[Sick leave risk factors in a sample of women employed in the public sector. The SEMM study]. / Determinanti delle assenze per malattia in un campione di donne dipendenti di ente pubblico. Lo studio SEMM.

OMS reports describe an increase of levels of sickness leaves (SL) at work in all industrialized countries in last decades. Aims of this study are to assess incidence of SL from work in a sample of women public employees and to identify significant factors, among individual, behavioural, familiar, occupational and work strain related. The survey took place between April 1992 and December 1998. After the baseline examination, a two years follow-up was conducted, to detect any SL longer than one day. N. 8123 female employees of the Municipality of Milan were enrolled, undergoing a baseline health examination. They belong to the following municipality sectors (SM): kindergarten, register office, clerks and police. The overall response rate was 76% (3698 females and 2448 males). The present analysis was restricted to female only, who showed almost double incidence of SL than men. Interpolation of logistic models allowed to identify the following predictive independent factors: physical activity in leisure time, work length and social support at work, for incidence of short SL; physical activity at work, hypertension and smoking habit for intermediate SL; and perceived work strain and number of familiar contacts for long SL.

["The Italian decree 195/2006 on the protection of workers against risks arising from noise"]. / Direttiva Rumore.

The Italian decree 195/2006 incorporates the European Directive 2003/10/CE on the minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents (noise). It is rather different to previous decree 277/1991, particularly as regard of the new exposure limit value and the elimination of annex VI and VII. We discus here only two aspects that we consider relevant and quite critical: 1) The calculation of the exposure limit values as noise equivalent level: it is a method that underestimates the potential damage of impulsive noise, so the risk evaluation remains quite inaccurate. 2) To take account of the attenuation provided by the individual hearing protectors worn by the worker in determining the worker's effective exposure when applying the exposure limit values: this must not apply to the obligations of employer to control the risk at source avoiding or reducing exposure to the minimum. Furthermore the attenuation power of individual hearing protectors is difficult to measure because his variability during the time and among different subjects. Then we evaluate and discus the new duties of Occupational Physician in this matter. The daily exposure limit values and action values are in fact in part modified as well as the methodology for organize the programs of prevention, health surveillance, information and formation of workers. As support for his activity we proposed the guidelines that The Italian Society of Occupational Health and Industrial Hygiene (SIMLII) has published in 2003, which provides recommendations for the health surveillance for the prevention of noise induced hearing loss at the workplace.

[Research and formal demonstration of evidence of efficiency in occupational medicine]. / Ricerca e dimostrazione formale delle prove di efficacia in medicina del lavoro.

There is an increasing pressure on occupational health professionals to ensure that their practice is based on a quality standard and an evidence of appropriateness. The efficacy-effectiveness of their activity strictly depends on their intellectual and professional integrity, their technical and legal competence, but also on the quality of the relations with the company organisation they are able to establish. We asked to some occupational physician when they considered their interventions in the workplace to be efficacious. Then, accordingto our epexrience, we propose some effectiveness indicators, particular concerning health surveillance and health educttaon, that should be evaluated to verify the health professional agccvity agreement to quality standards.

[Reliability of the Karasek scale in the assessment of perceived occupational stress and gender-related differences in scores. The SEMM study]. / Affidabilità della scala di Karasek per la valutazione dello stress lavorativo percepito e differenze dei punteggi tra sessi. Lo studio SEMM.

In recent years more attention has been paid to the relationship between work organization and job stress and chronic-degenerative diseases. Aims of this report are the assessment of the reliability and internal consistency of the Karasek's Job Content Questionnaire-JCQ and to assess age-specific distributions of core JCQ scores between the gender groups. The study has been carried out in a large group of employees (n. 7871 subjects, 5270 women and 2601 men) of the Municipality of Milano in the years between 1992 and 1996. Decision Latitude (DL), Psychological Job Demand (PJD) and Social Support at Work (SSW) scores were calculated. Reliability of the JCQ was satisfactory, with Cronback's alpha suitable values for DL and SSW and acceptable for PJD. From the distribution of gender- and age-specific mean scores, women show reduced probabilities of developing a favorable career and of perceiving satisfactorily the support from colleagues and supervisors than men when they get older. This results suggest that the Karasek's JCQ is an effective toll to describe perceived job stress conditions in this Italian work setting.

[The assessment of the coronary risk in a work setting. The results of the SEMM study and the outlook for prevention in Italy. Surveillance of Employees Municipality of Milan]. / Valutazione del rischio coronarico in collettività lavorative. Risultati dello studio SEMM (Surveillance of Employees Municipality of Milan) e prospettive di prevenzione in Italia.

BACKGROUND: The goals of the present report are to assess the differences in distribution of traditional coronary risk factors in a work setting, aimed at identifying specific groups at risk and to compare mean values of such risk factors and of an overall risk score of the entire working sample with the results observed in the third WHO-MONICA population survey carried out in northern Italy (Area Brianza). METHODS: In the SEMM study 7872 employees (2601 men and 5271 women) were enrolled between 1992 and 1996. The third MONICA survey in Brianza was carried out on an age- and gender-stratified random sample of 831 men and 884 women in 1993-1994, selected from the 25-64-year-old residents of five municipalities, representative of the study population. In both studies coronary risk factors were measured according to the MONICA protocol, adopting standardized methods. RESULTS: In comparison with the MONICA population sample, the entire working group showed lower mean levels of blood pressure and total cholesterol, higher prevalence of current cigarette smokers and lower mean levels of HDL cholesterol, in both gender groups. Prevalence of overweight subjects was higher among men in the working group, but the opposite pattern was detected in women. The overall risk score, calculated using the coefficients of a proportional hazard survival equation estimated in a large collaborative Italian follow-up study, resulted lower in the working sample, in both gender groups. This result may be attributed to a selection bias known in occupational epidemiology as "healthy worker effect". In contrast to this finding, the prevalence of smokers, in particular among women, was higher in the employed sample, indicating that working stress conditions may play some role. CONCLUSIONS: In order to extend the assessment of cardiovascular risk factors as well as prevention activities in work settings, some advantages are highlighted: the high participation rates, the feasibility to adopt standardized protocols, and easier and cheap procedures for censoring in follow-up studies. Moreover, due to the recently adopted legislation in Italy which increases the number of working categories to be included in periodic clinical examinations, prevention activities in work settings to contrast the epidemic of widespread chronic diseases, like cardiovascular diseases, are encouraged. This will also allow for the investigation of individual variations over time of coronary risk factors.

[Auditory thresholds in young Italians from 18-19 years of age]. / La soglia uditiva in giovani italiani di 18-19 anni.

The aim of the study was to assess the state of hearing levels in young Italian subjects via an epidemiological study, and also, by means of a questionnaire, to assess the attitude of young people to music, how they listen to music and how they perceive the risk of noise-induced hearing damage. The sample studied consisted of 391 youths undergoing their first medical examination for military service. The hearing threshold was assessed by means of a semiclinical tonal audiometry with sound-proof earphones calibrated to ISO Standard 389 following the method of ISO Standard 6189. At the end of the study 315 youths were judged eligible for the study, 81% of whom lived in the city of Milan. 63% said they went to a discotheque 1-4 times a week and 3% said they listened to music with earphones at maximum volume. These conditions are considered to be potentially dangerous for hearing since among youths leaving discotheques disorders have been observed that are indicative of hearing fatigue: lowering of the hearing level 7%, buzzing in the ears 37%, sense of muffled sound 12%. In the group studied, environmental noise was a factor of disturbance for sleep (13%), for study and reading (43%), listening to the radio, to music and watching TV (29%). Only 7 youths said their hearing was "not normal", but the thresholds were all higher than audiometric zero, which are clearly worse than the values observed in similar studies reported in the literature. This study reports the mean values, SD, minimum and maximum and centile values of the distribution of hearing thresholds, separately for right and left ears. A comparison was made between the hearing in the group least exposed: a significant difference was observed only for the right ear while for the left ear there was only a tendency. The authors conclude that hearing in young people to-day is worse than in the past, whatever be the causes, and that due account should be taken of this state of affairs, by encouraging prevention programmes for noise-induce hearing loss at all levels and on every possible occasion.

[Validation of the Italian version of the Kjellberg and Iwanowski's Mood Scale]. / Validazione della versione Italiana della Mood Scale di Kjellberg & Iwanowski.

Two questionnaires were administered to evaluate stress risk factors in 1652 employees of the Milan Town Council (772 Social Service personnel and 880 administrative staff). The study was focused on cardiovascular diseases. The Mopsy questionnaire is a selection of scales selected by the World Health Organization for international multicenter studies on cardiovascular morbidity, while the Mood Scale of Kjellberg & Iwanowski (1989) is a brief scale translated from Swedish used to measure "actual" stress and arousal state in neurotoxicology. The aim of the present study was to validate the Italian version of the Mood Scale for its possible use in health surveillance and research on stress and arousal changes at work. Appropriate statistical data analyses were applied to study the construct validity (factor analysis), concurrent validity (correlations with the Mopsy scale) and internal consistency (Cronbach alpha). The data confirm the Swedish results on the Mood Scale factor analysis. A good face and construct validity and a good internal consistency were observed. Nevertheless, the Mood Scale does not allow collection of demographic, anamnestic and personal data as does the Mopsy questionnaire.

[Hearing loss in workers in the ceramics industry: a profile of the damage assessed by a longitudinal study]. / Perdita uditiva dei lavoratori del comparto ceramica: profilo di danno valutato mediante studio longitudinale.

Over the period 1980-1990, 2024 workers in ceramic plants in the Emilia-Romagna region, Italy were evaluated for exposure to noise and hearing loss. Data collected by the National Health Service Local of Occupational and Preventive Medicine Units were used. In a relatively young population (34.8 years mean age, 8.98 years s.d.) exposed for not too long to > 90 dBA noise levels (87.2 for less than 4 years) a statistically significant effect of exposure was found only on the audiometric frequency of 6 kHz (95% confidence interval for mean hearing loss for 1 year exposure to > 90 dBA: 0.05-0.72 dB). An initial isolated loss at the audiometric frequency of 6 kHz was found to be significantly associated with (was a prognostic indicator of) a subsequent impairment at 4 kHz.

[The determination of the criteria for selecting and using personal means of acoustic protection]. / Determinazione dei criteri per la scelta e la utilizzazione dei mezzi personali di protezione acustica.

The most frequent occupational disease in Italy is noise-induced hearing loss. Not only is this disease invalidating and irreversible, it also involves extremely high direct and indirect costs for both the injured worker and the employer. Appropriate preventive measures are therefore essential and include personal protection devices. Recent Italian legislation (DL 277 15/8/91) assigns an important role to personal acoustic protection devices, raising, in certain situations, serious problems in terms of fitness for specific jobs. On the basis of an analysis of the characteristics of the various types of hearing protection aids, including efficacy, capacity of attenuation, influence on intelligibility of speech and perception of danger signals, guidelines are supplied for their best possible use.

[An integrated course in occupational medicine. A proposed teaching program based on the new organization of the degree course in medicine and surgery]. / Corso integrato di Medicina del Lavoro. Proposta di programma didattico secondo il nuovo ordinamento del corso di laurea in Medicina e Chirurgia.

The curriculum of Italian Medical School of the Faculty of Medicine has been recently renewed at a national level. Considering the numerous innovations introduced, a new role has been attributed to the teaching of occupational health, particularly occupational medicine. Occupational Medicine is usually regarded as a part of community medicine and, despite the fact that occupational disease may be in decline in industrially developed countries, the increasing concern regarding environmental pollution related health effects, stress the relevance of the methodologies already formulated within the occupational health disciplines. Of all environmental factors, occupational medicine has contributed largely to the knowledge about the health effects of occupation and its role in the complex problem at work related to today's medical students as a way of introducing the appreciation of worldwide environmental effects and how to measure, monitor and modify them. In this article the content of the occupational health course is revised and according to the principles of modern medical pedagogy, the teaching is divided in primary and secondary objectives and organized to the resolution of real problems. The importance of the relevant evidences of clinical occupational medicine is discussed and their insertion into other clinical disciplines is proposed. The knowledge of distribution, recognition, management and prevention of the major occupational diseases is a final target of the teaching. The introduction of innovative teaching methods such as factory visits, case history discussion or role playing exercises is suggested as an integrated, multidisciplinary approach able to promote the preventive attitude of students. The efficacy of the teaching has to be evaluated with appropriate methods every time, to verify both informative and formative aspects.

A clinical, neurophysiological and behavioral study of female workers exposed to 1,1,1-trichloroethane.

Twenty-two female subjects working in a factory in which 1,1,1-trichloroethane was the only solvent used were investigated by means of clinical, neurophysiological and psychometric methods so that the neurotoxicity of the solvent could be evaluated. On the basis of the ambient air concentrations of 1,1,1-trichloroethane ranging from 110 to 990 ppm, the workers were divided into three risk groups and compared with a reference group. No significant difference was observed between the exposed and unexposed females with respect to clinical features, maximal motor conduction velocity, conduction velocity of slow fibers, and psychometric data. The most frequent complaints of the workers were of the "neurotic" type with a slightly higher, but not significant, difference in the exposed group. The results obtained favor the absence of a manifest neurotoxic effect of 1,1,1-trichloroethane under the specific work conditions of the investigation; generally unfavorable work conditions seem to have played a prominent role in the genesis of the neurotic complaints. The importance of a global methodological approach in the study of work-related risks, particularly in neurological and psychological surveys, is stressed.