Search PubMed⌕ Search

Biomedical subjects

G Franco

Publications and source records attributed to G Franco.

At least 163 records · Page 9Linked to original sources
PubMedDate not supplied

[From scientific evidence to operative practice: towards a model of occupational medicine based on on efficacy evidence].

There is increasing interest in improving health care practice and in providing evidence-based health care, that is, care in which different stakeholders consistently consider research evidence when making decisions. Quality of health care is presently viewed as a goal towards which different health care settings are geared. In comparison with this approach and in spite of the large development potentialities, occupational health practice is only at the beginning of the process. ILO convention No. 161 already pointed out the need to provide customers with quality-oriented services and evidence-based services. Occupational health practice can be analysed by means of a general system model already established for health care systems including input (structure, management, personnel, equipment), process (activities, performance), output (advice, recommendation), outcome (good life quality, sickness absence, work ability). All these elements can be critically measured with appropriate indicators to evaluate their efficacy. Despite general agreement about the importance of such analysis, there is a lack of data on the efficacy of prevention programmes. According to the evidence-based medicine model, which is commonly used by many other medical specialties, occupational health physicians could adopt a similar approach in order to implement more efficacious interventions. The evidence-based paradigm consists in the conscientious, explicit and judicious use of available best evidence in making decisions about health care problems. The practice of evidence-based medicine means integrating individual expertise with the best current evidence from systematic research. Evidence-based occupational health should implement this innovative approach to evaluate and to improve the efficiency of prevention services by means of the ability to (i) formulate the questions on the problem; (ii) search for scientific evidence; (iii) critically evaluate scientific evidence; (iv) use evidence as a key element for the decision process.

Evidence-Based Medicine↗
PubMedDate not supplied

[Headache as atypical presentation of celiac disease: report of a clinical case].

Coeliac disease (CD) is a gluten dependent enteropathy with genetic predisposition. The introduction of the gluten with the diet leads to a damage of the intestinal mucosa losing the ability of absorption. Together with the "classic forms", in wich the intestinal symptomatology is prevalent, there are atypical forms, with unusual clinical presentation and silent forms with no clinical symptoms. The neurologic symptoms are not frequent and regard seizures, headache, ataxia and psychiatric problems. We report on a patient with headache since 3 years of age in which the headache the only manifestation of CD. The diagnosis of CD was made at 11 years, when he came at our observation for episodes of headache. Also the older sister is found affected by CD. After three months of gluten free diet, it was obtained the complete resolution of the headache. Also if the pathogenesis of the headache in patient with CD is unknown we think that a autoimmune, vascular or blood flow mechanism could be ipotizeable.

Celiac Disease↗
PubMedDate not supplied

[Criteria for the management of low back pain in health care workers].

Low back pain represents one of the most frequent health problems in several working populations and is an important problem for occupation health doctors. In fact, these professionals are often required to face with the specific management of this condition, also by participating with other professionals into the implementation of organizational and structural measures. This contribute describes a variety of interventions aimed at treating the syndrome and recovering the working ability of the patient-worker, including the initial clinical evaluation, the assessment of the casual relationship between work and the syndrome, the treatment, the formulation of proposals to modify the worker's physical and working activity, the ongoing heath surveillance and a more in-depth clinical and instrumental evaluation, including surgical treatment.

Algorithms↗
PubMedDate not supplied

[Proposal of environmental and biological monitoring and health surveillance of the exposed to inhalation anesthetics. Consensus. A Study Group on Occupational Exposure to Inhalation Anesthetics].

The Study Group on Occupational Exposure to Inhalation Anaesthetics of the Lombardy Association of Occupational Health and Industrial Hygiene prepared a document that was discussed during the Congress "Occupational Risks due to Inhalation Anaesthetics", held in Brescia, Italy, on May 12, 1992. The same document was then approved by the Directory Council of the Lombardy Association of Occupational Health and Industrial Hygiene. Data on environmental concentrations of Nitrous Oxide collected from 1989 to 1991 in 269 operating rooms of 47 hospitals in Lombardy are reported. The measured levels are considerably lower than those collected from the same Study Group from 1985 to 1987 in 111 operating rooms. The methodologies for exposure control are discussed, regarding both environmental and biological monitoring. These two techniques are complementary and can be used with standardized methods. The review of the literature on the early effects showed, even with some uncertainty at the current exposure levels, effects on liver and Central Nervous System. Still controversial are the data regarding the reproductive toxicity. Health surveillance programs have been organized in the last 5 years in 18 Lombardy hospitals and they indicate no cases of pathologies due to inhalation anesthetics on 1498 subjects. Operative proposals are suggested on the methodology and the frequency of environmental/biological monitoring and health surveillance. The "technical limit values" reported in the document from the Italian Ministry of Health are also discussed. Finally, research topics are suggested in order to assess the early effects of exposure.

Anesthesia, Inhalation↗
PubMedDate not supplied

[Early effects of exposure to anesthetic gases and vapors. A critical review on the suitability of several indicators of the effect].

Apart from a risk excess of liver disease among operating theatre personnel and of spontaneous abortion in women exposed during pregnancy, no definitive conclusion can be drawn regarding health impairment among anaesthesiology staff. However, many studies pointed out that several adverse effects occur as a consequence of experimental, therapeutic and occupational exposure to inhalation anaesthetics. This paper reviews the early changes of the organ systems (hepatobiliary, renal, cardiac, hematopoietic, reproductive systems; immunologic functions; cytogenetic effects), which are considered to follow anaesthetics exposure, to evaluate their possible use as biological indices of effect. The liver microsomal enzyme system has received particular attention with the aim of clarifying the mechanisms involved in anaesthetics hepatotoxicity. An increased microsomal enzyme activity was observed in experimental conditions and in humans. This inductive effect, which reflects metabolic changes affecting liver function, is commonly considered the earliest sign caused by exposure to several chemicals (other than anaesthetics) and may be evaluated by means of biomarkers, among which the measurement of urinary D-glucaric acid excretion is a well established non-invasive tool. Urinary D-glucaric acid excretion represents the most promising early metabolic effect of the exposure to anaesthetics. However, its measurement is not yet suitable as an index of effect for use in biomonitoring practice. The main aspects to be studied in the future are the following: (i) the evaluation of urinary D-glucaric acid excretion in the acute and chronic exposure to low-dose anaesthetics to check the existence of a dose-response relationship; (ii) the study of other parameters (urinary enzymes, immunological profile, chromosome aberrations) in selected groups of exposed and control subjects, in which both exposure and confounding factors (age, gender, life style, former diseases) as well as concomitant occupational exposures should be carefully taken into account.

Adult↗
PubMedDate not supplied

[Assessment of appropriateness and verification of interventions in the professional practice of the occupational physician].

Evaluation of Occupational Health Practice is both an intriguing research field and an essential tool to assure the quality of intervention. The objectives of this paper are: (i) to define the principles of evaluation and the role of quality assurance of intervention, (ii) to define the principles of audit of professional practice, (iii) to outline the role of research in evaluating and improving intervention and other practice.

Humans↗
PubMedDate not supplied

[Postural tenosynovitis caused by misuse of a computer input device (mouse)].

Several reports of postural problems among video display unit workers are available, most frequently involving the back, neck and shoulder. The case described is an example of tenosynovitis of the right wrist at the point where the wrist rests on the work surface while operating the mouse in a computer workstation (2-3 hours/day 6 days/week). The alteration was caused by a combination of friction and pressure on the wrist joint tendon due to the faulty positioning of the hand and wrist. This is the normal resting position for the wrist (inclined towards the ulnar side), and is thus the most natural position to adopt. The reported alteration, which responded to a short period of rest and treatment with non-steroid anti-inflammatory drugs for 2-3 days, is described as an example of common injury caused by an unusual faulty posture of the hand. The preventive measures suggested to avoid the occurrence of this type of injury include: (i) instead of resting the weight of the hand on the ulnar side of the wrist it should be distributed between the two pads of fatty tissue which form the base of the palm, (ii) the mouse button could be clicked with the third finger instead of the index finger in order to avoid the tendency of hand to roll into the faulty rest position.

Computer Terminals↗
PubMedDate not supplied

[Effectiveness of interventions for the control and prevention of tuberculosis in health care facilities: a review of ATS,CDC, OSHA recommendations].

BACKGROUND: Health care workers (HCWs) are occupationally exposed to a multitude of biological hazards, and among these to the risk of tuberculosis (TB) infection, especially involving individuals working in specific workplace (TB and Chest divisions, Infectious Diseases wards, Microbiology laboratories) and performing thoracic endoscopy and "cough-inducing" procedures. According to national legislation (title VIII D.lgs. 626/94, 1998 Health Minister guide lines document) concerning the control and prevention of TB transmission among HCWs, health care facilities are required to (i) perform an accurate risk assessment and (ii) implement an exposure control plan and worker health surveillance program, thus involving the occupational health professionals. OBJECTIVES: The aim of this paper is to provide a general view of the epidemiological and scientific evidence related to the effectiveness of health interventions in the prevention of occupational TB infection. METHODS: Comparative evaluation and critical review of U.S. CDC (1994) guidelines, OSHA (1997) rules, and the most recent ATS and CDC (2000) "statement" documents. RESULTS: In low risk groups TCT shows decreased positive predictive value, high variability, and can be confounded by other factors (age, BCG, MNT), thus reducing its diagnostic value for latent TB infection. CONCLUSIONS: Recent recommendations on the control of TB infection in health care settings underline the need of implementing accurate risk evaluation in all hospital units, compared to the epidemiological profile in the community, and "targeted tuberculin testing" programs among high risk HCWs.

BCG Vaccine↗
PubMedDate not supplied

[Health policy and occupational health: tools and methods to assure quality and appropriateness of interventions].

BACKGROUND: Although all health care organizations and professionals are encouraged to follow the explicit aim of reducing the burden of illness, accidents and disability, there is increasing pressure on health professionals to ensure that the practice be based on a quality standard and on evidence of appropriateness. OBJECTIVES AND METHODS: The paper aims to focus on both the concept and dimensions of appropriateness (a complex issue with various dimensions and definitions) and on the different research and practice models aimed at search, analysis and synthesis of the best available evidence to be applied in the decision process of health and medical practice. Literature analysis has been carried out to find available tools and methods to identify, implement and monitor the evidence of efficacy in health care systems and services. RESULTS: Most definitions of appropriateness address a number of requirements. An appropriate practice should be effective (based on sound evidence); efficient (providing that cost is considered) and consistent with the ethical principles and preferences of the relevant individual, community or society. Appropriateness is considered as the next frontier in the development of health care research: there is still limited knowledge, awareness, or research on this aspect. Health Technology Assessment consists of a multidisciplinary activity based on the systematic examination of technical performance, safety, clinical effectiveness and efficiency, including socio-economic, legal and ethical aspects. Evidence Based Medicine originates from an individual perspective and aims at using rigorous criteria to obtain the best available evidence in order to provide efficient interventions. The Clinical Practice Guidelines, based on both evidence and opinions of experts, are intended to assist clinical decisions for health professional and providers for the improvement of professional practices and system efficiency, taking into account local customers, health needs and preferences. CONCLUSIONS: Several models exist for measuring and evaluating the efficacy of health systems and health services. They can be adapted for evaluating and measuring public and occupational health practices. These tools support good practice through quality-standardized interventions aiming at the health protection of communities and individuals. These models, which are presented in a specific framework in which their outcomes and critical factors are evaluated, should be adapted to public and occupational health interventions to satisfy implicit and explicit needs of individuals and populations at risk thus assuring their quality and appropriateness.

Biomedical Technology↗
PubMedDate not supplied

[Experimental validation of the Evidence-Based Occupational Health paradigm and of the PICO model in the decision making process applied by occupational health physicians].

BACKGROUND: Health care organizations are increasingly aware of the need to apply quality assurance principles to serve their mission and there is an increasing pressure on health professionals to ensure that the practice is based on evidence of appropriateness. Medical specialists of different disciplines, including occupational health, are presently required to shift from habitual practices to evidence-based practices, and have began to use an approach based on the paradigm of Evidence-Based Medicine and of Evidence-Based Occupational Health (EBOH). OBJECTIVE AND METHODS: The study was carried out to analyse how the paradigm of the EBOH could be implemented in the search, analysis and synthesis of the best available evidence to apply in the decision-making process in occupational health practice. Out of 464 medical examinations consecutively performed by 4 occupational health physicians, 6 cases were selected on the basis of their complexity and the need for further investigation. Each case was submitted to each of the 4 physicians, who were asked to make a decision according to the EBOH paradigm: i.e., (i) identification of the problem according to the PICO model, (ii) solution of the problem according to his/her internal evidence or experience (iii) search for scientific external evidence, (iv) critical appraisal of such evidence, (v) application of the evidence in the decision-making process, (vi) comparison between internal evidence and external evidence. Outcome measurements, including satisfaction of the physicians, were collected. RESULTS: No differences were found between the decisions based on external evidence or on internal evidence in about 50% of the cases (13/24). In about 1/3 of the cases (7/24) no agreement was observed between the decisions taken on the basis of internal and external evidence. In some cases (5/24) no useful information was added for the purposes of decision-making. In about 50% of the cases the professionals were satisfied with the information found in databases, due to its usefulness both in increasing their knowledge and in improving their practice. CONCLUSIONS: Due to their involvement in a corporate system, the participants were aware of the need to practice according to quality assurance principles and to relinquish ineffective and obsolete practices. They agreed with the need to search for the best available evidence with the aim of guaranteeing efficacious interventions. In spite of a number of obstacles to the application of the EBOH paradigm to occupational health practice, the study demonstrated that such approach can be successfully applied in this field and that it can be proposed for the search of appropriate solutions to the problems usually encountered in professional practice.

Decision Support Systems, Clinical↗
PubMedDate not supplied

[Association between relational and organizational factors and occurrence of musculoskeletal disease in health personnel].

INTRODUCTION AND OBJECTIVES: Even if work musculo-skeletal disorders represent a serious and commonly observed health problem among health care workers, few data are available about physical therapists. This study aims to compare the musculoskeletal disorders prevalence over two different health care populations and MATERIALS AND METHODS: Two populations have been studied: (i) 100 nurses working in the teaching hospital Azienda Policlinico di Modena and (ii) 100 physical therapists working in different hospitals in Modena and Reggio Emilia. The ergonomic risk assessment has been made according to the Ergo Web questionnaire. A self-reported questionnaire [partly built according to Outil de Repérage et d'Evaluation des Gestes (OREGE) method] has been used to collect data about physiological factors, musculo-skeletal symptoms of the upper limb and spine, stress indexes and psychosocial indexes. RESULTS: The two populations are comparable as far as the data of physiological and working anamnesis. The physical therapists have an higher prevalence of neck pain (p<0.01), whereas the nurses have an higher prevalence of low back pain (p<0.01). Furthermore, the physical therapists have an higher index of pain (involving prevalence, number of occurrences and intensity of the disorder) of right upper limb too. The nurses have higher working strain (p=0.00), attention need at work (p=0.00), poor autonomy (p<0.01) indexes than physical therapists. The indexes' analysis shows that musculo-skeletal disorders are associated to stress and psychosocial factors in both populations.

Adult↗
PubMedDate not supplied

[Evidence based occupational health: from theory to practice].

BACKGROUND: Health care organizations are increasingly aware of the need to apply quality assurance principles to serve their mission and there is an increasing pressure on health professionals to ensure that the practice be based on evidence of appropriateness. Therefore, medical specialists of different disciplines, including occupational health, are presently required to shift from habitual practices to evidence-based practices. OBJECTIVE AND METHODS: This paper aims at illustrating the opportunity offered by the Evidence Based Medicine (EBM), which can be used in the decision making process of the occupational physician according to the Evidence Based Occupational Health (EBOH) paradigm. The EBOH approach consists of 4 steps (i) the formulation of the problem according to the PICO model, (ii) the search for scientific external evidence based on scientific papers and documents available in different database, (iv) the critical appraisal of such evidence, (v) the application of the evidence in the decision making process. RESULTS AND CONCLUSIONS: In spite of some barriers, such as time constraint, which could prevent looking for searchable information, the evidence-based decision-making process should be based on the evidence provided by major resources to answer the question emerging during the practice. Acquiring the skill for information managing facilitates searching appropriate solutions to problems usually met during the professional practice and the adoption of behaviours which will improve the practice.

Evidence-Based Medicine↗
PubMedDate not supplied

[Ethical analysis of the decision-making process in occupational health practice].

BACKGROUND: Changes in workplaces and work organizations represent a challenge for governments, social partners and occupational health professionals whose aim is to appropriately satisfy emerging requirements and needs. An increasing number of occupational health problems requires a high-quality standard practice supported by ethically consistent decisions. The ethical aspect of the practice is strictly linked to that of appropriateness, involving requirements of effectiveness, efficiency and respect of ethical principles of the individual, community and society. OBJECTIVES AND METHODS: The paper aims at focusing the ethical components of the quality of an occupational health program by taking a systematic approach to the ethical problems. The approach consists of a 2-step process. The first step consists of appraising the basic ethical principles of the dilemma ("to do good": to prevent or to remove evil and to do or to promote good; "not to do evil", implying not to inflict evil; to do no harm; autonomy implying respect of other's freedom and self-determination; justice implying equity, solidarity and non discrimination). The second step consists of detecting the stakeholders involved or interested in the decision. The alternatives are discussed according to the assessment of ethical costs (violating the consistentprinciple) and ethical benefits (fulfilment of the consistent principle) for the stakeholders. RESULTS: Systematic analysis of the ethical components of the dilemma according to ethical principles and their discussion within a framework involving different stakeholders makes it possible to recognise ethical costs and ethical benefits of the alternative decisions. The decisions may have different costs and benefits, which should be considered and weighed to take a proper decision. Although there is no certainty about the suitability of the decision, the assessment of the ethical components may be a valuable tool in decision-making based on the awareness that any ethical aspect has been considered. CONCLUSION: Occupational health professionals are requested to act with respect for general ethical principles and preferences of the individual, groups and setting. A high-quality practice will take into account the ethical content and the ethical conduct and any intervention will include analysis of ethical principles to compare alternative decisions and their consequences for the different stakeholders. This approach guarantees a practice based on, in addition to scientific evidence, the assessment of ethical costs and ethical benefits to favour decisions preventing conflicts.

Cost-Benefit Analysis↗
PubMedDate not supplied

[Assessment of efficacy and economic impact of an influenza vaccination campaign in the personnel of a health care setting].

INTRODUCTION: Although vaccination against influenza is a well-established practice among the elderly in rest homes, in community-dwelling elderly people and in persons with underlying medical conditions associated with a high risk of complications, vaccination of workers is not always considered cost-effective, even though influenza is high on the list of diseases of public health importance. The aim of this study was to evaluate the efficacy and the cost-benefit ratio of an influenza vaccination campaign in health care workers (HCW) of a teaching hospital. METHODS: A group of 423 HCW vaccinated against influenza during the 2002-2003 winter season was compared with a group of subjects not vaccinated, matched for sex and working area. The following outcomes were considered: (i) prevalence of influenza-like illness (ILI); (ii) days of absence from work due to ILL The cost-benefit ratio was calculated with a model using the following indices. indirect benefits (IB), indirect non medical costs (IC) and direct costs (DC). RESULTS: The prevalence of ILI in the non vaccinated group (102 cases out of 423 subjects, 24%) was significantly increased (p < 0.001) compared with vaccinated subjects (64 cases out of 423, 15%). Working days lost for ILI were 516 in the non-vaccinated group versus 315 reported in the vaccinated group. Economic impact evaluation showed a cost of Euro 35,786.88 in vaccinees and of Euro 57,759.52 in the non-vaccinees. The resulting IB was Euro 21,078.64. The DC and IC for vaccination were Euro 2,463.29 and Euro 2,172.53 respectively. The overall cost-benefit ratio (IB/DC+IC) was 4.5. DISCUSSION: The study shows that the influenza vaccination campaign was effective in preventing the influenza syndrome in HCW The economic impact assessment shows a cost-saving with an important cost-benefit ratio. This study suggests that a continuous effort should be recommended to increase the compliance of HCW with vaccination practice both to reduce their chance of becoming infected and for the economic benefits for healthy working adults.

Adult↗
PubMedDate not supplied

The development of clinical prediction guides requires reproducible decision-making outputs: a field study.

BACKGROUND: The decisions taken by occupational physicians (OPs) generally show low reproducibility and reflect some uncertainties linked to the decision making process. AIM: The aim of the study was to evaluate the variability of different OP decisions in order to assess their reproducibility, which is regarded as a quality factor of the professional practice. METHODS: 4 OPs examined the records of 100 selected hospital workers with impaired health conditions in order to take decisions about job fitness, advice to workers, referral to clinical physician, need for further investigations, report of occupational disease and recommendation for the general practitioner. The variability of inter-individual decision was measured by percent agreement and Cohen's kappa test. RESULTS: After accounting for variability expected by chance, the agreement among decisions on job fitness ranged from fair to substantial, but high variability was observed for most other assessments. CONCLUSION: The observed inter-individual variability for some decisions taken by different OPs represents a crucial aspect to be dealt with, as the reproducibility of medical decisions is indispensable for the clinical prediction guides to be built and adopted for improving the practice.

Biomechanical Phenomena↗