rubrica

Lavoro

  • Dario Consonni1

  1. Clinica del lavoro, Milano

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Ricerca bibliografica periodo 15 ottobre 2010 – 17 gennaio 2011

 

Di ogni articolo è disponibile l'abstract. Per visualizzarlo basta cliccare sul titolo.

Gli articoli sono stati separati per i seguenti capitoli:

LEGISLAZIONE, MEDICINA LEGALE

1. Crosignani P, Amendola P, Scaburri A, Chiappino G, Marinaccio A. Confounders and confusion: Dealing with cancer cases of occupational origin. Am J Ind Med. 2010 Oct;53(10):1002-5.
Fondazione IRCCS Istituto dei Tumori, Milano, Italy. occam@istitutotumori.mi.it
Abstract
BACKGROUND: The recognition of occupational cancers is often hampered by confusion between the individual determinants of the disease and effects at the group level. METHODS: Here we propose an approach, based on the evaluation of the attributable risk at the group level, that provides quantitative estimates of the roles of multiple causes in individuals affected of cancer within a population exposed to  occupational risk. RESULTS: The estimate of individual probability can be easily obtained computing  the attributable risk. This can be often achieved by using the existing information available in the literature. CONCLUSIONS: Dismissing the occupation as a cause of a cancer in an exposed subject on the sole basis of potential confounding is erroneous and should be withdrawn from medical practice.

Breve commento a cura di Dario Consonni
La nota di commento mostra l’applicazione al singolo di una misura epidemiologica di impatto nella popolazione e ribadisce alcuni concetti relativi alla definizione del nesso di causalità nel caso dei tumori di sospetta origina professionale. Utile per gli epidemiologi ma forse ancora di più per i medici del lavoro (e i medici in generale), coinvolti sia nella fase di denuncia di sospetta malattia professionale che nella fase di giudizio come consulenti.

2. Alpaca RI, Rota C, Canali C, Migliore A, Di Rico R, Trenti T, Cariani E. Effectiveness of the biological monitoring of chemical exposure in the workplace: Results of a survey in an area of Northern Italy.  Int J Hyg Environ Health. 2010 Oct 16. [Epub ahead of print]
Workplace Prevention and Safety Service (SPSAL), South Area, Azienda Unità Sanitaria Locale (AUSL) Modena, Modena, Italy.
Abstract
A survey of biological monitoring results from 2000 to 2008 was carried out as a  part of institutional activities performed by the Workplace Prevention and Safety Service (SPSAL) of the south area of Modena district (Italy). The survey involved 18 companies employing 945 workers altogether. According to workplace exposure, routine biological monitoring had been carried out yearly or 6-monthly in private laboratories chosen by each company. Analysis of consecutive data from six plants showed fluctuating biomarker levels inconsistent with expected occupational exposure and sometimes exceeding biological exposure indices. Surveillance samplings were thus organized for comparison to be carried out in a public reference laboratory. Overall results showed systematic underestimation of marker levels by the laboratories in charge of routine biomonitoring that, together with inappropriate biomarker selection and timing of sample collection, led to insufficient and/or ineffective corrective measures. These results raise major concerns on the reliability of laboratory assessments performed for the routine biomonitoring of exposed workers. Continuous surveillance of the consistency between biological and ambient monitoring data, together with the systematic evaluation of the analytical quality of laboratory results, would be essential for a reliable assessment of health risk in the workplace.

Breve commento a cura di Dario Consonni
Questo articolo mette il dito nella piaga dell’applicazione delle norme per la prevenzione negli ambienti di lavoro, spesso assolte nella forma ma disattese nella sostanza. L’articolo pone sul piatto anche il problema della qualità del settore privato nel campo della prevenzione (e della sanità in generale).

3. Mastrangelo G, Lange JH, Fadda E, Agostini O, Agnesi R, Bardin A, Cegolon L. The evaluation of a health education campaign on the use of leave from work during pregnancy. BMC Public Health. 2010 Nov 12;10:694.
Padua University, Department of Environmental Medicine and Public Health, Padua, Italy.
Abstract
BACKGROUND: The Italian Protective Maternity Legislation allows a woman to apply  for early maternity leave from work during pregnancy if she is affected by health problems (option A) or if her working conditions are incompatible with pregnancy  (option B). A community based health education program, implemented between 1995  to 1998 in North Eastern Italy, provided counseling (by a team of gynecologists,  pediatricians, geneticists, psychologists and occupational physicians), and an information leaflet detailing the risks during pregnancy and the governmental benefits available to expectant mothers. This leaflet was distributed to women who were under occupational medical surveillance and to women attending any healthcare office and outpatient department and was also mailed to women working  at home as shoemakers.The effectiveness of this intervention has been evaluated in this investigation using an evidence based approach. METHODS: A quasi-experimental design was adopted, applying several outcome measurements before (1989 to 1994) and after (1999 to 2005) the intervention. The outcome (ratio B/A) is the number of women receiving approval for B (circumstance where the pregnant woman is employed to undertake activities forbidden under the  Article 7 of Law 151/2001, and it is impossible to change her duties) to those receiving approval for A (risky pregnancy due to personal medical conditions, Article 17 of the same Law). A linear regression coefficient (for B/A against years) was obtained separately for time periods "before" (1989-94) and "after" (1999-2005) the intervention program. The two regression coefficients were compared using a t-test. RESULTS: The trend over-time for the ratio B/A was steady before the initial intervention (y = 0.008x - 16.087; t = 2.09; p > 0.05) then increased considerably (y = 0.0426x - 84.89; t = 19.55; p < 0.001) in coincidence with the  start of the education campaign. There was a significant difference between the two regression coefficients (t = 7.58; p < 0.001). CONCLUSION: From a bureaucratic perspective Option B is far more complicated than A. In fact it implies an active approach involving an arrangement between the claimant and the employer, who has to certify to the relevant Authority that the  woman's working conditions are incompatible with pregnancy. The increasing number of women availing of option B, as recommended, therefore suggests the suitability of such educational campaign(s).

INFORTUNI E FATTORI FISICI

1. Mastrangelo G, Rylander R, Buja A, Marangi G, Fadda E, Fedeli U, Cegolon L. Work related injuries: estimating the incidence among illegally employed immigrants. BMC Res Notes. 2010 Dec 8;3:331.
Padua University, Department of Environmental Medicine and Public Health, Padua, Italy. l.cegolon@gmail.com.
Abstract
ABSTRACT:BACKGROUND: Statistics on occupational accidents are based on data from registered employees. With the increasing number of immigrants employed illegally and/or without regular working visas in many developed countries, it is of interest to estimate the injury rate among such unregistered workers. FINDINGS: The current study was conducted in an area of North-Eastern Italy. The sources of information employed in the present study were the Accidents and Emergencies records of a hospital; the population data on foreign-born residents in the hospital catchment area (Health Care District 4, Primary Care Trust 20, Province of Verona, Veneto Region, North-Eastern Italy); and the estimated proportion of illegally employed workers in representative samples from the Province of Verona and the Veneto Region. Of the 419 A&E records collected between January and December 2004 among non European Union (non-EU) immigrants, 146 aroused suspicion by reporting the home, rather than the workplace, as the site of the accident. These cases were the numerator of the rate. The number of illegally employed non-EU workers, denominator of the rate, was estimated according to different assumptions and ranged from between 537 to 1,338 individuals. The corresponding rates varied from 109.1 to 271.8 per 1,000 non-EU illegal employees, against 65 per 1,000 reported in Italy in 2004.
CONCLUSIONS: The results of this study suggest that there is an unrecorded burden of illegally employed immigrants suffering from work related injuries. Additional efforts for prevention of injuries in the workplace are required to decrease this number. It can be concluded that the Italian National Institute for the Insurance of Work Related Injuries (INAIL) probably underestimates the incidence of these accidents in Italy.

Breve commento a cura di Dario Consonni
L’articolo, di attualità vista la continua evoluzione della dinamiche migratorie, cerca di quantificare l’entità della sottostima degli infortuni nel settore del lavoro sommerso. La metodica potrebbe  probabilmente essere facilmente applicata in altre aree a maggior prevalenza di lavoro illegale.

2. Montorselli NB, Lombardini C, Magagnotti N, Marchi E, Neri F, Picchi G, Spinelli R.Relating safety, productivity and company type for motor-manual logging operations in the Italian Alps. Accid Anal Prev. 2010 Nov;42(6):2013-7. Epub 2010 Jul 7.
Department of Environmental Science and Technology in Forestry, University of Florence, Via S. Bonaventura 13, I-50145 Firenze, Italy. montorselli@unifi.it
Abstract
The study compared the performance of four different logging crews with respect to productivity, organization and safety. To this purpose, the authors developed  a data collection method capable of providing a quantitative analysis of risk-taking behavior. Four crews were tested under the same working conditions, representative of close-to-nature alpine forestry. Motor-manual working methods were applied, since these methods are still prevalent in the specific study area, despite the growing popularity of mechanical processors. Crews from public companies showed a significantly lower frequency of risk-taking behavior. The best safety performance was offered by the only (public) crew that had been administered formal safety training. The study seems to deny the common prejudice that safety practice is inversely proportional to productivity. Instead, productivity is increased by introducing more efficient working methods and equipment. The quantitative analysis of risk-taking behavior developed in this study can be applied to a number of industrial fields besides forestry. Characterizing risk-taking behavior for a given case may eventually lead to the development of custom-made training programmes, which may address problem areas while avoiding that the message is weakened by the inclusion of redundant information. In the specific case of logging crews in the central Alps, the study suggests that current training courses may be weak on ergonomics, and advocates a staged training programme, focusing first on accident reduction and then expanding to the prevention of chronic illness.
3. Proto AR, Zimbalatti G. Risk assessment of repetitive movements in the citrus fruit industry.  J Agric Saf Health. 2010 Oct;16(4):219-28.
Department of Agroforestry and Environmental Sciences and Technologies, Mediterranean University of Reggio Calabria, Feo di Vito, Reggio Calabria 89122, Italy. andrea.proto@unirc.it
Abstract
Musculoskeletal disorders are injuries of the muscles, nerves, tendons, ligaments, joints, cartilage, or spinal discs and are often classified as soft tissue injuries. They are the result of chronic or gradual development and are not caused by acute incidents such as slips, trips, or falls. The significance of this phenomenon prompted us to carry out a broader study of pathologies attributable to repetitive movements in the upper limbs within the citrus growing industry. Calabria, a very important region for citrus fruit growing in Italy, was chosen as the study area. The study analyzed the risks of repetitive movements for 180 workers on 35 different farms using the OCRA (Occupational Repetitive Actions) checklist method By analyzing the scores obtained in the different work phases, it was possible to determine the tasks that incur more risk in the citrus fruit industry. The OCRA checklist considers all the repetitive tasks involved in a complex job and estimates the level of exposure to each worker. In support of the specific aims of the present study, it is possible to identify a series of working conditions for which the level of risk may be easonably estimated and for which it is possible to adopt a checklist system. The results of this study suggest that there must be a significant increase in the use of effective ergonomic interventions in the workplace in order to attain reductions in the number of local musculoskeletal complaints.
4. Zanardi F, Cooke RM, Maiorana A, Curti S, Farioli A, Bonfiglioli R, Violante FS, Mattioli S. "Is this case of a very rare disease work-related?" A review of reported cases of Pacinian neuroma. Scand J Work Environ Health. 2010 Nov 17. [Epub ahead of print]
Università di Bologna, Unita Operativa di Medicina del Lavoro, Policlinico S.Orsola-Malpighi, via Pelagio Palagi, 9, I-40138 Bologna, Italy.s.mattioli@unibo.it.
OBJECTIVE: In response to a request for a medicolegal opinion from an orthopaedic technician with pacinian neuroma of the hand, we conducted a systematic review of reported cases designed to assess whether this rare disease could be considered as being work-related. METHODS: We used Medline, Embase, Google Scholar, Google and a manual search to identify reports of histologically confirmed pacinian neuroma of the hand manifesting after 15 years of age. Cases with available information (from article/authors) on personal history were considered eligible.  We tabulated information on age/gender; localization and histopathologic features; signs/symptoms; history of local trauma; occupation, sports/hobbies or  other physical exposures; right- or left-handedness; and outcome. RESULTS: We found 44 eligible cases (including the present referral). Of these, 21 (48%) followed a trauma [<6 months from onset/presentation (N=7); 0.5-2 years from onset (N=6); ≥2 years from onset (N=7)] involving the same anatomic site. Three of these 21 traumas definitely occurred at work, and a further 2 cases occurred at the site of definite work-related repetitive microtrauma. CONCLUSIONS: The results reinforce the concept that pacinian neuroma of the hand can follow local  trauma or repetitive microtrauma. Implicated traumas were either recent or remote, and they sometimes occurred while performing manual tasks at work. We concluded that the referred case could plausibly be considered work-related.
5. Vanacore N, Cocco P, Fadda D, Dosemeci M. Job strain, hypoxia and risk of amyotrophic lateral sclerosis: Results from a death certificate study. Amyotroph Lateral Scler. 2010 Oct;11(5):430-4.
Centro Nazionale di Epidemiologia, Istituto Superiore di Sanità, Roma, Italy.nicola.vanacore@iss.it
Abstract
Amyotrophic lateral sclerosis (ALS) most likely results from a multifactorial gene-environment interaction. Strenuous physical activity and occupational exposures have been suggested to play a role, and an abnormal response to hypoxia has been proposed in ALS pathogenesis. To test the hypothesis of an excess risk in occupations typically leading to intermittent hypoxia at the tissue level, we  accessed a large publicly available database, including death certificates from 24 U.S. states in 1984-1998. We conducted a case-control analysis of 14,628 deaths due to ALS therein reported and 58,512 controls deceased from other selected causes of death, frequency matched by age, gender and broad geographic area. ALS risk associated with physical activity, and occupations leading to intermittent hypoxia, such as fire fighters and professional athletes, were calculated with unconditional logistic regression, adjusting by age, marital status, residence, and socioeconomic status. Physical activity in general did not show an association with ALS risk. Risk associated with occupation as a professional athlete was elevated (OR = 1.81, 99% CI 0.69-4.78), but not significantly so. Fire fighters showed a significant two-fold excess ALS risk (OR = 2.0; 99% CI 1.2-3.2). Based on our findings and the current clinical, epidemiological and experimental evidence, we suggest that occupational conditions typically leading to intermittent hypoxia, such as fire fighting, might be an ALS risk factor in subjects genetically prone to an abnormal response to hypoxia.

FATTORI DI RISCHIO IN OSPEDALE

1. Sottani C, Porro B, Comelli M, Imbriani M, Minoia C. An analysis to study trends in occupational exposure to antineoplastic drugs among health care workers.J Chromatogr B Analyt Technol Biomed Life Sci. 2010 Oct 1;878(27):2593-605. Epub 2010 Apr 28.
Laboratory for Environmental and Toxicological Testing, IRCCS Pavia, S. Maugeri Foundation, via S. Maugeri 10, Pavia, Italy. cristina.sottani@fsm.it
Abstract
The use of antineoplastic agents for the treatment of cancer and other non-neoplastic diseases is an increasingly common practice in hospitals. As a result, workers involved with handling antineoplastic drugs may be accidentally exposed to these agents, placing them at potential risk for long term adverse effects. To date, the challenge of protecting workers' health is persisting and expanding, with an increasing number of publications demonstrating that contamination of antineoplastic drugs (ADs) is still present on work surfaces after cleaning procedures are concluded. In this paper, five workplaces were selected for surveillance of professional exposure to ADs. Hospital pharmacies involved in the study were set in the North (Units A1 and B2), Center (Units C3 and D4) and South (Unit E5) of Italy. Contamination levels on a number of work surfaces and trends over a 10-year period are presented. Environmental and biological levels were obtained by high performance liquid chromatography (HPLC)  coupled with tandem mass spectrometry (MS/MS). A strong reduction of surface contamination was evidenced since 2003, when the recommended procedures for the safe handling of antineoplastic drugs started to be followed by health care workers. Employers' adherence to these recommendations allowed risk characterisation to achieve other important goals. The percentage of positive urine samples was found to be around 30% in the 1990s and 2% in the 2000s. Moreover, no positive samples were detected in 2006 or 2007. In conclusion, our study emphasized that one helpful strategy to reduce risk to all potentially exposed workers is also provided by a data-storage system that allows potential risks of working to be rapidly identified and controlled.
2. Villarini M, Dominici L, Piccinini R, Fatigoni C, Ambrogi M, Curti G, Morucci P,  Muzi G, Monarca S, Moretti M. Assessment of primary, oxidative and excision repaired DNA damage in hospital personnel handling antineoplastic drugs.  Mutagenesis. 2010 Nov 26. [Epub ahead of print]
Department of Medical-Surgical Specialties and Public Health University of Perugia, Via del Giochetto, 06122 Perugia, Italy.
Abstract
The International Agency for Research on Cancer has classified several antineoplastic drugs in Group 1 (human carcinogens), among which chlorambucil, cyclophosphamide (CP) and tamoxifen, Group 2A (probable human carcinogens), among which cisplatin, etoposide, N-ethyl- and N-methyl-N-nitrosourea, and Group 2B (possible human carcinogens), among which bleomycins, merphalan and mitomycin C.  The widespread use of these mutagenic/carcinogenic drugs in the treatment of cancer has led to anxiety about possible genotoxic hazards to medical personnel handling these drugs. The aim of the present study was to evaluate work environment contamination by antineoplastic drugs in a hospital in Central Italy  and to assess the genotoxic risks associated with antineoplastic drug handling. The study group comprised 52 exposed subjects and 52 controls. Environmental contamination was assessed by taking wipe samples from different surfaces in preparation and administration rooms and nonwoven swabs were used as pads for the surrogate evaluation of dermal exposure, 5-fluorouracil and cytarabine were chosen as markers of exposure to antineoplastic drugs in the working environment. The actual exposure to antineoplastic drugs was evaluated by determining the urinary excretion of CP. The extent of primary, oxidative and excision repaired DNA damage was measured in peripheral blood leukocytes with the alkaline comet assay. To evaluate the role, if any, of genetic variants in the extent of genotoxic effects related to antineoplastic drug occupational exposure, the study subjects were genotyped for GSTM1, GSTT1, GSTP1 and TP53 polymorphisms. Primary DNA damage significantly increased in leukocytes of exposed nurses compared to controls. The use of personal protective equipment (i.e. gloves and/mask) was associated with a decrease in the extent of primary DNA damage.
3. Signorotto P, del Vecchio A, Montorfano M, Maisano F, Giagnorio M, Bellanca R,Colombo A, Calandrino R. Dosimetric data and radiation risk analysis for new procedures in interventional cardiology. Radiat Prot Dosimetry. 2010 Dec;142(2-4):201-8. Epub 2010 Sep 21.
Medical Physics Department, San Raffaele Scientific Institute, Milano, Italy.
Abstract
The purpose of this study was to evaluate radiation doses to the patients and operators during interventional cardiology procedures, with a particular focus on the transcatheter aortic valve implantation (TAVI). Patient doses for 5549 diagnostic and therapeutic procedures and 76 TAVI were examined, as well as occupational doses to Cardiology Department operators. The average patient dose for TAVI was double that of PTCA and six times higher than a simple CA; statistically significant differences were shown in the average patient dose for  both transfemoral and transapical access; the measurements show a corresponding increase in the average occupational dose for the cardiologist. Interventional cardiology could increase the collective dose and occupationally exposed worker doses; this increase could be significant if the use of certain procedures is extended to younger people; particular attention in the choice of procedure, optimisation and staff education and organisation is therefore suggested.

INQUINAMENTO

1. Sancini A, Tomei F, Tomei G, Ciarrocca M, Palermo P, Gioffrè PA, Tasciotti Z, Fiaschetti M, Cetica C, Caciari T. Exposure to urban stressors and free testosterone plasma values. Int Arch Occup Environ Health. 2010 Nov 11. [Epub ahead of print]
Department of Occuptional Medicine, Universita' di Roma "Sapienza", Viale Regina Elena 336, 00161, Rome, Italy
Abstract
OBJECTIVES: The chemical agents present in the environment, such as traffic pollutants, may affect male fertility. Traffic policemen are daily exposed to traffic pollutants. The aim of this study is to evaluate whether occupational exposure to urban stressors could cause alterations in free testosterone plasma values in male traffic policemen versus administrative staff of Municipal Police  of a big Italian city. METHODS: Both groups were divided into two subgroups based on age (first group: 30-40 years; second group: 41-50 years) to assess whether age could affect laboratory results of free testosterone plasma levels in traffic policemen versus controls. The characterization of exposure to urban pollutants for traffic policemen was assessed using the concentrations of pollutants monitored in fixed stations. A total of 220 subjects were studied: 110 traffic policemen and 110 controls, after excluding subjects with main confounding factors. RESULTS: Mean free testosterone values were significantly lower in traffic policemen than in controls (P < 0.001). Such statistical reduction persisted stratifying the mean testosterone values for classes of age (30-40 and  41-50 year) of workers (respectively P < 0.001 and P < 0.001). The distribution into classes of testosterone values in traffic policemen and in controls was significant (P < 0.001), and this result persisted after the stratification for classes of age of workers (30-40 year: P < 0.001) (41-50 year: P < 0.001). CONCLUSIONS: According to data in literature, free testosterone plasma levels could be used as an early biological marker, to be employed in occupational sets, valuable for the group, even before the onset of values out of range and of fertility disorders.
2. Calogero AE, La Vignera S, Condorelli R, Perdichizzi A, Valenti D, Asero P, Carbone U, Boggia B, De Rosa N, Lombardi G, D'Agata R, Vicari E, De Rosa M. Environmental car exhaust pollution damages human sperm chromatin and DNA. J Endocrinol Invest. 2010 Oct 15. [Epub ahead of print]
Section of Endocrinology, Andrology and Internal Medicine and Master in Andrological, Human Reproduction and Biotechnology Sciences, Department of Biomedical Sciences, University of Catania, Catania, Italy. acaloger@unict.it.
Abstract
Objective: The adverse role of traffic pollutants on male fertility is well known. Aim of this study was to evaluate their effects on sperm chromatin/DNA integrity. Methods: To accomplish this, 36 men working at motorway tollgates and  32 unexposed healthy men (controls) were enrolled. All of them were interviewed about their lifestyle. Hormone, semen samples and environmental and biological markers of pollution were evaluated. Sperm chromatin and DNA integrity were evaluated by flow cytometry following propidium iodide staining and TUNEL assay, respectively. Results: LH, FSH and testosterone serum levels were within the normal range in tollgate workers. Sperm concentration, total sperm count, total and progressive motility, and normal forms were significantly lower in these men  compared to controls. Motorway tollgate workers had a significantly higher percentage of spermatozoa with damaged chromatin and DNA fragmentation, a late sign of apoptosis, compared to controls. A significant direct correlation was found between spermatozoa with damaged chromatin or fragmented DNA and the length of occupational exposure, suggesting a time-dependent relationship. Conclusion: This study showed that car exhaust exposure has a sperm genotoxic effect on human spermatozoa. This may be of relevant importance not only for the reproductive performance of the men exposed, but also for the offspring health.

FATTORI PSICOSOCIALI

1. Ferrario MM, Veronesi G, Chambless LE, Sega R, Fornari C, Bonzini M, Cesana G. The contribution of major risk factors and job strain to occupational class differences in coronary heart disease incidence: the MONICA Brianza and PAMELA population-based cohorts. Occup Environ Med. 2010 Dec 30. [Epub ahead of print]
Dipartimento di Medicina Sperimentale, Università degli Studi dell'Insubria, Varese, Italy.
Abstract
Objectives We investigated the contribution of major coronary heart disease (CHD) risk factors and job strain to occupational class differences in CHD incidence in a pooled-cohort prospective study in northern Italy. Methods 2964 men aged 25-74 from four northern Italian population-based cohorts were investigated at baseline and followed for first fatal or non-fatal CHD event (171 events). Standardised procedures were used for baseline risk factor measurements, follow-up and validation of CHD events. Four occupational classes were derived from the Erikson-Goldthorpe-Portocarero social class scheme: higher and lower professionals and administrators, non-manual workers, skilled and unskilled manual workers, and the self-employed. HRs were estimated with Cox models. Results Among CHD-free subjects, with non-manual workers as the reference group, age-adjusted excess risks were found for professionals and administrators (+84%, p=0.02), the self-employed (+72%, p=0.04) and manual workers (+63%, p=0.04). The relationship was consistent across different CHD diagnostic categories. Adjusting for major risk factors only slightly reduced the reported excess risks. In a sub-sample of currently employed subjects, adjusting for major risk factors, sport physical activity and job strain reduced the excess risk for manual workers (relative change = -71.4%) but did not substantially modify the excess risks of professionals and administrators and the self-employed. Conclusions In our study, we found higher CHD incidence rates for manual workers, professionals and administrators, and the self-employed, compared to non-manual workers. When the entire spectrum of job categories is considered, the job strain model helped explain the CHD excess risk for manual workers but not for other occupational classes.
2. d'Errico A, Cardano M, Landriscina T, Marinacci C, Pasian S, Petrelli A, Costa G. Workplace stress and prescription of antidepressant medications: a prospective study on a sample of Italian workers. Int Arch Occup Environ Health. 2010 Oct 16. [Epub ahead of print]
Epidemiology Unit ASL TO3-Piedmont Region, Via Sabaudia 164, Grugliasco, TO,Italy, angelo.derrico@epi.piemonte.it.
Abstract
PURPOSE: The main aim of this study was to examine prospectively the relationship between antidepressant prescriptions (ADP), as a proxy of depressive symptoms, and work-related stress, measured according to the demand-control model. METHODS: A cohort of 2,046 union workers who participated in a survey on working conditions and health in 1999-2000 was followed up to 2005, through the Regional  Drug Prescription Register, for an ADP. The relative risks associated with demand, control and job strain were estimated using Poisson regression, adjusting for age, sex and other workplace factors (shift work, overtime, loud noise and psychological violence). RESULTS: In final multivariable models, high demand significantly increased the risk of depressive symptoms among blue collars (RR = 1.82), whereas among white collars, it was significantly protective (RR = 0.38). No significant relationship was found for job control or strain in either occupational class. CONCLUSIONS: The direct association observed elsewhere among blue collars between depressive symptoms and demand was confirmed, but not  for job control or job strain. It cannot be ruled out that the association with demand was at least in part determined by reverse causation, due to exposure over-reporting among subjects with subclinical depressive symptoms at baseline. The protective effect of demand among white collars is not consistent with the literature and may be attributable to the particular characteristics of this sample, which included mainly workers employed in public administrative positions.