[Quality oriented education: the experience of the Prevention Department of the Empoli Local Health Company n 11]. / La formazione per la qualità: l'esperienza del Dipartimento della Prevenzione della Azienda USL 11 di Empoli.

Quality management (QM) is a key issue for the Italian National Health System (NHS). Regione Toscana is currently undertaking a pilot programme to promote QM in Prevention Departments (PD). An introductory training to such programme was devised in the PD of the Local Health Unit no.11 Empoli, since the management was persuaded that all staff should be provided with basic knowledge concerning quality before being enrolled in QM programmes. Managers in charge of PD Units were offered a one-day training,focused on their role in promoting and achieving a QM culture, as an opportunity to be directly involved in the drafting of the DP quality handbook and in improving working procedures. The whole staff took part in a more extensive two-days course, including the basic concepts about QM in health systems, and the illustration of the programme in Regione Toscana; they were also asked to draw up some working procedures according to the draft already used in the Local Health Unit no.11, to be included in the DP quality handbook. The goal of this training programme was to implement a process capable of improving integrated working procedures through the competence, autonomy and responsibility of PD professionals.

[Investigation on health status of silica exposed workers in "cotto Fiorentino" companies]. / Indagine sullo stato di salute degli esposti a silice nelle aziende del cotto Fiorentino.

The manufactured in "cotto" is typical of Chianti Fiorentino with about 400 employees. In 2005. the UF PISLL encountered an exposure to silica more than TLV, particularly for some tasks; were prescribed interventions of prevention and was undertaken an investigation of the occupational health status with occupational health physician. We observed 227 workers, 208 males and 19 females, with average age of 43 years and average age working of 15 years. The habit of smoking tobacco was higher than for the general population. The assessment of exposure to silica has been detected for 59 workers (mean 0.05 mg / mc); at pulmonary function testing resulted: 10 with airway obstruction and 4 airflow limitation; by 140 chest X - ray acquired 1 was interstitial pulmonary disease and 1 was bronchopneumonia. Among the diseases not related to exposure to silica, emerging 42 cases of low back pain, 28 hearing loss, 7 with hypertension. Non uniformity in health surveillance and diagnostic criteria highlights the need to cooperate between occupational doctor in public prevention and control service and qualified occupational doctor to ensure a standard of quality in the prevention of disease in exposed to silica.

[Skin and respiratory allergic disease caused by polyfunctional aziridine]. / Allergopatie cutanee e respiratorie da aziridina polifunzionale.

BACKGROUND: Polyfunctional aziridine (PFA) hardener is increasingly used in water-based paints and inks as a replacement for organic solvents. Allergic contact dermatitis, contact urticaria, respiratory allergy in occupationally exposed patients with hypersensitivity to PFA are reported. OBJECTIVES: The aim was to study a population of adhesive tape printers for occupational respiratory and skin sensitisation to PFA hardener. Also 2 cases of occupational asthma in workers exposed to PFA in tanneries are reported. METHODS: A standard series prick and patch tests was carried out on 15 workers with skin symptoms out of 36 adhesive tape printers exposed to PFA. Prick tests with a 1% PFA water solution and patch tests with a dilution series (0.1-0.32-0.5-1%) of PFA in petrolatum were performed. Lung and nasal provocation tests with PFA hardener were also carried out on 4 subjects with skin and respiratory symptoms. RESULTS: Skin sensitivity to PFA prick tests was demonstrated in 8.3% of the exposed population; 22.2% of the exposed workers suffered from allergic contact dermatitis due to PFA with positive patch tests for this compound. One case of occupational rhinitis due to PFA was diagnosed. CONCLUSIONS: PFA is a strong sensitizer and the use of gloves and protective clothing appears to be insufficient to prevent occupational allergic diseases. Elimination of PFA from production processes is desirable.

Blood--artificial surface interactions during cardiopulmonary bypass. A comparative study of four oxygenators.

Evaluation of the biocompatibility of four different types of oxygenator (bubble, membrane, hollow fibre and 'hybrid') was performed on 26 patients undergoing cardiopulmonary bypass during elective coronary surgery. More platelet derangement and an increased degree of hemolysis, revealed by higher plasmatic concentration of beta-thromboglobulin, platelet factor 4 and plasmatic free hemoglobin (p less than 0.05), was seen when using the bubble oxygenator. Damage to blood cells was minimal with the membrane oxygenator while the 'hybrid' and the hollow fibre oxygenators proved to rank at an intermediate level. Complement activation at the beginning of the cardiopulmonary bypass occurred via the alternative pathway as demonstrated by C3ades arg increase (up to nine times) without a concomitant elevation of C4ades arg. Cardiopulmonary bypass complement activation was quantitatively similar with all the oxygenators. A further activation via the classical pathway occurred in all the patients after protamine injection. Consistent differences as far as clinical and biological effects exist among the various commercially available cardiopulmonary bypass apparatus; our study provides guidelines for the evaluation and selection of devices which might reduce postoperative sequelae.