[Not Available]. / Diabetes mellitus in critical jobs.

BACKGROUND: Diabetes is a disease with high social impact and it is important to consider how work may be influenced by it or whether work itself may promote or accelerate its course. OBJECTIVES: The objective was to investigate the prevalence of diabetes in four critical categories of workers. The survey involved construction workers, truck drivers, bus drivers and shift workers in the manufacturing sector. METHODS: In the years 2012-14 we investigated 2034 males workers, through personal history, physical examination, laboratory tests. The subjects with fasting glucose >125 mg/dl underwent a second control and haemoglobin A1c determination. Positive cases were referred to specialist control. Expected prevalence and standardized prevalence ratio (SPR) were calculated using official data regarding diabetes prevalence in Italy. RESULTS: The prevalence of diabetes in 608 truck drivers was 4.4% (expected 2.6%, SPR 1.69, IC95% 1.08 to 2.31); in 860 construction workers 1.9% (expected 2.1%, SPR 0.90, IC95% 0.48 to 1.33); in 378 bus drivers 2.6% (expected 3.5%, SPR 0.74, IC95% 0.29 to 1.20); in 188 shift workers 3.2% (expected 2.1%, SPR 1.52, IC95% 0.33 to 2.71). In the age range 35-59 years the prevalence in 467 truck drivers was 5.1% (expected 2.4%, SPR 2.13, IC 95% 1.29 to 2.96). DISCUSSION: Diabetes was confirmed to be highly prevalent at working ages. The study highlighted an increased diabetes prevalence among truck drivers, whereas other jobs might represent protective factors; this hypothesis, however, needs further investigation.

Inflammatory Markers and Genetic Polymorphisms in Workers Exposed to Flour Dust.

OBJECTIVE: The aim of this study is to evaluate inflammatory markers and pro-inflammatory CD14 and Toll-like Receptor 4 (TLR4) polymorphisms in workers exposed to flour dust. METHODS: Polymorphisms in TLR4 and CD14 were identified in our study population of 167 workers that included 63 healthy subjects (HS), 45 atopic subjects (A), and 59 subjects diagnosed clinically with occupational asthma/rhinitis (OAR). Endpoint measures in this study included fractional exhaled nitric oxide and serum concentrations of interleukin IL-6, IL-8, and tumor necrosis factor-alpha (TNF-α). RESULTS: We identified a polymorphism in CD14 (rs2569190) that may be differentially expressed (P = 0.06). IL-6 concentrations in the serum were significantly higher in the A and OAR groups (P < 0.01) than in subjects in the HS group, while IL-8 concentrations were significantly elevated only in the OAR group (P < 0.01). Interestingly, TNF-α concentrations in the OAR group were significantly reduced when compared with subjects in the HS group (P < 0.01). CONCLUSION: Cytokines are likely a defensive response in atopic and healthy workers. A protective genotype is hypothesized for occupational asthma.

[Competency evaluation of the company physician to improve prevention efficiency in the company]. / La valorizzazione delle competenze del Medico del Lavoro per migliorare I'efficacia della prevenzione in azienda.

The activity of the occupational physician (OP) in the enterprise has as its purpose the protection of the health of workers and consists of two main areas: health surveillance and risk assessment. Every day thle OP have to take into account both the results of clinical diagnostic investigation and the outcomes of the estimation of occupational exposure to risk factors by making a right mix between what is proven by scientific evidence and professional experience. He also knows that its effectiveness is closely linked to the contribution of other figures ofprevention in the company. In the scientific literature, the authors are unanimous in considering the effective actions to reduce exposure to risk, risk behaviors, injuries, occupational illnesses, disability, absenteeism. The use of indicators of effectiveness and / or appropriateness for the enhancement of its contribution, especially as a consultant in the field ofprevention and health protection in the compmany and then with anmt active role in corporate governance of prevention, are a must and no longer postponed, as well as the development of tools that document in formal terms, its contributioni (annual health report, the definition of risk profiles). I, this paper, by analyzing the results of specific experiences in the surveillance of construction workers, drivers and bakers, the authors want to emmphasize the contribution of the OP.

[The importance of upper limb diseases in occupational medicine]. / La rilevanza delle patologie dell'arto superiore in ambito professionale.

BACKGROUND AND OBJECTIVES: In this work the authors analyse the results of the clinical evaluation of patients affected by suspected work related musculo-skeletal disorders (WMSDs), observed throughout 2008-2009 in the specific ambulatory of Occupational Medicine Division of Ospedali Riuaniti di Bergamo. The aim is to illustrate the epidemiological relevance of upper limb (UL) WMSDs. METHODS: We observed 430 patients (mean age 46,9 years, DS 9,3; mean working seniority 29 years, DS 10,4), investigating 600 disorders in diferent musculoskeletal segments. Most of the patients (66%) got to the division for a clinical consultation requested by general practitioners, 29,8% by occupational physicians, 4,2% by national insurance for occupational injuries and diseases (INAIL). RESULTS: Most of the patients (38,4%) were employed in construction industry. Among the 600 disorders investigated, 34,5% was at lumbar spine, 74,5% was at upper limb. The clinical diagnosis was already clear at the first consultation for 81,6% of subjects with low back pain and for 56,5% of patients with upper limb disorders; for the others was necessary to prescribe some instrumental exams or specialistic (neurologic, physiatric, orthopaedic) medical examination. We concluded for a diagnosis of WMSDs in 48,3% of the 600 cases: the percentage is 50,2% if we consider only disorders at lumbar spine and 52,5% among disorders at upper limb. The most frequent reason of refusing occupational aetiology, in the cases of low back pain, was the concomitant presence of other diseases at the segment; on the contrary, for the cases of upper limb disorders, was the lack of correlation between type of disease and professional exposure. DISCUSSION: All physicians demonstrate a high attention about upper limb disorders, topical subject of great epidemiological interest. General practitioners and occupational physicians have to take more advantage of diagnostic support and clinical evaluations offered by Occupational Medicine Divisions an Universities about WMSDs. In consideration of the dificulties to diagnose upper limb disorders and proving correlation with professional exposure is useful to promote specific courses for general practitioners and occupational physicians.

[Work-related musculoskeletal disorders: appropriateness of the requests of clinical consultation in occupational medicine departments]. / Le patologie muscoloscheletriche lavoro-correlate: l'appropriatezza nell'invio dei pazienti a strutture di secondo livello.

BACKGROUND AND OBJECTIVES: The authors analyze the results of the clinical assessment of patients suffering from suspected work-related muscular-skeletal disorders (WMSDs), observed during the course of 2008 in the Department of Occupational Medicine of the Ospedali Riuniti hospital in Bergamo. The aim was to analyse the appropriateness of the requests of clinical consultation, comparing the cases sent by general practitioners and by occupational physicians. METHODS: We assessed 149 patients (mean age 47 years, DS 9.4; mean work seniority 29.5 years, DS 10.2), investigating 218 disorders in different muscular-skeletal segments. The majority of patients (63.7%) for whom a clinical consultation was requested were sent by general practitioners, 32.9% by occupational physicians, 3.4% by the National Insurance Institute for Occupational Accidents and Diseases (INAIL). The assessment was made in two steps: first a clinical and instrumental definition of the disorders, prescribing the necessary medical investigations were the diagnosis was not already clear; secondly a definition of the aetiology, requesting documentation about working conditions when this was not clear from the medical history, experience and literature, or making an inspection. RESULTS: A majority of the patients (40.2%) were employed in the construction industry. Regarding symptoms, 54.4% of the subjects reported low back pain, 74.5% upper limb disorders (some of the patients reported several problems in different segments). The clinical diagnosis was already clear at the first consultation for 62.8% of all cases; for the other 37.2% it was necessary to prescribe some instrumental examinations or specialistic (neurologic, physiatric, orthopaedic) medical examinations. We concluded for a diagnosis of WMSDs in 99 (45.4%) of the 218 cases (50% of the assessments requested by occupational physicians, 45.3% of the assessments requested by general practitioners). The most frequent reason for rejecting an occupational aetiology was the lack of correlation between type of disease and occupational exposure, both for patients referred by occupational physicians (58.1%) and by general practitioners (51.8%). DISCUSSION: The results demonstrated that the appropriateness requests for clinical consultation was identical for general practitioners and occupational physicians. All physicians showed a high degree of attention for the upper limb disorders, which is a topical subject of great epidemiological interest. General practitioners and occupational physicians need to take more advantage of the diagnostic support and clinical evaluations offered by Occupational Medicine Departments and Universities for WMSDs.