Giornale italiano di medicina del lavoro ed ergonomia
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G Ital Med Lav Ergon · Oct 2014
Review[Overdiagnosis and defensive medicine in occupational medicine].
In clinical medicine since some years overdiagnosis is giving rise to growing attention and concern. Overdiagnosis is the diagnosis of a "disease" that will never cause symptoms or death during a patient's lifetime. It is a side effect of testing for early forms of disease which may turn people into patients unnecessarily and may lead to treatments that do no good and perhaps do harm. ⋯ In Italy the National Insurance for occupational diseases (INAIL) regularly recognizes less than 50% of the notified diseases; this might suggest overdiagnosis and possibly overattribution in reporting. Physicians dealing with the diagnosis of occupational diseases are obviously requested to perform a careful, up-to-date and active investigation. When applying to the diagnosis of occupational diseases, proper logical criteria should be even antecedent to a good diagnostic technique, due to social outcome for the worker.
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G Ital Med Lav Ergon · Jan 2013
ReviewMotor and sensory rehabilitation after lower limb amputation: state of art and perspective of change.
The rehabilitation of the amputated patient is based on a coordinated sequence of diagnostic, prognostic and therapeutic procedures carried out by an interdisciplinary rehabilitation team, that works globally on all patient problems. The objectives of the different phases of the rehabilitation treatment were reviewed. ⋯ Among these the psychological aspects, the alterations of all sensory inputs, the secondary alterations at the bone, articular and muscular level, pain of the residual limb and the phantom limb. Finally, the basic criteria to be used to choose the kind of prosthesis in relation to the characteristics and expectations of the amputated person, and the results of the recovery of the autonomy and walking ability, will be schematically described.
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Organizational justice is a construct defining the quality of social interaction at work. Organizational justice can be divided into three categories: procedural justice (fairness of the decision-making procedures), distributive justice (fairness of outcomes) and relational justice (equity and fairness in the interpersonal treatment of employees by their supervisors). ⋯ Low perceived justice has been shown to be associated with experienced stress reactions and related physiological and behavioral reactions, such as inflammation, sleeping problems, cardiovascular regulation and cognitive impairments, and with a high rate of work absenteeism. This paper is a review of the literature on organizational justice and its impact on workers' health.
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Rheumatic diseases, like many other chronic diseases, represent an important public health burden. To reduce the social and economic impact of these pathologies, an appropriate management of these conditions should be encouraged based on the use of established intervention strategies. ⋯ CBT include the teaching of life and coping skills that can assist the patient in productive problem solving and prevention or minimization of future pain episodes and stressful events. Moreover, several studies suggest that the cognitive-behavioural approach is efficacious in rheumatoid arthritis, osteoarthritis and fibromyalgia in improving not only the psychological adjustment during the course of the disease but also physical function.
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G Ital Med Lav Ergon · Oct 2004
Review Comparative Study[Individual susceptibility to occupational carcinogens: the evidence from biomonitoring and molecular epidemiology studies].
This paper reviews the literature on the influence of metabolic and DNA repair polymorphisms of biological indicators of genotoxic risk commonly used in biomonitoring occupational exposure to carcinogens. Genetic polymorphisms which influence biomarkers (urinary metabolites, protein and DNA adducts), include P450 cytochromes (CYPs) and glutathione S-transferases (GSTs) in exposure to polycyclic aromatic hydrocarbons (PAHs), and acetyltransferases (NATs) in exposure to aromatic amines (AAs). As regards exposure to benzene, also relevant is the influence of epoxydohydrolase (EPHX) and NAD(P)H quinone oxidoreductase (NQO1) on the urinary excretion of t,t-muconic and phenylmercapturic acids. ⋯ Other risk factors, such as heredity (siblings of cancer patients have a risk factor > or = 3 with respect to the general population), ethnicity (Chileans > Caucasians; Japanese > Americans) and gender (women > men), have still not been clearly characterized and these are also reported in this paper. It is clear from the above that genetic differences underlie individual susceptibility to lung cancer, whether caused by exposure to tobacco smoke or to occupational carcinogens like PAHs. Some of these indicators of exposure/individual susceptibility can be evaluated in groups at high risk of occupational lung cancer, such as coke-oven and aluminium workers and those exposed to coal tar fumes and soot, etc., with the aim of identifying subjects who are susceptible due to the high concentrations of carcinogens found in their working environment.