Giornale italiano di medicina del lavoro ed ergonomia最新文献

Summary: Orthostatic hypotension (OH) is a disabling condition accompanying several diseases. It has increased morbidity and mortality, and limited chances of treatment. We report a case of a patient with stable ischemic heart disease and severe OH unresponsive to usual care. A baseline 75° head-up tilt test (HUT) was positive for symptomatic OH, i.e. pre-syncope with a systolic arterial pressure drop of 35 mmHg. On top of optimal treatment, ivabradine was started. Symptoms improved within 24 hours. At a repeated HUT, the patient could tolerate the up-right position up to 25 minutes. He was able to undergo an individualized training program with further amelioration of quality of life. Thereafter, titration of ACE inhibitors became possible. Lasting benefits were present at a 6-month follow-up. To our knowledge, this is the first reported case of successful use of ivabradine to integrate cardiac rehabilitation for management of a highly disabling OH.

Summary: The 8-week mindfulness meditation (MM) trainings have proven to be helpful for reducing burnout due to work-related stress. Most studies reported these positive effects with evaluations made immediately before and immediately after the therapeutic interventions. Little is known, however, about the symptoms of burnout in the months following these interventions. In our exploratory study, the effects of an 8-week MM training were assessed in a group of health care professionals (n = 19) with vulnerability to develop burnout; a 9-month follow-up was conducted on the subjects (n=8) who continued to meditate after the end of the training. Other health care professionals of the same company, who did not meditate during this research, served as control group. Burnout, mindfulness abilities and job satisfaction were evaluated through self-reports. Data showed that during the training the levels of burnout did not decrease, but significant reductions were observed during the follow-up. This indicates the possibility of obtaining results with MM even in subjects who do not have standard response time to the therapy and highlights the importance of monitoring the healing process.

Summary: Background. Musculoskeletal disorders (MSD) have been described as one of the major causes of physical pain and disability. Health professions, in general, are among those at higher risk of injury. Objective. The aim of the study was to carry out a systematic review of cross-sectional studies on physical-physiotherapeutic musculoskeletal disorders in physiotherapists. Materials and Methods. Bibliographic research was carried out through the PUBMED, PEDRO, and CINAHL databases. The selected articles had to comply with the following inclusion criteria: original peer review articles, English and Italian articles, cross-sectional studies with sample sizes of at least 25 physiotherapists, and no time limit. Results. In general, the results of studies on the WRMDs of physiotherapists have been comparable, with the exception of some differences between the various countries linked to both the level of development and the psychosocial and epidemiological status of the physiotherapy profession. Healthcare workers are among the professional categories most exposed to work-related musculoskeletal disorders because they are in direct contact with the patient, which often requires an important physical commitment to lifting and relocating patients for long-held incongruous postures, for repetitive movements, for joint effort, and for overload in manual techniques.

Summary: Background. The phenomenon of accidents during the university course is a public health problem. Students spend a lot of time at university and in structure for training. This this leads them to be exposed to biological, chemical and ergonomic risk of accidents or occupational diseases. Aim. The aim of this study is to describe accidents that occurred to students of Sapienza University in Rome during the period 2010-2015. Materials and Methods. Retrospective study conducted on a cohort of students from Sapienza University in the years 2010-2015. As a source of data was used register of accidents reported by the students. Results. During the period considered, injuries were recorded in 791 students, mainly female (71.8%). Nursing students were the most affected (92.8%), followed by medical students (5.7%) and finally students of other faculties (1.5%). Point wounds were the most frequent (n=462) representing 58.4% of the total and occur mainly at the wrist and hand (n=380); the second most frequent type of injury is contact with biological liquid (n=159) followed by contusions (n=72), the most affected site in this case are the head and the face (n=81; n=23). Contusions often also involve multiple regions (n=17). In lesser numbers there are also the distortions (n=55), and fractures (n=26) the most frequent first ankle and foot (25.5%), the second most frequent wrist and hand (34.6%) The incidence of accidents ranged from 0.079% in 2011 to 0.161% in 2012. Conclusion. There is a need to design measures for more intensive specific training on biomedical students, especially nursing students, as the most exposed category, in order to reduce the accident phenomenon. Particular attention should be paid to the safe handling of sharp objects. It would be beneficial to include in the course of teaching lessons aimed at security and greater awareness of the risk.

Summary: The energy cost of physical activity is a well-documented field of research both in non-disabled subjects and in subjects with physical disabilities, in particular spinal cord lesions. The aim of this study was, therefore, to investigate the energy cost and subjective fatigue in disabled persons who make daily use of a manual wheelchair by comparing three different types of wheelchair (standard, lightweight and ultra-light) in order to obtain indices useful for prescribing the most effective and appropriate wheelchairaid for the individual patient. The study was carried out on 18 patients affected by paraplegia or paraparesis due to spinal cord injury at different levels. Result revealed a significant difference across the three types of wheelchair, with the energy expenditure to cover 100 m increasing from the ultra-light (lowest expenditure) to the lightweight to the standard type (highest expenditure). The differences observed in the average energy consumed to cover a distance of 100 meters with the three types of wheelchair confirm the hypothesis that it is the weight of the wheelchair chosen by the rehabilitation team together with the patient that constitutes the fundamental criterion in making such a prescription. Obviously, in making the final choice, other factors as well need to be taken into account, such as the person's age and anthropometric characteristics, the nature of the disability and prognosis, the achievable degree of autonomy, functional capacities, personal preferences, the type of use (domestic or external), accessibility, reliability and durability, esthetic features, eventual accessories available, etc.

Summary: Many studies have confirmed the existence of a close relationship between job satisfaction and health. The Siena University Hospital introduced the Lean approach to support personnel development/empowerment and promote a constant improvement in work organization, with the aim of creating value for patients, professionals and the whole organization. The purpose of this study was to examine whether the introduction and the development of this improvement approach in healthcare could contribute to the enhancement of psychological wellbeing and employee satisfaction, with a positive value in preventing related stress work. The Lyne and Barrett Employee Wellbeing Questionnaire (EWQ) was administered to employees involved in selected Lean projects carried out at the Siena University Hospital. The EWQ is composed of 59 items and it is structured in three areas: organizational wellbeing, working satisfaction and workload. The analysis of the results showed significant evidence of the impact of improvement activities on the working satisfaction and the workload.

Summary: Nanomaterials can revolutionize everyday products, but there are still many unanswered questions about the risks they may pose to human health and the environment. Inconsistent definitions and metrological issues are still of concern for manufacturers, importers and distributors who are demanded to comply with strict regulations. It is also likely that the increasing number of nanomaterial-containing products available on the market will vary the chemical and physical properties of the waste produced, which is currently treated in traditional plants without any particular differentiation. Treatment efficiency for nanomaterials-containing waste should then be addressed and the risks of uncontrolled emissions considered. Finally, the risks associated with the use of nanomaterials-containing products may not be sufficiently characterized as current exposure estimation models are not designed for estimating exposure to nanomaterials and they are likely to be affected by large uncertainties. Hence, it would be important for national and international institutions to provide, as soon as possible, harmonized regulations covering all aspects of the life cycle of products and waste containing nanomaterials. This paper is proposed as a starting point for reflection on the main regulatory and management issues associated with products and waste containing nanomaterials, focusing mainly on the European framework.

Summary: Background. Interruptions occurring during the drug preparation and administration have a documented effect on patients' safety. However, literature has paid little attention to show how the introduction of a set of standardized organizational interventions, based on the combination of the current evidence, could reduce the number of interruptions occurring during drug therapy management. For this reason, this study used the most recent evidence to combine a set of standardized organizational interventions, and it was aimed to assess the effect of those interventions on the number of interruptions occurring during drug therapy management (Hypothesis a) and the overall duration of the therapy administration (Hypothesis b). Methods. A quasi-experimental study was performed, using pre- and a post- organizational implementation data collections in a single Italian center. The data collections were related to the interruptions and 40 shifts were randomly selected for both pre- and post-phase, respectively on December 2016 and February 2017. The standardized organizational interventions were implemented using the current evidence on this topic. Results. The standardized organizational interventions decreased the interruptions in the post-implementation phase, but those had not an effect on the duration of the therapy administration. Conclusions. This study represented an updated evidence, which describes the effect of a standardized and evidence-based set of organisational interventions' implementation on drug therapy management. Our results suggest a number of hints for managers and future researches. Managers should keep into account the usefulness of those interventions, while future researches with experimental designs are needed to provide harder evidence on this topic.

Summary: Introduction. Assessing nursing engagement and designing strategies to improve engagement according to the specific needs of the staff have been considered essential to avoid losing nurses, mitigate future shortages and improve patients' outcomes. Objectives. To explore engagement levels of staff nurses working in an Italian public health-care trust comprising a general hospital, a rehabilitation hospital, district centers and mental health services, and their association with demographic and professional variables. Methods. The Health Care Advisory Board's Nurse Engagement Survey (NES) was used to measure 547 nurses' engagement levels. Results. Out of 499 nurses, 8% were engaged, 40% were content, 39% were ambivalent and 13% were disengaged. According to the multiple linear regression analysis which has showed R 27.3% (R2 7.5%) of the variance in the total score of NES, being older than 45 years was associated with an increased likelihood of being work-engaged (β 0.121, [Confidence of Interval] CI 95% 0.066 to 0.457); differently, having the intention to leave the unit in the next three months (β -0.168, CI 95% -0.552 to -0.179), and working at the hospital levels as compared to other settings (e.g., Mental Health Service, β -0.150, CI 95% -0.140 to -0.038) were negatively associated with the WE. Conclusions. Nursing leaders should prioritize strategies to increase Registered Nurses' engagement. Specific initiatives devoted to younger nurses and to those intending to leave the unit, as well as to those working at the hospital level, are needed given these groups have a higher likelihood to be not or poorly engaged.

Summary: Background. Angelo Iannaccone is certainly one of the most important personalities in the field of occupational medicine of the last century. Aims. The fiftieth anniversary of the Post-graduate School of Occupational Medicine of the Catholic University of Rome gives us the opportunity to define this extraordinary figure of man and scientist, at over 35 years from his death. Results. Prof. Iannaccone was among the very first, if not the first to deal with chronobiology and occupational ergonomics in Italy, adopting the modern perspective of "upstream" prevention, since the design phase, which had to be based on the adaptation of work to man and not vice versa. He carried out important and pioneering studies on the effects of benzene on the hematopoietic apparatus and of various industrial toxicants on the neuroendocrine system. In establishing the formative principles for the occupational physician, he devoted a significant space to industrial hygiene, in the interdisciplinary perspective of prevention sciences. He gave a significant contribution to the scientific society of occupational medicine, first as a member of the board, then as the president of the Italian Society of Occupational Medicine and Industrial Hygiene. He realized the Institute of Occupational Medicine of the Catholic University of Rome and founded the post-graduate school. Conclusions. Prof. Iannaccone's contribution to occupational health and industrial hygiene emphasized applied research and prevention in the workplace.