[The Work Ability Index in hospital workers]. / L'Indice di Capacità di Lavoro in operatori sanitari.

The Work Ability Index was used as a complementary tool for the periodical health surveillance of health care workers in order to evaluate their functional working capacity and to plan more appropriate preventive and compensatory measures. 867 health care workers of both sexes (337 men, 530 women), aged between 23 to 65 years and with a work experience from 0.5 to 48 years were examined. They were physicians, registered and assistant nurses, biologists, technicians and clerks, working in hospital departments, ambulatory health care services, laboratories and offices. WAI proved to be "excellent" in 27.0%, "good" in 49.7%, "moderate" in 20.1% and "poor" in 3.2%. Women showed significantly lower mean WAI than men in all age groups, particularly among registered and assistant nurses. Women shift workers showed a more pronounced decrease of WAI over the years as compared to their colleagues day workers by increasing the number of illnesses suffered, WAI similarly decreased in all age groups, but less among physicians and clerks.

[Exposure to the risk of the manual lifting of patients and the results of a clinical study in 4 hospital establishments of northern Italy]. / Esposizione al rischio di movimentazione manuale dei pazienti e risultati dell'indagine clinica in quattro aziende ospedaliere del Nord Italia.

The paper reports the results of a study carried out in four hospitals in northern Italy to assess exposure to patient handling and the consequent risks for the lumbar region of the spine. The methods proposed by the EPM Research Unit were used. Altogether, in the four hospitals there were 148 wards and 5596 staff. Of these, 34 wards and 510 workers were examined. The results of exposure assessment showed that the obstetrics departments had negligible risk (MAPO Index 0-1.5), urology and general surgery departments an intermediate risk (MAPO Index 1.51-5.0), while the departments of medicine, orthopaedics, neurology and rehabilitation had high risks (MAPO Index > 5.0). Of the 510 workers who underwent physical and anamnestic assessment for spinal disorders, 44% worked in the departments of medicine, which are known to have a high risk The prevalence of subjects who reported episodes of acute low back pain in the last 12 months (11.4%) was 5 times that of a group of workers not exposed to manual load handling (2.3%). Analysis of the same disorder referred to each job showed higher prevalences in the non-nursing staff (technical 25%, general 27%). The frequency of degenerative disorders of the lumbar spine was slightly lower than the figure for the country as a whole (6.7%). It is clear that measures for improvement of the environment are required aimed particularly at installing aids and staff training (for the specific risk factor), also so as to better manage the reallocation of workers judged unfit for patient handling who, in the group under study, were 5%.

Acute trichloroethylene poisoning by ingestion: clinical and pharmacokinetic aspects.

Five hours after ingestion of an unknown amount of trichloroethylene (TCE) a 32-year-old woman was admitted to hospital in deep coma. The neurological condition remained unchanged for 3 days, after which there was an improvement of the central nervous system function. The concentrations of TCE in the blood, which were measured during 7 days after the solvent ingestion, gave us the opportunity to study some toxicokinetic parameters of TCE. Using a physiologically based pharmacokinetic model, the toxicokinetic parameters and blood concentrations of TCE are discussed in relation to the neurological conditions. Moreover the same model has suggested that the alveolar hyperventilation during the first 12 h following the TCE poisoning is the only treatment which may shorten the duration of the poisoning.

"Dynamic" biological exposure indexes for n-hexane and 2,5-hexanedione, suggested by a physiologically based pharmacokinetic model.

Biological exposure index (BEI) of n-hexane was studied for accuracy using a physiologically based pharmacokinetic (PB-PK) model. The kinetics of n-hexane in alveolar air, blood, urine, and other tissues were simulated for different values of alveolar ventilations and also for constant and variable exposures. The kinetics of 2,5-hexanedione, the toxic n-hexane metabolite, were also simulated. The ranges of n-hexane concentrations in biological media and the urinary concentrations of 2,5-hexanedione are discussed in connection with a mean n-hexane exposure of 180 mg/m3 (50 ppm) (threshold limit value [TLV] suggested by American Conference of Governmental Industrial Hygienists [ACGIH] for 1988-89). The experimental and field data as well as those predicted by simulation with the PB-PK model were comparable. The physiological-pharmacokinetic simulations are used to propose the "dynamic" BEIs of n-hexane and 2,5-hexanedione. The use of simulation with PB-PK models enables a better understanding of the limits, advantages, and issues associated with biological monitoring of exposures to industrial solvents.

[Peripheral neuropathy caused by incongruous posture in shoe manufacture workers]. / Neuropatie periferiche da posture incongrue in lavoratori calzaturieri.

Nine cases of local neuropathy are described in shoe-manufacture workers. Clinical and electrophysiological examination excluded diseases such as toxic polyneuropathies due to n-hexane. Specific lesions of the ulnar nerve were located near the elbow where the forced and uncomfortable posture facilitated the compression of the nerve in the cubital tunnel. The severity of the neuropathies ranged from relatively slight, with paresthesia of some of the fingers, to evident hypotrophy of the inter-osseous muscles of the hand. All the 9 cases sewed shoe uppers using sewing machines operating 25 cm above the arm support, thus obliging the operator to work with one or both elbows resting on the support, with the arms and shoe-upper held up. Five cases presented a neuropathy of the right arm, 3 of the left arm, and in one case the lesions were bilateral. The features of the work station are described and the possible promoting factors and the ergonomic pathogenesis of these neuropathies are discussed.