Cystic malformation of the aqueduct and of the fourth ventricle.
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Brain Diseases↗
Biomedical subjects
E Occhipinti
Publications and source records attributed to E Occhipinti.
[The assessment of exposure to and the activity of the manual lifting of patients in wards: methods, procedures, the exposure index (MAPO) and classification criteria. Movimientazione e Assistenza Pazienti Ospedalizzati (Lifting and Assistance to Hospitalized Patients)].
Since a method for quantifying exposure to patient handling in hospital wards is lacking, the authors describe and propose a model for identifying the main risk factors in this type of occupational exposure: presence of disabled patients, staff engaged on manual handling of patients, structure of the working environment, equipment and aids for moving patients, training of workers according to the specific risk. For each factor a procedure for identification and assessment is proposed that is easily applicable in practice. The authors also propose a formula for the calculation of a condensed exposure index (MAPO Index), which brings together the various factors. The exposure index, which requires further, detailed study and validation, makes it possible, in practice, to plan the preventive and health measures according to a specific order of priority, thus complying with the requirements of Chapter V of Law 626/94. From a practical point of view, in the present state of knowledge, it can be stated that for MAPO Index values between 0 and 1.5, risk is deemed negligible, average for values between 1.51 and 5, and high for values exceeding 5.
Environment, Controlled↗
[Clinical studies in health workers employed in the manual lifting of patients: methods for the examination of spinal lesions].
To enable different research groups to make a standardized collection of clinical data on alterations of the lumbar region of the spine, protocols were used for the collection and classification of data that were proposed and thoroughly validated by the authors. The protocols include a clinical/functional examination of the spine, checking for positive anamnestic threshold, for pain on pressure/palpation of the spiny apophyses and paravertebral muscles, for painful movements, in order to classify 1st, 2nd and 3rd grade functional spondylarthropathy (for different regions of the spine). An ad hoc questionnaire was also prepared for the quantitative and qualitative study of true acute low back pain and the ingravescent low back pain controlled at the onset pharmacologically. The results of this questionnaire make it possible to calculate the incidence of acute low back pain (true and pharmacologically controlled).
Female↗
[The assessment of the risk due to the manual lifting of patients: the initial descriptive and analytical results on exposure levels].
The paper reports the results of risk evaluation of patient lifting or moving obtained from a multicentre study on 216 wards, for both acute hospital patients and in geriatric residences. In all situations the exposure to patient lifting was assessed using a concise index (MAPO). Analysis of the results showed that only 9% of the workers could be considered as exposed to negligible risk (MAPO Index = 0-1.5); of these 95.7% worked in hospital wards and only 4.3% in geriatric wards. A further confirmation of the higher level of exposure of workers in long-term hospitalization was that 42.3% were exposed to elevated levels (MAPO Index > 5) compared with 27.7% observed in hospital ward workers. The mean values of the exposure index were 6.8 for hospital wards and 9.64 for geriatric residences and, although much higher in the latter, both categories showed high exposure. In the orthopaedic departments of the hospitals the values were higher than in the geriatric wards (MAPO Index = 10.1); medical and surgical departments showed values similar to the mean values observed in the geriatric wards. These high values were due to: severe shortage of equipment life lifting devices (95.5%) and minor aids (99.5%), partial inadequacy of the working environment (69.2%), poor training and information (96.1% lacking); only the supply of wheelchairs was adequate (65.8%). All of which points to an almost generalized non-observance of the regulations listed under Chapter V of Law No. 626/94. However, the proposed method of evaluation allows anyone who has to carry out prevention and improvement measures to identify priority criteria specifically aimed at the individual factors taken into consideration. By simulating an intervention for improvement aimed at equipment and training, 96% of the wards would be included in the negligible exposure class (MAPO Index 0-1.5).
Humans↗
[The application of a synthetic index of exposure in the manual lifting of patients: the initial validation experiences].
Via a multicentre study coordinated by the EPM research group carried out in 216 wards in a total of 56 hospitals, old peoples homes and geriatric departments, it was possible to quantify exposure to patient handling (classified in 4 classes: 0-1.5 negligible, 1.51-5 slight to average, 5.01-10 average to high, > 10 elevated), and at the same time identify the damage to the lumbosacral spine thus caused. Both assessment of exposure and identification of health impairment were carried out using homogeneous methods. Subjects with work seniority in the job of less than 6 months and subjects who had been transferred because of back trouble were excluded from the study. It was therefore possible to carry out two types of study to assess the association between exposure and impairment. In study A, covering 3021 subjects, an analysis was performed of the association between exposure index, positive response to the anamnestic threshold for lumbosacral disorders and acute low back pain using the method of logistic analysis to obtain the prevalence odds ratios. In study B, covering 418 subjects, the analysis of association was performed on the incidence rates of episodes of acute low back pain and pharmacologically controlled acute low back pain, assuming that exposure in the wards had remained constant. The technique used was Poisson regression, thereby calculating the relative incidence rate ratios. Both for PORs and IRRs the reference group consisted of the exposure class judged as negligible (exposure index 0-1.5). The results showed that the PORs calculated for positive lumbar threshold were significant for increasing exposure classes with a positive trend for the second and third exposure class but not for the last, presumably due to a healthy worker selection effect. Neither in Study A nor in Study B were any associations observed between exposure and acute low back pain occurring in the previous 12 months: this may be due to the fact that the impairment indicator does not appear to be appropriate in terms of latency period. A different result was obtained in Study B which showed a good association between exposure and incidence rates of episodes of acute low back pain and pharmacologically controlled acute low back pain according to department. The IRRs showed a positive trend both for acute episodes (IRR: 1.932, 2.439, 2.847) and for acute plus pharmacologically controlled acute episodes (1.798, 1.830, 4.523). On the basis of these results, even with the caution required for the reasons explained in the text, it seems to be possible to identify three grades of exposure which correspond to increasing probability of impairment of the lumbosacral region of the spine: the first where risk seems negligible corresponds to an exposure level between 0 and 1.5. The second, where the episodes of low back pain may occur with an incidence 3.8 times greater, corresponds to an exposure level between 1.51 and 5, and the third corresponds to exposure levels exceeding 5, where the episodes of low back pain may occur with an incidence up to 5.6 times greater than expected.
Acute Disease↗
[Assessment criteria in the choice of aids for the lifting of patients].
A fundamental part of the prevention strategies aimed at reducing risk due to manual handling of patients is the use of appropriate aids. This paper defines the basic types of aids for hospital wards: patient lifting devices, aids for hygiene and minor aids; and also proposes a procedure for choice of the type of aid: the procedure uses a specific protocol and also analyzes work organization and the environmental features of the ward. The proposed criteria for choice concern in the first place the fundamental requirements of the equipment: safety for operator and patient, simplicity of use and comfort for the patient. Secondly the basic determinants for choice of the type of aid are the type of disabled patient usually present in the ward and the analysis of the movements made in handling patients. On this basis, for each type of aid, the specific features are defined which direct the choice of supply for the various wards that will be adequate and effective both in reducing risk due to manual handling of patients and in improving the comfort of the patients.
Equipment and Supplies, Hospital↗
[The management of cases of "conditional" work fitness due to spinal pathologies in health personnel].
On the basis of the trend in the literature, a process was identified, that uses the results of assessment of exposure to manual handling of patients, in order to practically manage, according to defined priorities, the transfer to other jobs of a large number of cases (about 8-10% of the workforce) that were potentially unfit due to back disorders. Aside from the procedures for clinical classification and grading of the severity of the disorders, which have been dealt with elsewhere, general indications are given for the association of cases of disease with assistance to hospitalised patients according to the spinal involvement required, with appropriate evaluation and classification into different degrees of severity. It is recommended to keep the system of association "cases of disease/workplace" dynamic over time so as to guarantee the best possible working conditions practically and technically achievable, especially for these subjects.
Disability Evaluation↗
Remarks concerning 102 watersoluble contrast ventriculographies.
The Authors report their experience in using water-soluble contrast medium in ventriculographies having carried out 102 ventriculographies partly with Dimer X and partly with "Uromiro 300". Their conclusions are practically similar to those already reported by the many Authors who have written on this subject: 1) facility of examination particularly in urgent cases; 2) excellent neuroradiological definition of the cases; 3) possibility of obtaining a selective ventriculography; 4) indication especially in space-occupying lesions of the posterior cranial contrast medium; 6) possibility of reducing complication rate by carefully carrying out the examination and by avoiding the use of excessive quantities of contrast. In particular the Authors describe some useful methods for obtaining better technical results from the examination and reducing the complication rate.
Aged↗
[Aging at work and musculoskeletal disorders].
By means of a critical review of the international literature and of their own published experiences, the Authors discuss the influence of the "age" factor on work related musculoskeletal disorders of the spine and upper limbs. Regarding the spine, the lumbosacral spine in particular, there is evidence (both in relation to pathways and from epidemiological data) of the influence of age in determining a progressive increase in the occurrence of spondyloarthropathy with clear radiological signs. For upper limb disorders the influence of the "age" factor is still under debate and in any case does not seem of great importance. As far prevention is concerned for elderly workers subject to fixed postures and repetitive movements of the upper limbs it seems sufficient, to adopt the general measures used for the whole working population. However, specific measures should be adopted for elderly workers exposed to manual material handling (MMH). These consist in using reference values for the recommended weight that are lower than those adopted for younger workers (aged 18-45 years) and in implementing specific programs of active health surveillance.
Adolescent↗
[Proposal and preliminary validation of a check-list for the assessment of occupational exposure to repetitive movements of the upper lims].
Over the last few years the Authors developed and implemented, a specific check-list for a "rapid" assessment of occupational exposure to repetitive movements and exertion of the upper limbs, after verifying the lack of such a tool which also had to be coherent with the latest data in the specialized literature. The check-list model and the relevant application procedures are presented and discussed. The check-list was applied by trained factory technicians in 46 different working tasks where the OCRA method previously proposed by the Authors was also applied by independent observers. Since 46 pairs of observation data were available (OCRA index and check-list score) it was possible to verify, via parametric and nonparametric statistical tests, the level of association between the two variables and to find the best simple regression function (exponential in this case) of the OCRA index from the check-list score. By means of this function, which was highly significant (R2 = 0.98, p < 0.0000), the values of the check-list score which better corresponded to the critical values (for exposure assessment) of the OCRA index looked for. The following correspondance values between OCRA Index and check-list were then established with a view to classifying exposure levels. The check-list "critical" scores were established considering the need for obtaining, in borderline cases, a potential effect of overestimation of the exposure level. On the basis of practical application experience and the preliminary validation results, recommendations are made and the caution needed in the use of the check-list is suggested.
Arm↗
Exposure assessment of upper limb repetitive movements: a consensus document developed by the Technical Committee on Musculoskeletal Disorders of International Ergonomics Association (IEA) endorsed by International Commission on Occupational Health (ICOH).
This consensus document intends to supply a set of definitions, criteria and procedures useful to describe and, wherever possible, to assess the work conditions that can represent a physical overload for the upper limbs. The document is aimed at all the operators, i.e. occupational doctors but mainly technicians, who are, involved in risk exposure assessment and management. The document intends to provide methods and procedures easily applicable in the field, possibly not requiring sophisticated instrumentation and when possible based on observation procedures. The proposed methods shall be based as far as possible on knowledge and data from scientific literature: should they be contradictory or deficient, reference will be made to standards or pre-standards issued by national and international agencies and bodies, with the experience of researchers involved and common sense. In this regard, it is to be emphasized that the potential users increasingly demand an easily applicable method for description and assessment of work with repetitive movements. The group intends to give a response even if there are still uncertainties from a strictly scientific standpoint: however the group commits itself to perform subsequent validations especially of as yet unconsolidated issues. This document focuses specifically on identification of risk factors and describes some of the methods that have been developed for evaluating them. There is a rapidly developing body of literature on job analysis and not yet agreement on a single best way to analyze jobs. Professional judgement is required to select the appropriate methods. Analysis and design of jobs should to be integrated into an ongoing ergonomics program that includes management commitment, training, health surveillance, and medical case management. In summing up this report, space must be given to the check lists that are so often seen in the medical press, although this is not the occasion to propose a detailed analytical review.
Arm↗
Angiographic evaluation of the operability of some posterior fossa malformations in infancy.
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Arachnoid↗
Unusual late complication of ventriculo-atrial shunts: case report.
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Catheterization↗
[The experience of the EPM (Ergonomics of Posture and Movement) Research Unit in risk analysis and the prevention of work-related musculo-skeletal diseases (WMSDs)].
The twenty-year experience of the "Ergonomics of Posture and Movement (epm)" Research Unit for prevention of work-related musculoskeletal disorders (WMSDs) is briefly summarized. The epm research unit is the outcome of an agreement between Milan University (Clinica del Lavoro Luigi Devoto), Milan Polytechnic, Don Gnocchi Foundation IRCCS (Bioengineering Centre) and the Regional Health Service (CEMOC of ICP Hospital). Early activities of epm (1985-1993) are first outlined: they are characterized by a wide range of laboratory studies allowing the development of original methods and criteria for on-site analysis of fixed postures and awkward movements and for ad hoc clinical examination of the musculoskeletal apparatus in working populations. Epm contributions are reviewed for the analysis of working activity involving manual load handling (adapted NIOSH method) and hospital patients (MAPO method) as well as for standardization of health surveillance protocols of spinal diseases. Updated contributions are reported on analysis and prevention of upper limb MSDs connected with upper limb repetitive movements (OCRA method). Finally epm's main collaborations with national and international Authorities are summarized as well as the major technical (health promotion) publications addressed to operators and workers, in different working situations, for prevention of musculoskeletal disorders due to biomechanical overload.
Ambulatory Care Facilities↗
[Musculoskeletal conditions of the upper and lower limbs as an occupational disease: what kind and under what conditions. Consensus document of a national working-group. ISPESL].
BACKGROUND AND OBJECTIVES: In via of the progressive emergence in Italy of work-related musculoskeletal disorders, the EPM Research Unit decided to set up a national working group with the aim of producing a Consensus Document including methods and criteria as an initial attempt towards managing such diseases as true "listed" work-related diseases as is already done in the other European Union countries. The working group includes experts from INAIL, ISPESL, welfare assistance institutions, local prevention and health protection services: The group's research activity was included in ISPESL's funded research plan. CONTENTS: The Consensus Document includes a review of epidemiologic issues reported in the international literature, comments on the application of current legislation, observations on the guilt profiles of employers and occupational physicians, as well as medical-legal issues. The document proposes an analytical list of musculoskeletal disorders of upper (and lower) limbs and the operational criteria for identification of working activities involving a risk from upper limb biomechanical overload. In this case, more than on other occasions, it was realized how difficult it is to adopt consolidated task/risk/damage matrices since the same task may or may not be at risk depending both on the way the task is done and on the technical aspects (lines, work parts, procedures, tools) and organization (rate, rotas, breaks). CONCLUSIONS: For the specific aims of the present document, it is possible to identify, though not exhaustively and with some limitations, a series of jobs and working conditions where the risk may be reasonably presumed and for which it is possible to adopt a list system (at least as regards "significant exposure"). The document also includes a chapter on health surveillance recommendations for the occupational physician.
Adult↗
[Biomechanical overload diseases: epidemiologic data].
Work-related musculoskeletal disorders are a major problem for industrialised societies, particularly in view of the elevated prevalence of low back pain (LBP) and carpal tunnel syndrome (CTS) among manual workers. Epidemiological studies show that work-related risk factors, such as lifting, twisting, bending, exposure to whole body vibration, and prolonged postures are prominent risk factors for LBP. For CTS, repetitive movements, hand-arm vibrations and use of forceful hand movements appear to be the major work-related risk factors. Psychological and psychosocial factors can also affect the onset of both disorders. This review provides an overview of the main evidence in the scientific literature on these issues.
Biomechanical Phenomena↗
[Results of risk and impairment assessment in groups of workers exposed to repetitive strain and movement of the upper limbs in various sectors of industry].
BACKGROUND: This presents study the results of a number of investigations regarding risks associated with biomechanical overload of the upper limbs and the consequent health effects (UL-WMSDs) in a large sample of workers in various different jobs. METHODS: Risk assessment regarded 15 different working environments in which 4044 subjects were employed. Most were metalworking factories in which the workers performed assembly tasks (3015 workers). Some made motors for electrical appliances (714 workers), others assembled miniature components (shock absorbers and remote controls: 259 workers), while others handled larger sized parts such as components of large domestic appliances (refrigerators, freezers, ovens: 2037 workers). The sample also included workers in the meat processing industry (chicken and turkey, 969 workers) and hotel room cleaners (60). Exposure assessment was performed using the OCRA checklist for quantifying the risk attributable intrinsically to each individual workstation, as if used for the entire shift. The values thus obtained were entered into a special software program that, for each working area, produced mean weighted values for the results of the checklist and their percentage distribution over four categories: no risk (green), low risk (yellow), moderate risk (red) and high risk (purple). In 11 of the 15 working environments considered, a total of 3511 workers (2221 women and 1290 men) underwent a complete and standardized clinical examination of the upper limbs. Comparisons of the results of exposure evaluation and of the clinical surveys were made between the different types of jobs and between males and females.
Adult↗
[Sepsis by Candida in VLBW neonates: therapy with liposomal Amphotericin B].
Candida spp. are recently frequent cause of nosocomial sepsis in neonates admitted in NICU, expecially VLBW. Amphotericin B is used in the treament of infections caused by Candida, but heavy side effects, expecially due to renal toxiticy, prevent often its use in the VLBW neonates. We used a new formulation of Amphotericin (AmBisome--NEXSTAR), in the treatment of 17 VLBW neonates affected by sepsis caused by Candida albicans, admitted in our NICU during two years. Twelve neonates survived, one neonate died for NEC and bowel perforation. The treatment was prolonged for 13 days (7-33 days), the total amount of dose was 65 mg/Kg, none side effect was noted.
Amphotericin B↗