Nicola Magnavita

Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study

BackgroundViolence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention.MethodsAll health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75 % in 2005, 71 % in 2007, and 94 % in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form) for reporting violent incidents, the DCS (demand/control/support) model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health.ResultsOne out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress.ConclusionOur study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors.

Marked elevation of myocardial trace elements in idiopathic dilated cardiomyopathy compared with secondary cardiac dysfunction

OBJECTIVES We sought to investigate the possible pathogenetic role of myocardial trace elements (TE) in patients with various forms of cardiac failure. BACKGROUND Both myocardial TE accumulation and deficiency have been associated with the development of heart failure indistinguishable from an idiopathic dilated cardiomyopathy. METHODS Myocardial and muscular content of 32 TE has been assessed in biopsy samples of 13 patients (pts) with clinical, hemodynamic and histologic diagnosis of idiopathic dilated cardiomyopathy (IDCM), all without past or current exposure to TE. One muscular and one left ventricular (LV) endomyocardial specimen from each patient, drawn with metal contamination-free technique, were analyzed by neutron activation analysis and compared with 1) similar surgical samples from patients with valvular (12 pts) and ischemic (13 pts) heart disease comparable for age and degree of LV dysfunction; 2) papillary and skeletal muscle surgical biopsies from 10 pts with mitral stenosis and normal LV function, and 3) LV endomyocardial biopsies from four normal subjects. RESULTS A large increase (>10,000 times for mercury and antimony) of TE concentration has been observed in myocardial but not in muscular samples in all pts with IDCM. Patients with secondary cardiac dysfunction had mild increase (< or = 5 times) of myocardial TE and normal muscular TE. In particular, in pts with IDCM mean mercury concentration was 22,000 times (178,400 ng/g vs. 8 ng/g), antimony 12,000 times (19,260 ng/g vs. 1.5 ng/g), gold 11 times (26 ng/g vs. 2.3 ng/g), chromium 13 times (2,300 ng/g vs. 177 ng/g) and cobalt 4 times (86,5 ng/g vs. 20 ng/g) higher than in control subjects. CONCLUSIONS A large, significant increase of myocardial TE is present in IDCM but not in secondary cardiac dysfunction. The increased concentration of TE in pts with IDCM may adversely affect mitochondrial activity and myocardial metabolism and worsen cellular function.

Work-related musculoskeletal complaints in sonologists.

The prevalence of musculoskeletal complaints of the hand and wrist, and the neck and back, in physicians who operate sonography equipment was evaluated, and associations between these complaints and various work-related and personal variables were studied. A questionnaire survey was distributed among physician sonographers (sonologists) in Italy. The relationship between work habits and musculoskeletal complaints was analyzed by logistic regression models adjusted for gender, age, and duration of work with ultrasound. A total of 2041 physician sonographers completed the questionnaire. It was found that a large proportion of the subjects regularly had work-related complaints, such as neck and back pain (NBP) (18.5%) or hand and wrist cumulative trauma disorder (HWD) (5.3%). Roughly 80% of the sonographers were currently affected, or had been affected in the past, by one or more work-related symptoms. Various work-related factors appeared to be related to musculoskeletal syndromes. The average time spent for each examination was related both to NBP and HWD. Discomfort for transducer design was the best predictor of HWD, whereas a comfortable chair and correct position of the body protected from the onset of NBP. These results support the role of ergonomic factors in the pathogenesis of both NBP and HWD in sonographers.

Destructive spondyloarthropathy of the cervical spine in long-term hemodialyzed patients: a five-year clinical radiological prospective study.

Abstract. Objective:To describe the radiographic features and progression of cervical spine destructive spondyloarthropathy (DSA) in hemodialyzed patients, and to evaluate the relationship between this disease and patient characteristics, biochemical values, and hemodialysis duration. Design and patients:Standard radiographs, and lateral flexion and extension views of the cervical spine, were performed annually for 5 years in 31 hemodialyzed patients who were divided into three groups at the commencement of the study: those showing (I) DSA, (II) vertebral rim erosions (VRE) without DSA, and (III) absence of DSA and VRE. Magnetic resonance (MR) imaging and computed tomography (CT) were performed in seven and two patients respectively. The imaging features were evaluated for the presence and progression of spondyloarthropathy and correlated with clinical and biochemical variables. Statistical analysis was performed using one-way analysis of variance. Results: The duration of hemodialysis appeared to be the main predictive factor (P=0.0003) for DSA, which was found in six patients (19%). DSA was found to correlate with higher levels of beta2-microglobulin (P<0.00001), parathyroid hormone (P<0.05), and alkaline phosphatase (P<0.05). Clinical symptoms were minimal. In two patients, MR imaging revealed changes mimicking spondylodiscitis. In another patient, CT of the craniocervical junction showed bone resorption due to a pseudotumor, and basilar invagination. Conclusions: DSA of the cervical spine is often clinically silent. Pathogenesis of DSA may be multifactorial but its progression is most influenced by the duration of hemodialysis. On MR imaging, DSA may mimic spondylodiscitis.

Association of work-related stress with mental health problems in a special police force unit

Objectives Law and order enforcement tasks may expose special force police officers to significant psychosocial risk factors. The aim of this work is to investigate the relationship between job stress and the presence of mental health symptoms while controlling sociodemographical, occupational and personality variables in special force police officers. Method At different time points, 292 of 294 members of the ‘VI Reparto Mobile’, a special police force engaged exclusively in the enforcement of law and order, responded to our invitation to complete questionnaires for the assessment of personality traits, work-related stress (using the Demand–Control–Support (DCS) and the Effort–Reward–Imbalance (ERI) models) and mental health problems such as depression, anxiety and burnout. Results Regression analyses showed that lower levels of support and reward and higher levels of effort and overcommitment were associated with higher levels of mental health symptoms. Psychological screening revealed 21 (7.3%) likely cases of mild depression (Beck Depression Inventory, BDI≥10). Officers who had experienced a discrepancy between work effort and rewards showed a marked increase in the risk of depression (OR 7.89, 95% CI 2.32 to 26.82) when compared with their counterparts who did not perceive themselves to be in a condition of distress. Conclusions The findings of this study suggest that work-related stress may play a role in the development of mental health problems in police officers. The prevalence of mental health symptoms in the cohort investigated here was low, but not negligible in the case of depression. Since special forces police officers have to perform sensitive tasks for which a healthy psychological functioning is needed, the results of this study suggest that steps should be taken to prevent distress and improve the mental well-being of these workers.

Methylated HBHA Produced in M. smegmatis Discriminates between Active and Non-Active Tuberculosis Disease among RD1-Responders

Background A challenge in tuberculosis (TB) research is to develop a new immunological test that can help distinguish, among subjects responsive to QuantiFERON TB Gold In tube (QFT-IT), those who are able to control Mtb replication (remote LTBI, recent infection and past TB) from those who cannot (active TB disease). IFN-γ response to the Heparin-binding-hemagglutinin (HBHA) of Mtb has been associated with LTBI, but the cumbersome procedures of purifying the methylated and immunological active form of the protein from Mtb or M. bovis Bacillus Calmette et Guerin (BCG) have prevented its implementation in a diagnostic test. Therefore, the aim of the present study was to evaluate the IFN-γ response to methylated HBHA of Mtb produced in M. smegmatis (rHBHAms) in individuals at different stages of TB who scored positive to QFT-IT. Methodology/Principal Findings 87 individuals at different stages of TB who scored positive to QFT-IT were selected. IFN-γ response to in vitro whole blood stimulation with rHBHAms was evaluated by short-term and long-term tests and detected by ELISA or flow cytometry. We demonstrated that the IFN-γ response to rHBHAms is mediated by CD4+ T-cells with an effector-memory phenotype. This response, evaluated by short-term-tests, is significantly lower in active TB than in remote LTBI (p = 0.0010) and past TB (p = 0.0152). These results were confirmed by long-term tests. The qualitative data confirmed that IFN-γ responses higher than the cut-off point identified by ROC analysis are associated with the status of non-active disease. Conclusions In this study we show that the T-cell response to a recombinant and methylated HBHA of Mtb produced in M. smegmatis is useful to discriminate between active and non-active TB disease among those responsive to QFT-IT in a whole blood system. Further studies are needed to improve the accuracy of the assay.

Work stress in radiologists. A pilot study

Purpose . We studied occupational stress and its psychosocial effects in a sample of Italian radiologists and radiotherapistsMaterials and methods . Radiologists and radiotherapists attending two medical conferences were invited to complete a questionnaire comprising four sections investigating the risk of occupational stress (organisational discomfort, Karasek’s Job Content Questionnaire, Siegrist’s Effort-Reward Imbalance, Warr’s Job Satisfaction) and four sections investigating the health effects of such stress (Goldberg’s Anxiety and Depression scales, General Health Questionnaire, Lifestyles Questionnaire)Results . Radiologists and radiotherapists generally expressed high levels of control, reward and satisfaction. However, 38.5% complained of severe organisational discomfort, 24% reported job strain, 28% reported effort/reward imbalance and 25% were dissatisfied. Female radiologists and radiotherapists showed higher levels of organisational discomfort than their male colleagues. Younger and less experienced radiologists and radiotherapists had higher strain scores than their older and more experienced colleagues. A significant correlation was observed between stress predictors and the effects of stress on health, including depression and anxiety, psychological distress and unhealthy lifestylesConclusions . Radiologists and radiotherapists are exposed to major occupational stress factors, and a significant percentage of them suffer from workplace stress. A special effort is required to prevent this conditionRiassuntoObiettivo . Abbiamo inteso indagare l’entità dello stress professionale nei radiologi e radioterapisti e le conseguenze psicosociali associateMateriali e metodi . I partecipanti a due congressi sono stati invitati a compilare un questionario composto da quattro diverse sezioni per misurare il rischio (disagio, contenuto del lavoro secondo il modello di Karasek, discrepanza tra impegno e risultati secondo il modello di Siegrist, e soddisfazione lavorativa secondo Warr) e quattro sezioni per misurare gli effetti dello stress da lavoro (ansia e depressione secondo il questionario di Goldberg, malessere secondo il General Health Questionnaire, stili di vita)Risultati . Nelle risposte rilevate, i medici del campione analizzato esprimono mediamente elevati livelli di discrezionalità, di ricompensa e di soddisfazione dal lavoro, che tuttavia si associano ad un elevato livello di disagio per le condizioni di lavoro nel 38,5% degli specialisti. Il 24% degli intervistati si trova in condizioni di job strain, il 28% soffre per la discrepanza tra impegno prestato sul lavoro e risultati ottenuti, il 25% è insoddisfatto del lavoro. Il disagio per l’organizzazione del lavoro è maggiore nelle donne. Lo stress da lavoro colpisce soprattutto i medici più giovani e con minore esperienza lavorativa. Tutte le variabili indicative di stress da lavoro risultano significativamente associate con gli effetti: ansia, depressione, malessere psicologico, cattivi stili di vitaConclusioni . I radiologi e i radioterapisti sono esposti a rilevanti e specifici fattori di stress professionale. Lo stress da lavoro è presente in circa un quarto dei casi. È necessario un impegno specifico per la prevenzione di tale condizione

Workplace Violence and Occupational Stress in Healthcare Workers: A Chicken-and-Egg Situation-Results of a 6-Year Follow-Up Study

OBJECTIVES Violence at work (WV) is an important occupational hazard for health care workers (HCWs). A number of surveys addressing the causes and effects of WV have shown that it is associated with work-related stress. However, it is not clear what direction this relationship takes, that is, whether job strain facilitates aggression against HCWs or WV is the cause of job strain. METHODS From 2003 to 2009, HCWs from a public health care unit were asked to self-assess their level of work-related stress and to report aggression that occurred in the 12-month period preceding their routine medical examination. In 2009, physical and mental health and job satisfaction were also assessed. A total of 698 out of 723 HCWs (96.5%) completed the study. FINDINGS Job strain and lack of social support were predictors of the occurrence of nonphysical aggression during the ensuing year. HCWs who experienced WV reported high strain and low support at work in the following year. The experience of nonphysical violence and a prolonged state of strain and social isolation were significant predictors of psychological problems and bad health at follow-up. CONCLUSIONS AND IMPLICATIONS The relationship between work-related distress and WV is bidirectional. The monitoring of workers through questionnaires distributed before their periodic examination is a simple and effective way of studying WV and monitoring distress. CLINICAL RELEVANCE The findings of the present study may facilitate the subsequent design of participatory intervention for the prevention of violence in healthcare facilities. This should always be accompanied by measures designed to reduce strain and improve social support.

A 12-year follow-up study of malpractice claims against radiologists in Italy

Purpose.Malpractice claims filed against radiologists have become a relevant phenomenon in Italy and are a real risk in the radiologists’ professional activity.Materials and methods.Insurance claims of Italian radiologists over the 1993–2004 period were anonymously assessed. A total of 990 insurance claims were classified according to cause: (1) missed diagnosis, (2) complications of the radiological procedure, (3) failure to order further radiological examinations, (4) radiation treatment, (5) slip-and-fall injuries, (6) miscellaneous causes.Results.A total of 990 claims were filed during the period, with most claims being filed a considerable time after the event. As a consequence, the estimated incidence may be 44 per 1,000. In other words, 44% of Italian radiologists have received, or will receive, a summons regarding their professional activity of the past 10 years. Misdiagnosis made up the first and most important claim category. Missed abnormalities on breast radiographs accounted for the greatest percentage of cases. Missed bone abnormalities were the following most common diagnostic errors. Complications following interventional procedures accounted for 10% of all cases. A few cases resulted from the radiologist’s failure to order further diagnostic examinations. Lastly, radiologists were frequently named as one of multiple defendants, together with medical (or surgical) doctors, in cases of patient death in roughly 6% of all cases.Conclusions.The risk of medical malpractice litigation for Italian radiologists is by now comparable to that for American radiologists. Strict adherence to radiological standards may be a means of reducing the risk of legal action and obviating litigation.

Malpractice stress syndrome in radiologists and radiotherapists: perceived causes and consequences

PurposeRadiology is among the specialties with an increasing risk of litigation. Regardless of the outcome of legal proceedings, physicians who are sued usually perceive the claim as an assault on their integrity and may suffer psychological or physical effects known as “malpractice stress syndrome”.Materials and methodsTwo hundred and six radiologists and 108 radiotherapists responded to a questionnaire containing specific items concerning their perception of malpractice stress and their opinions about the causes of clinical errors, as well as an assessment of work satisfaction and general health.ResultsOne third of physicians had been sued for malpractice. Age was significantly related to the occurrence of malpractice litigation. Radiological errors were purportedly related to occupational discomfort, and the latter variable was significantly associated with work dissatisfaction and a low level of psychological and physical well-being.ConclusionsRadiologists are well acquainted with medical malpractice and its causes; however, they have limited familiarity with clinical risk management practices and often ignore procedures of informed consent. A targeted educational effort is required to overcome these shortcomings.RiassuntoObiettivoLe denunce contro i radiologi per responsabilità civile e penale sono in continuo aumento. Indipendentemente dall’esito del processo, il medico coinvolto può andare incontro ad una serie di disturbi psicofisici che vanno sotto il nome di “stress da malpractice”. Abbiamo inteso indagare le opinioni dei radiologi sul fenomeno della malpractice medica e le esperienze di coloro che sono stati denunciati per malpractice.Materiali e metodiUn questionario relativo alle cause dell’errore e della malpractice ed alle sue conseguenze è stato sottoposto a 206 radiologi e 108 radioterapisti, nel corso di due congressi delle rispettive specialità.RisultatiMentre l’occorrenza di denunce per presunta malpractice si correla con l’età dello specialista, la frequenza degli errori sarebbe associata ad un insieme di fattori di disagio lavorativo, che a loro volta si correlano con una scarsa soddisfazione dal lavoro e un ridotto benessere psicofisico.ConclusioniI radiologi hanno una buona conoscenza del fenomeno della cosiddetta malpractice medica e della cause che contribuiscono ad enfatizzarlo, così come delle condizioni lavorative che causano stress da lavoro, insoddisfazione e aumento degli errori; mostrano però una insufficiente padronanza delle tecniche di clinical risk management e della dottrina del consenso informato. Per colmare tale tipo di carenza è necessario uno sforzo educativo particolare.