Giornale Italiano di Medicina del Lavoro ed Ergonomia

Legal responsibility of vaccinating doctor

Flavia Beccia — 2021-04-01

The legal responsibility of the vaccinating doctor is one of the central issues in the current setting of the Covid-19 pandemic. The aim of this statement is to outline the profiles of the medical legal liability, with a focus on the figure of the vaccinating physician, in criminal, civil, and disciplinary terms, based on the Italian legislation in force. The vaccinating doctor responds for his work in the field of vaccination in the same way as any other health service should perform (diagnostic, therapeutic, etc.). Helpful in this context is the adoption of the L. 76/2021; it was developed to find a balance between safeguarding the person privacy and greater guarantees for the doctor. This law introduces a criminal shield that can put a limit to litigation, curbing the phenomenon of so-called defensive medicine. The climate of uncertainty and fear of legal repercussions for the doctors, and the constant updating and redefinition of the indications of operability in the vaccination campaigns, underline the need to focus on the knowledge of the responsibilities and the safeguard of the vaccinating doctors. In addition to the regulatory cornerstones, the statement also addresses the issue of informed consent and the role of the occupational doctor as a central figure in the vaccination campaign in the workplace.

A proposal for the management of health surveillance and monitoring procedures in relation to the risks posed by SARS-COV-2 to hospital and nursing home workers, based on strategies implemented in the facilities of the Fondazione Opera San Camillo

Gianni Saretto — 2021-04-01

This paper describes how the health surveillance protocols adopted in hospitals and nursing homes have changed in response to the spread of SARS-CoV-2 and its risks. These changes concern assessments that must be performed with urgency, to detect potential cases and symptoms that may indicate contagion and to protect vulnerable and hypersensitive workers. Besides, these changes have been implemented in order to regulate how the appointed occupational physician should perform everyday tasks, particularly in regard to preventive visits, periodic visits, office visits, and visits meant to authorize one’s return to the workplace. This paper recommends that both preventive visits and periodic visits should include rapid antigen swab tests to screen for SARS-CoV-2 (which, if positive, should be confirmed by molecular tests) and serologic tests to detect IgG SARS-CoV-2 antibodies. Since this phase involves great risks for healthcare facilities, this paper proposes that swab testing should be performed every month and that serologic testing should be performed every three months (depending on whether the first test detects the presence of IgG antibodies). By combining antigen and molecular swab tests, healthcare professionals can diagnose workers with SARS-CoV-2 and identify positive asymptomatic cases. Because of its costs and its long turnaround times for results, molecular swab testing is recommended only when one needs to confirm a positive antigen swab test result. Serologic testing should be used alongside swab testing, to acquire data concerning the immunity of workers.

Biological injuries in a hospital in puglia: an observational study between nurses and nursing students

Elsa Vitale — 2021-04-01

Introduction. An injury caused by a biological agent is an event that causes damage to the health of the operator. Nursing is one of the most affected professions. Objectives. This study aims to analyze and quantify the injuries caused by exposure to biological agents among working nurses and students of the degree course in Nursing at the “F. Miulli” Regional General Ecclesiastical Body, located in Acquaviva delle Fonti, province of Bari, Italy. Methods. The retrospective study was carried out by collecting data from May 2019 to July 2019. The data were collected from the archive of biological accidents for the five-year period 2014-2018. The data collected was divided according to the professional category of the subject: whether it is a nurse-worker, or a nurse-student, enrolled in the Nursing course of the University of Bari Aldo Moro. Results. 249 injuries caused by biological agents were recorded, of which 69.1% were female and 30.9% were male. The operating units most involved are the medical branch departments (55.4%). The anatomical sites most affected are the upper limbs with 205 cases. Discussion. It is necessary to invest in training and refresher campaigns for nursing staff and nursing students in order to ensure the standards of effectiveness of the services provided and safety in providing them.

Lumbar discopathies: correlation between pathology, work eligibility and recognition of technopathy

Luca Di Giampaolo — 2021-04-01

Background. Spondylodiscopathies are usually counted among the “work-related diseases” that are those chronic-degenerative diseases with multifactorial etiology where the work environment can sometimes assume the role of direct and efficient contributing cause. Low back pain is the main cause of functional limitation and absence from work in the western world, resulting in a huge individually and socially economic burden. Objective. This work was designed to provide an overview of the impact that lumbar rachipathies have on health surveillance, highlighting the correlations between the pathology severity, characterization of professional risk and issue of elegibility for the specific task. Methods. Was analyzed a case studies of lumbar rachipathies reports received by INAIL in the entire Abruzzo region in 2017, the last year available in the INAIL database at the time of data extrapolation dating back to May 2019. For each dossier were collected data extrapolated from: DVR, medical record and risk, instrumental examinations and specialist visits. The software “Epi Info” version 7 was used for the statistical analysis of the sample, provided by the CDC (Centers for Disease Control and Prevention) in Atlanta. Results. The expression of work elegibility with limitations and/or prescriptions by the phisicians is related only to clinical symptoms and not to the presence of a herniated disc on CT or MRI tests. The exposure to risk from MMH and WBV, documented in the DVR, was not found to be related to the presence of a herniated disc on instrumental examinations. There was no significant difference in the average age between workers recognized as technopathic from non-technopathic. Conclusions. Although biomechanical overload has always been considered as an important wear element of the intervertebral disc, genetic influences and constitutional factors seem to be elements more implicated in the development of hernial disc disease.

Beyond the assessment of work-related stress risk: the management standards approach for organizational wellbeing

Francesco Marcatto — 2021-04-01

The in-depth assessment of work-related stress risk (WRS) represents both a regulatory obligation and a moment to reflect on the health conditions of the organization. This paper reports the results obtained from the in-depth WRS assessment conducted in a facility management company through the administration of the HSE Management Standards Indicator Tool (HSE-MS IT) and further measures aimed at assessing perceived stress, job satisfaction, and job motivation. A total of 196 workers took part in the study. The WRS assessment revealed the presence of risk in the Demand, Relationships, and Peer Support dimensions and of serious risk in the Control dimension. Through correlations and multiple regressions analyses the organizational areas significantly associated with perceived stress, job satisfaction and job motivation have been identified. The direct and indirect effect of the Management Standards on the three output measures was also evaluated using path analysis models. Demand, Control, and Relationships resulted to have a direct effect on perceived stress, while Peer Support and Management Support had an effect on job satisfaction and job motivation respectively. Perceived stress also has a direct effect on job satisfaction, which in turn resulted to affect job motivation. In conclusion, an in-depth WRS assessment that combines the traditional approach based on Management Standards with additional measures of organizational well-being, can give the opportunity to identify not only the key factors leading to WRS, but also the management areas critically associated to other elements that contribute to organizational well-being, such as job satisfaction and motivation.

Resilience skills as a protective factor against burnout for health professionals: a cross-sectional study on new hires from the hospital of Lodi

Ivana Cacciatori — 2021-04-01

Burnout symptoms are very common in health professionals. Public health workers are exposed to high levels of distress due to the need to face their parents’ health problems. For this reason, they need to preserve some resources that can protect them from emotional exhaustion, depersonalization and low personal realization. Therefore, we analyzed the relationship between resilience and burnout in a sample of 85 health workers from the hospital of Lodi. Subjects who took part of the study are physicians, nurses, health and social workers, etc. Results show a significative correlation (p < 0.01) between resilience and two of the three burnout dimensions (emotional exhaustion and personal realization) and a predictive value of resilience for the same dimensions mentioned above (p < 0.01). These considerations confirm the importance of resilience to face distress and to avoid burnout.

Lesson learned from an international training program on patients’ medication adherence for healthcare professionals

Marina Maffoni — 2021-04-01

Objective. Healthcare professionals play a crucial role for promoting medication adherence in older adults. This research aimed to assess changes in professionals’ opinions about medication adherence after attending a course, collecting suggestions for future educational programs. Method. A one-week course on medication adherence in older adults was held involving 32 healthcare professionals and students from Italy, Portugal and Poland as part of the Erasmus+ Skills4Adherence Project. Prior to and at the end of the course, participants provided three keyword answers through a Google Form. Responses were collectively discussed and commented on. Results. At the end of the course a general tendency to put more attention on patient’s beliefs and engagement was revealed. The caregivers’ role was also underlined. As to suggestions for education, three keywords were considered not enough to characterize adherence issues. Conversely, professionals considered collective discussions and roleplaying to be effective for increasing awareness on this theme. Discussion and conclusion. Several changes in healthcare professionals’ opinions regarding determinants of medicationadherence were revealed after this dedicated course. Overall, multidisciplinary and practical training programs should be proposed for increasing healthcare professionals’ awareness of factors impacting on medication adherence in older adults.

Evaluating best evidence in occupational therapy for patients with hip replacement: guidelines

Giovanni Galeoto — 2021-04-01

Object. The following study was carried out in order to evaluate through guidelines the best evidence in occupational therapy for daily activities and quality of life of patients with hip prostheses. Methods. Recommendations were generated following the grading method of the National Program for Guidelines/National System Guidelines (PNLG-SNLG), a system for developing guidelines for recommendations in clinical practice. The Appraisal of Guidelines Research & Evaluation in Europe (AGREE) tool was also applied. Results. A total of seven studies were included in this research: one randomized controlled trial, two systematic reviews, two outcomes research studies, and two observational studies. We found that, for the three clinical questions we proposed, more research on the effectiveness of treatments is required. Conclusions. The evidence resulting from this study is not sufficient to determine whether the rehabilitation techniques under consideration are effective.

ICF model implementation in an interdisciplinary intervention for intraparenchymal hemorrhage (IPH) with focus on neuropsychological functioning: a case report

Martina Vigorè — 2021-04-01

Spontaneous intraparenchymal hemorrhage (IPH) is relatively common and has a very important impact on clinical outcomes, motor and functional abilities and it may affect different cognitive domains. A 60-year-old male was admitted in post-acute phase, at Istituti Clinici Scientifici Maugeri IRCCS, to undertake neuro-motor treatment for a period of 4 months. The patient was affected by IPH. The clinical presentation revealed left hemiparesis, mild dysphagia, cognitive deficits (attention, visuospatial abilities and executive functions), psychiatric symptoms, emotional dysregulation and previous difficulties in medication management. The patient received an intensive cognitive, motor, speech and occupational rehabilitative intervention. Neuropsychological, motor, speech and occupational assessment and computerized tomography were performed before and after rehabilitative training to evaluate changes after the interdisciplinary intervention. The patient showed an improvement in cognitive, motor, speech and functional performances as well as in emotional aspects. After 1 year at home, the patient performed an outpatient visit that shown the substantial maintenance of the performances reached after the rehabilitative intervention. Rehabilitative interventions after IPH should always be provided by interdisciplinary teams in order to reach the best possible clinical outcomes and to maintain them over time.

The assessment of quality of life and arthropathy In the adult hemophilic patient

Giuseppe Di Natali — 2021-04-01

Haemophilia in its most severe clinical form can lead to alterations in the physical and psychosocial state with important repercussions on the quality of life. Purpose. A retrospective study was conducted to highlight the impact of haemophilic arthropathy on quality of life. Materials. We considered 25 patients, with a mean age of 42 years (min 17 – max 71) with haemophilia A, 18 had the severe clinical form (72%). The WFH Physical Examination Score, specific for haemophilia, was used for joint function; the joints examined were: knee, ankle, hip and elbow. To assess the quality of life, two generic self-filling questionnaires were used, SF-36 and the EQ 5D. Results. Significant statistical values have shown that arthropathy affects the SF-36 domain of general health (p < 0.010) and the subjective well-being EQ-VAS (p = 0.007). Conclusions. In the treatment of haemophilic arthropathy, prevention is essential, understood both as a prophylactic medical therapy and as a physiotherapeutic treatment in order to maintain or improve joint function and at the same time play a fundamental role in improving the quality of life of patients.

The punctuation of silence

Claudia Pisani — 2021-04-01

How do we stand facing silence, as human beings before therapists? A look at the silence in music and in the therapeutic field to focus attention to silence as tool for Music Therapy. In Latin Language we have two words to define silence, tacere and silere and the nuances between their meanings arise clearly; recognize them in our daily life and in the therapeutic relationship can be a source to achieve an authentic listening and a greater awareness of the time of return to the sound gesture. Moreover, looking for pauses in therapeutic listening, open to stimulating field of research on the bodily effects caused not only by the peculiarities of the musical (melody, harmony, rhythm, timbre), but also by the different balances between sound and silence.