[Promoting the quality of health surveillance of workers exposed to wood dust, with particular care to NPSC, in the territory of the Health Agency of Florence]. / Promozione della qualità della sorveglianza sanitaria dei lavoratori esposti a polvere di legno, con particolare riferimento ai TuNS, nel territorio di competenza della Azienda Sanitoria di Firenze.

Wood dust can cause occupational-related naso-sinusal cancer, characterized by a latency period of about 40 years. The Tuscany Cancer Registry estimates that cases of NPSC are from 20-25 per year into the Region (33% related to wood dust). These neoplasms are surgically treatable at early-stage and, for this reason, a rapid endoscopic diagnosis is considered to be reasonably useful for prognostic issues. We used a questionnaire to investigate nasal symptoms and NOSQ and SOLAR questionnaires to highlight respiratory/skins diseases, and a spirometry for each worker. Subjects with a working-age of more than 15 years, and those that were positive to the questionnaire and/or to the medical history were were referred to a specialist in otolaryngology. The prevalence of endoscopic positive findings--detected especially in subjects with a working age of more than 15 years--confirms the significance of the problem.

Carpal tunnel syndrome and ulnar neuropathy at the elbow in floor cleaners.

OBJECTIVE: To determine the occurrence of carpal tunnel syndrome (CTS) and ulnar neuropathy at the elbow (UNE) in a cohort of floor cleaners and to check differences between workers with and without CTS. METHODS: All female floor cleaners of three major hospitals in Tuscany (Italy) were contacted. Clinical and electrophysiological severity of CTS and UNE were evaluated with standardized scales and symptoms were assessed with the self-administered Boston Questionnaire (BQ); demographic and non-occupational factors and durations of current and previous occupations were recorded. Univariate analysis of risk factors was performed in workers with and without CTS. Logistic regression was used to evaluate the capacity of independent variables to predict CTS. RESULTS: Out of a total of 179 cleaners, 145 (81%)-mean age 39.6 years (20-64 years)-were enrolled in the study; 70 (48%) had CTS (diagnosis based on clinical and electrophysiological findings). BQ symptom and hand function scores were anomalous in 108 (74%) and 84 (58%) subjects, respectively. UNE was detected in 7/103 women. Univariate analysis showed that cleaners with CTS were older, had greater BMI and longer exposure to cleaning with previous employers than those without CTS. In the logistic regression, the only predictor of CTS was cleaning with previous employers (O.R. 12.1, 95% CI 3-49.9). CONCLUSIONS: These results indicate a high occurrence of CTS in floor cleaners; UNE is less frequent than CTS, presumably due to repetitive movements that stress wrists more than elbows. The only predictive factor of CTS was cleaning as an occupation with previous employers. Therefore, the actual risk factor for CTS could not be cleaning per se, but how this job is performed.

[Progress of studies promoted by the MODS collaborative group]. / Fase di avanzamento degli studi promossi dal gruppo collaborativo MODS.

In industrialised countries, carpal tunnel syndrome (CTS) is considered an epidemic work-related disease. We have set up the MODS (Malattie Occupazionali Da Sovraccarico biomeccanico, biomechanical overload-related occupational diseases) collaborative group, formed by epidemiologists, ergonomists and occupational physicians to investigate CTS in Italy, applying the methods that epidemiologists commonly use to understand epidemics. Several studies are already ongoing. Two different descriptive studies based on current hospitalisation data are in the reporting phase. A pilot case-control multicentre study (260 cases and 520 controls in 13 centres) is in the final phase of data collection. A longitudinal study on a cohort of 3000 subjects exposed to different risk factors has reached the third year of follow-up. Moreover, a surveillance system has been set up to cover selected districts of the Emilia Romagna region. These studies will generate new information about the prevalence and incidence of CTS in Italy, along with identification of regional, high-risk job titles and work sectors, and the relative influence of non-occupational factors.

[Frequency of lumbago in a cohort of nursing students]. / Frequenza della lombalgia in una coorte di allievi infermieri.

The etiology and frequency of low back pain among health care personnel have been widely studied by means of cross sectional studies. The aim of our study was to calculate low back pain incidence in a prospective cohort of nursing students. A population of 344 subjects (72 males and 272 females) was involved in this investigation. Every student was submitted to a clinical and functional examination of the spine before beginning training and was checked in two following steps by a specific questionnaire for epidemiological studies of spinal disorders in working communities. 197 subjects (57.3%)(41 males and 156 females) completed follow-up. The low back pain incidence was similar at the end of two exposure periods (12.1% and 13.1%). The cumulative incidence was 22.5% throughout the study period. The longitudinal study allowed good control of selection bias and confounding factors; more over it showed that compared to other measurements of occurrence the cumulative incidence was between other occurrence measures, more informative, in our case, than prevalence and incidence rates. A cumulative incidence of low back pain over 20% after only two years of exposure in a young and healthy population of nursing students, requires implementation of ergonomic measures for patient handling tasks.