[Manual material handling risk assessment and ergonomic improvement in foodstuff retailing company]. / Valutazione del rischio nella movimentazione manuale di carichi e interventi ergonomici correttivi in un'azienda di distribuzione di generi alimentari.

The aim of this study is to assess and reduce the risk due to manual material handling in a company involved in the foodstuff retailing. The risk assessment was performed by NIOSH Variable Lifing Index in 13 different occupational conditions. As result the risk was present in any case, with VLI values ranging from 2.12 to 2.81. A good risk reduction has been accomplished correcting properly the most important multiplier involved in the computation of the revised NIOSH Lifting equation (lifting frequency and weight of heavier products). Even if the performed risk reduction has been significant, the residual risk is still higher than the level of acceptability.

[Evaluating patients manual handling hazards in nursing personnel of a hospital]. / Patologie muscolo-scheletriche in operatori addetti alla movimentazione di pazienti in istituto di riposo per anziani.

Low back pain (LBP) and shoulder and arm disorders are common among workers exposed to risk due to manual weight lifting, and this health care problem is also very costly. We also know that nursing personnel exposed to manual patient handling activity report high number of work-related musculoskeletal disorders. The objective of our study was to evaluate the relationships between work and musculoskeletal disorders in personnel exposed to manual patient handling activity. 160 health care workers of an hospice exposed to patient handling were compared to a control group of 172 people not exposed to the handling risk. In our study we considered only subject with pathology already diagnosed, withdrawing people with disturbs but without clinical trials. The statistical evaluation using the chi2 test has not shown any meaning in the comparison between the two groups, we have calculated the Odds Ratio risk for discal hernia and protrusion finding a risk between low and modest (1.52). We think that the least prevalence of musculoskeletal disorders to the back in the group exposed to manual patient handling activity, could be explained partly with the "healthy worker" effect and partly with the workplace improvement. That is demonstrated also with the M.A.P.O. index scoring between 0 and 1.5 (negligible risk).

Hepatitis B vaccination awareness and biological risk.

BACKGROUND: Hepatitis B virus is a possible risk in persons exposed to biological risk at work. Vaccination is the only prevention against infection. OBJECTIVES: A population of 1,408 employees of the University of Padua was investigated to define the immunological status for HBV and degree of awareness to hepatitis B vaccination. METHODS: The subjects were subdivided according to sex, age (< or = 40 or > 40 years old), level of education (college graduates or lower), and the extent of biological risk (no risk, low or high risk). Clinical history questionnaires were used and measurement of hepatitis B markers was carried out. RESULTS: The results showed that only 30.5% of the subjects had been vaccinated; among these, 90.2% showed a measurable level of anti-HBs antibodies, 8.2% showed anti-HBs antibodies lower than 10 IU/L, and 1.6% showed positive markers of previous infection. However, among non-vaccinated subjects 13.4% were positive for previous infection; in all subjects, prevalence of hepatitis B virus infection was 9.8%. The awareness to hepatitis B vaccination was altogether very low (30.5%), but females (44.2%), subjects less than 40 years of age (43.5%), college graduates (34.1%), and high risk exposed personnel (57.7%) were more likely to comply compared to male subjects (odds ratio 2.53), subjects more than 40 years of age (odds ratio 3.57), non-college graduates (odds ratio 1.65), or low risk exposed (odds ratio 13.42). CONCLUSIONS: The variables considered appeared to influence awareness to vaccination. Owing to low awareness, an information campaign was started and 90% of the invited subjects were immunized.

Risk of hepatitis C virus infection in a population exposed to biological materials.

BACKGROUND: Hepatitis C virus is an important cause of acute and chronic hepatitis and it is an agent parenterally transmitted. Workers handling biological materials may be exposed to high concentration of virus-infected fluids. METHODS: The seroprevalence of hepatitis C virus antibodies was investigated in a population of 809 subjects exposed to varying levels of biological risk owing to the handling of human fluids or tissues and in 408 controls. The exposed group was subdivided in three subgroups according to low and occasional (262), intermediate but continuous (311), and high (236) exposure to biological materials. RESULTS: The seroprevalence of hepatitis C antibodies was low (1.40%) in all subjects. The risk groups showed no significant differences with respect to the control group; the most exposed group showed a seroprevalence of 1.27%. Age but not sex appeared significantly correlated with seroprevalence of positive antibodies (chi 2 = 5.949, P < 0.025). Aspartate aminotransferase and alanine aminotransferase showed a highly significant increase (P < 0.01 and P < 0.001, respectively) in subjects with positive hepatitis C antibodies, other than a high significant prevalence of values above the normal limit (chi 2 = 26.613, P < 0.001 and chi 2 = 39.164, P < 0.001, respectively). Among 17 positive hepatitis C virus subjects, 8 (47.1%) were positive for hepatitis B virus, but not for its antigen. CONCLUSIONS: Hepatitis C virus infection appears to be a low risk for people employed in the biomedical field, yet infection is associated with a significant liver involvement.

Seroprevalence of hepatitis A markers in subjects exposed to biological risk.

OBJECTIVES: The seroprevalence of hepatitis A virus antibodies was investigated in a population of 1051 subjects, of whom 376 were controls and 675 were exposed to different degrees of biological risk. METHODS: The exposed group was subdivided into subjects at low (242), intermediate (265), and high (168) biological hazard; all subjects were employed in the biomedical field. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were also determined. RESULTS: The seroprevalence of positive hepatitis A antibodies was 44.9% in all subjects but was significantly higher in males (50.6%) than in females (34.2%) and increased according to age (25.9% in subjects aged < or =40 years and 62.2% in subjects aged >40 years). No difference related to exposure to the biological risk was observed. The prevalence of transaminases at levels above normal values (chi2 = 4.079, P<0.05 for AST and chi2 = 4.806, P<0.05 for ALT) and mean values (AST P<0.05; ALT P<0.001) appeared significant in hepatitis A virus-positive subjects. On the other hand, excluding individuals with positive hepatitis C virus antibodies (16) and positive hepatitis B virus surface antigen (12), a prevalence of transaminase alterations was not observed, but mean levels of ALT lasted significantly longer in subjects with positive hepatitis A virus antibodies (P<0.01). CONCLUSIONS: The results confirm that hepatitis A virus is not a risk for employees in the biomedical field, but the presence of hepatitis A virus antibodies suggests a possible, though not clinically evident, liver involvement.

[Reduction of the lung cancer risk among dairy ranchers: dose response relationship with the traditional indicators of professional exposure]. / Riduzione del rischio di cancro polmonare negli allevatori di bovini da latte: relazione dose-risposta con i tradizionali indicatori di esposizione professionale.

An epidemiological study of mortality was carried out in the Province of Padua in a cohort of family farmers. The subjects, identified from the SCAU files, were enrolled in the cohort if informations were available on complete registry data, date of beginning and of termination of farm work, size of farm, and number of dairy cattle. The 2,415 farmers selected were followed-up for mortality through the registry offices of their Communes of residence. The cause of death was obtained for the 541 decedents. The standardised mortality ratio (SMR) was the ratio between observed and expected mortality, calculated on the basis of the mortality rates in the regional general population. The lung cancer SMR was 0.54 (0.36-0.79; observed = 27) among the 1641 dairy farmers, and 0.78 (0.46-1.25; observed = 17) among the 774 arable farmers. Among dairy farmers, moreover, lung cancer SMRs showed a significant trend across the quartiles of length of work, number of cattle, area of farm, age at beginning farm work, and age at work termination. Dairy farmers are known to be exposed to higher airborne endotoxin concentrations, and it is reasonable to assume that this cumulative exposure further increases with years of work, number of cattle, and area of farm. Microbial endotoxin might have protected dairy farmers against lung cancer through a host factor, the Tumor Necrosis Factor, produced by alveolar macrophages.

Asthma due to isocyanates: a mail survey in a 1% sample of furniture workers in the Veneto region, Italy.

To ascertain the prevalence and risk factors in isocyanate asthma, we made a mail survey in a sample of workers in the wooden furniture industry, which uses large quantities of isocyanate-paints. Firms making up the initial sample, chosen from a register in the Veneto region, were asked to cooperate in the study. The study population, selected from the respondent firms, consisted of 1,430 subjects (about 2% of the parent population). Each subject received a self-administered questionnaire on respiratory symptoms and occupational history; this was mailed to his/her workplace. Completed questionnaires were returned by 730 subjects, who made up 51% of the population under examination (about 1% of the parent population). Fifteen subjects had suffered their first attack of asthma while in their present job: of these 7 were among the 121 who used paints (5.8% prevalence), and 8 were among the 609 who had no exposure (1.4% prevalence). The risk of asthma in the former group was therefore almost 5 times the risk in the latter. This result, however, is probably an underestimation because of the cross-sectional design of our study; at the time of study many asthmatics had already left their factory. There was a dose-response relationship between asthma and the length of exposure to isocyanates, the prevalence increasing from 2.2% in subjects with less than 20 years to 27.3% in workers with over 20 years' exposure. Lower prevalence of isocyanate asthma was found in the larger firms, where airborne exposure to isocyanate was believed to be lower. The continuous mode of exposure increased the risk of developing symptoms of asthma rather than intermittent acute exposure to high concentrations of isocyanates. Among painters, the prevalence of asthma ranged from 7.1% in non-smokers to 2.9% in smokers. As smoking appears to increase IgE production, a nonallergic mechanism may underlie isocyanate-induced occupational asthma.

[Mortality by tumors and other causes in dairy cattle and other agricultural workers in Veneto]. / Mortalità per tumori ed altre cause in allevatori di bovini da latte e in altri agricoltori nel Veneto.

The study was conducted to verify a reduction in mortality from tumors in dairy farm workers, exposed to endotoxins, which increase in the host a cytotoxic antitumoral. From the SCAU files of the Province of Padova, we selected 2.415 subjects with informations on: date of hire, date of work termination, number of dairy cattle, area of the farm. The vital status was ascertained through the Communes of residence, and for the 541 decedents the cause of death was established. The standardized mortality ratio (SMR) was calculated on the basis of age-sex-cause-calendar period specific mortality rates in the Veneto. In the 1.641 dairy farm workers, SMRs were significantly low for total tumors (= 81) and lung tumors (= 66), and significantly high for brain tumors (= 283). In other 774 farmers, no significant SMRs were observed. The data will be further processed to verify a dose-response relationship with the occupational risk indicators. Smoking habits will be collected.

Psychosocial outcome one year after heart surgery. A prospective study.

Ninety-nine of 118 patients receiving cardiac valve replacements (n = 55) or coronary artery bypass grafts (n = 44) were studied before surgery and again one year after surgery. Psychological, social, and physical variables were assessed. For the 19 subjects not returning for follow-up, medical data collected by their general practitioner were available. The physical results of surgery were good, with over 90% of the patients showing improvement. Mean scores for psychological distress and quality of life improved; however, a bad psychosocial adjustment was present in about 25% of patients at follow-up. Bad psychosocial adjustment was not correlated with surgical results. The preoperative variables most predictive of poor psychosocial outcome were high scores in the general hypochondriasis and irritability subscales of the illness Behaviour Questionnaire, bad psychological adjustment characterized by high anxiety, depression, and global scores on the Symptom Distress Checklist, and ischemic rather than valvular heart disease.

[Using a structural alternative (non-medical) in the "capillary" screening of arterial hypertension in a community. Means of intervention and evaluation in preventive cardiology]. / Utilizzazione di strutture alternative (non sanitarie) per uno screening "capillare" dell'ipertensione arteriosa nel territorio. Un mezzo di intervento e valutazione in cardiologia preventiva.

A "Community Control Programme of Hypertension" has been implemented in a Northern Italian population as part of an international co-operative pilot project promoted by World Health Organization. The programme was planned to last five years. Three years after the start we performed what we called a "capillary" screening in the community involved in the project. In fact a team of physicians and medical students moved about in the villages of the area where extemporary ambulances were set up with the aim of identifying new hypertensives, evaluating the state of the control of hypertension as compared with the situation at the outset of the study and, more generally, as a means of strengthening the ties between the project organization and the community. In doing so we also evaluated the feasibility of an alternative approach, based upon the cooperation with an organization outside the health service system, namely the Catholic Church, to achieve the set aims in a very religious population as ours. The parish priests of the villages did eagerly cooperate with our work both in the form of propaganda and in making available the parish buildings in which the ambulances were set up. We examined 1306 subjects (47.3% males), of whom 39.5% were hypertensives ("casual" blood pressure at or above 160 or 95 or treated). Of all the hypertensives, 28.6% were new hypertensives ("unaware"), 45.3% were being treated and 13.7% had a blood pressure lower than 160/95 mmHg while under treatment "effectively treated"); 16%, though, had blood pressure values at or above 200 or 120 mmHg. The state of control of hypertension was better in women and with increasing age. As compared with the findings at the outset of the study, 27,6% more "aware", 23.9% more treated and 9.6% more "effectively treated" hypertensives were found. Using the support of an alternative (non-medical) organization in a programme of preventive medicine in the community has proved to be, in our experience, a feasible, valuable and very cheap approach.

[Epidemiologic findings in esophageal cancer in the Veneto region]. / Rilievi epidemiologici sul cancro esofageo nella Regione Veneto.

The results of an epidemiological study using the case-control method on 150 oesophageal cancer cases, observed at the IIIrd Surgical Department in Padua and on 150 controls are presented. The results show that alcohol an maize flour (corn meal) are two aetiopathogenetic factors of verified statistical significance in oesophageal carcinoma in the Veneto population. This confirms other studies among populations with a high risk of oesophageal cancer.

[Relationships between clinico-therapeutic parameters and immunological status in patients with lung cancer]. / Rapporti tra parametri clinico-terapeutici e stato immunitario nel paziente portatore di cancro del polmone. Analisi di 150 casi.

150 patients with lung cancer have been studied from the immunological point of view: the two years that elapsed between the study and processing of the data permitted an evaluation of the prognosis in terms of immunology also. This study has been carried out in vivo by means of skin tests (BCG, PPD, Candida, Varidase, CCB, Mumps, BNCB) and in vitro with lymphocyte blastization in the presence of PHA and dependent antibody cytotoxicity. Serum factors which can interfere with lymphocyte cytotoxicity have also been studied. Peri- and intra-tumour lymphocyte infiltration and the lymph node activation stage have been analyzed in patients who underwent surgery. A real depression of the cell mediated immunity observed in the negative response to skin tests has been found. The study of in vitro parameters showed a deficient blast response in 86% of the cases examined, decreased cytotoxicity in 62% and the presence of inhibiting serum factors in 53%. No correlation was observed between positivity to skin tests, normal response to PHA, normal concentration of inhibiting serum factors on the one hand and survival on the other. The only finding which seems to be correlated with survival is lymphocyte infiltration; its peri- and intrastromal presence on the neoplasia may be associated with a significantly better prognosis.