[Occupational diseases caused by artificial optical radiation (AOR)]. / Le malattie professionali da radiazioni ottiche artificiali (ROA).

BACKGROUND: Italian national legislation guarantees safety and health for workers exposed to artificial optical radiations (AOR) by Legislative Decree 81/2008. OBJECTIVES AND METHODS: Effects and damages to health resulting from AOR exposure were analyzed from literature data. RESULTS: Ultraviolet radiations (UV), particularly those in the wavelength range between 220 and 310 nm, causes chronic conjunctivitis and kerato-conjunctivitis. Skin cancer caused by UV exposure included basal cell carcinoma, squamous cell carcinoma and melanoma. As regards Infrared Radiations (portion of the spectrum between 780 nm and 1 mm), the biological effect is essentially of thermal nature. Exposure to blue light (portion ofthe spectrum of visible light radiation in a wavelength range between 380 and 550 nm) causes exclusively retinal damage and is considered to be responsible for the development of situations of age-related macular degeneration (AMD). Even if experimental data are available, at the present time there is still no epidemiological evidence of retinal damage caused by blue light. CONCLUSIONS: The forensic criteria for investigating the causality link between occupational exposure to AOR and damage, and the methodology necessary for the assessment process, are reported. Two lists of occupational diseases which were included in the Italian Ministerial Decrees, issued respectively on April 2008 and 11 December 2009, are also considered. Lastly, on the basis of the current existing guidelines and scientific evidence, the authors propose occupational health surveillance protocols for workers exposed to AOR risk.

[Work at high altitudes: risk factors and health surveillance]. / Il lavoro in alta quota: fattori di rischio e sorveglianza sanitaria.

Work at high altitude (elevation equal to or greater than 3000 m above sea level) results in a physiological adaptation of the human organism to changing environmental conditions. The main problem related to the altitude is represented by the reduction of partial pressure of oxygen (hypoxia). Our study takes into consideration occupational risk factors: those related to physical environment of high altitude; those related to the worker; those related to the characteristics of the job. It is finally addressed the decision making process related to the formulation of the judgment of suitability for performance of work activities at high altitude. The health protocol proposed requires an accurate anamnestic investigation aimed at gathering information on pre-existing pathophysiological conditions that need, once identified, clinical and instrumental tests specific and targeted. These clinical protocols are analyzed and proposed for the main pathophysiologic conditions that pose a risk to health at high altitude.

[Work integration of impaired workers in a type-B social cooperative]. / L'inserimento professionale di lavoratori disabili in una cooperativa sociale di tipo B.

This research aims to evaluate job occupation results of impaired workers in a type-B social cooperative, taking into consideration not only specific occupational risks' analysis and assessment, but also organisational, relational and psycho-social matters essential for their stable job occupation. The impaired workers involved were all those hired by a type-B social cooperative from Jan 1999 until Dec 2007, ie. 16 workers (M 8, F 8), equal to 40% of employees' total number. Every impaired worker has been submitted to preventive health surveillance in order to evaluate the degree of disability and residual job ability in relation to the job tasks suitable for him/her. In order to find available tasks which can be performed by disadvantaged workers, the personnel chart has been analyzed, and 10 of the 16 workers (equal to 62.5%) have been considered fit for the specific task without limitations. The other 6 (37.5%) have been considered capable of the specific task with limitations and/or prescriptions, and for 2 of them (12.5%) a tutorial supervision prescription was also necessary. Among those 6 workers with limitations and/or prescriptions, 4 were psychologically impaired (67%) and 2 were physically impaired (37%). The situation of these 16 impaired workers has been periodically verified and followed up for 8 years. Not only have the fifteen workers continued to perform the task initially considered suitable for their health status, but for some of them (5 workers), an increase in job performance, in both complexity and shift duration, has been observed. Moreover, with the only exception of a psychologically impaired worker who did alternate between good comfort times and occasional disease acute phases, all other workers have shown good and stable gains in psychological and physical health conditions, performing requested tasks not only with efficiency, but also with commitment and motivation. All workers have shown a remarkable improvement in their ability to form relationships, mainly within the work environment amongst colleagues and supervisors, but also in a social and family environment. A special mention is deserved in the case of the only worker hired in our research who left the cooperative after many years of work activity where, after having attended specific professional courses, steadily and successfully joined a company still in the social field but not exclusively dedicated to impaired workers. It may be observed that when one faces the work integration of impaired workers, the usual risk evaluation processes cannot be enough for the reason that these workers, due to their 'disability', find themselves in hypersusceptible conditions in respect to occupational risk factors which are generally acceptable for the other workers. In risk assessment it is therefore necessary to perform an accurate and all-round study in every aspect of the job duty, even around those considered irrelevant which, as a result, may show to be unsuitable to the worker's health status or might alter his/her often precarious psychological-physical condition. In conclusion, in the risk assessment process used prior to the work integration of impaired workers considered by our research, the organisational, relational and psycho-social aspects of work activity have often played a primary role in respect to traditional risk factors usually monitored and evaluated.

[Reactive anxiety crisis: a unique case of work injury]. / Crisi d'ansia reattiva: un caso particolare di infortunio sul lavoro.

The present study aims to describe a unique case in view of the disease diagnosed, the conditions of onset and the management by INAIL (Italian National Institute of Insurance for Injuries at Work and Occupational Diseases). A worker, after a verbal, animated dispute with some collegues, had an acute psychiatric agitation attack and went to the nearest emergency room, where he was investigated. No neuropsychiatric alteration was diagnosed, but based on anamnestic data, the physicians diagnosed an anxiety crisis reactive to work environment. A medical certificate for injury at work was produced and sent to the Insurance Board (INAIL). The worker was off work for 105 days diagnosed with a persistent anxious depressive syndrome, secondary to the traumatic event. INAIL reassessed the case later and confirmed only the first 30 days as due to work accident, while the following period was judged as related to affectivity disturbance due to common disease, not to work environment. Our case opens new perspective for the occupational physician in the assessment of ASD as work injury and of PTSD as professional disease, suggesting to give more attention to psychiatric health of workers.

[Asthenopia and work at video display terminals: study of 191 workers exposed to the risk by administration of a standardized questionnaire and ophthalmologic evaluation]. / Astenopia e lavoro al videoterminale: studio di una popolazione di 191 lavoratori esposti al rischio mediante somministrazione di questionario anamnestico mirato e valutazione oftalmologica.

VDT (Visual Display Terminals) are commonly used in a wide range of occupational fields. Over the last ten years a number of studies have shown that ocular symptoms are the form of discomfort most frequently experienced by subjects who work at VDT. The symptoms as a whole characterize a complex syndrome named "asthenopia" and have been seen as a consequence of prolonged, fixed and closely oriented vision. In our study we have evaluated data derived from a standardized questionnaire (a series of questions elaborated and promoted by the Italian Society of Occupational Medicine and Industrial Hygiene). It was administered to a group of 191 workers who utilise VDT for more than 20 hours each week. We also took into consideration the results of ophthalmologic medical examinations performed on this particular group of workers. Prevalence of occupational asthenopia we found to be lower in this group than in the case of other reported investigations, though it proved to be higher in the case of female subjects. According to the Literature, symptoms intensity is related to the duration of weekly VDT use, there being no significant association with the number of years spent working at VDT. Our results show that prevalence of asthenopia was not significantly influenced by refractive alterations and this unexpected outcome might be explained by taking into account the small-size group of subjects affected by hypermetropic defects. It is well known that these are the most important factors in conditioning asthenopia. Our finding indicates the need for further research, which should include a larger group of VDT workers with refractive alterations and furthermore take into consideration environmental variables such as climate and illumination, since these are co-aetiological factors, known or suspected, of occupational asthenopia.

[Return to work of a pacemaker bearing worker: the relationship between health problems and electromagnetic interferences]. / L'inserimento lavorativo del soggetto portatore di pacemaker: problematiche sanitarie connesse con le interferenze di tipo elettromagnetico.

The potential effects of electromagnetic fields is a problem that interest the public opinion, as the modern society expose all people to electromagnetic non ionizing radiations. The problem has a particular and important meaning facing the return to normal life and work conditions of a cardiopatic subject bearing a pacemaker (PM) or implantable cardioverter defibrillator (ICD). Electromagnetic interferences can produce temporary or permanent malfunctions in these devices. Checking for the absence of electromagnetic interferences is necessary considering that correct functioning of these medical devices is essential for the life of the bearer. Precautions normally adopted by these subjects are generally adequate to ensure protection from interferences present in life environment; for occupational environment, there is often lack of adequate information, also due to late involving of the doctor specialist in occupational health. This work intends to study in depth a specific job, a carpentry-workshop with welding activities, starting with a case of a PM bearer who asked a doctor specialist in occupational health to evaluate the problems involved in his return to work. Electric and magnetic fields produced by equipments present in the workshop were measured and compared to data supplied by the literature to evaluate the possibility of interactions in the normally functioning of implanted electronic devices. On the basis of our experience, we have found some criterions for specific risk assessement to adopt for the definition of operative protocols for return to work of PM or ICD carriers, also considering the lack of specific procedures and indications for the doctor specialist in occupational health. The collected information and data from the literature suggest that welding can be a risk for a subject with PM; as observed in experimental conditions, electromagnetic radiations can alter particular sensitive devices and those with uncorrected settings.

Respiratory syndrome very similar to extrinsic allergic alveolitis due to Penicillium verrucosum in workers in a cheese factory.

A respiratory syndrome very similar to extrinsic allergic alveolitis due to Penicillium verrucosum was recognized in 4 workers employed in a Gorgonzola cheese factory. A mycogen allergy to P. verrucosum, used as starter in the production, was demonstrated by positive sputum culture and detection of specific antibodies in the blood. Intense and prolonged exposure to inhalation of fungal spores could have lead to the development of this allergic response. The fact that 2 of the subjects are siblings seems to indicate host susceptibility or immunological constitution in the pathogenesis of the respiratory allergy.