomenon has caused major problems of public order (PO), worsened by the presence of ever-increasing numbers of immigrants and multiculturalism, exposing the Special Forces of the Italian State Police in periods of intense work-related stress. AIMS: To explore the relationship between work context (OP routine i.e. mass migration control vs. OP extraordinary i.e. the G8 summit) of special force policemen and psychological measures of job strain (demand-control, JCQ and effort-reward imbalance, ERI) related to objective measure (sickness absences). CONCLUSIONS: data showed that in special police forces routine work as migration control is significantly more stressful than a single special event that presents a very high risk for law enforcement, probably due to positive changes in psychosocial work environment among special police force.