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Aims: To evaluate how improved treatment adherence with a lower-frequency regimen/treatment of intramuscular (IM) IFNβ-1a impacts therapeutic effectiveness in relapsing-remitting multiple sclerosis (MS) patients switching from a higher-frequency injectable regimen/treatment. Patients & methods: Italian patients with relapsing-remitting MS and prior poor adherence to high-frequency injectable treatments (n = 181) were followed for 24 months after starting IM IFNβ-1a. Results: During the study, 97.4% of patients were treatment adherent; 22.1% of patients reported a relapse. The estimated probability of remaining relapse-free after 2 years was 78%. A high dropout rate (52.5%) led to small sample size and reduced statistical power. Conclusion: Intramuscular IFNβ-1a treatment was associated with high adherence and a low relapse rate. Unfortunately, low patient retention limited the generalizability of these findings.

Background: Musculoskeletal disorders represent one of the most common complains among video display terminal (VDT) users and are responsible for an important burden of disease in white collars., Methods: From May 2017 to March 2018, 69 VDT users working at Trieste hospitals were recruited for a training session aimed to reduce musculoskeletal disorders in white collars workers. Thirty-three were assigned to the intervention group, whereas 36 comprised the control group. The intervention group received three personalized 1-hour-one-to-one sessions with a physiotherapist and a thorough evaluation of their workstation. Data were collected at baseline (T0), at 2 months (T1) and at 6 months (T2) using a standardized questionnaire and analyzed with the software STATA., Results: Overall pain significantly decreased in cases at T1 and T2 (p < 0.05). Headache significantly decreased in cases at T1 (p < 0.05). Body awareness significantly increased in cases both at T1 and T2 (p < 0.05). Headache was positively correlated with an increased perception of pain (Coef 6.85, CI95% 3.2-10.5; p < 0.001), while the intervention determined a significant reduction of overall pain during the follow up (OR 0.97, IC 0.95-0.99, p = 0.013). Cases showed a significant increase of the cranial-vertebral angle at the 6 months follow up (p < 0.05)., Conclusion: A tailored physiotherapeutic intervention has showed a statistically significant decrease in osteoarticular pain and an increased body awareness in VDT users undergoing a personalized training session.v.

Objective: This study aimed to validate Italian versions of Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale and Pain DETECT questionnaire (PD-Q) and evaluate the ability of these questionnaires to discriminate between nociceptive and neuropathic pain., Design: Multicenter prospective validation cohort study. Subjects and Setting. One hundred patients were included with a diagnosis formulated by a specialist in outpatient settings (50 affected by knee osteoarthritis as nociceptive pain and 50 affected by trigeminal or postherpetic neuralgia as neuropathic pain)., Methods: The Italian versions of both questionnaires according to Italian cultural characteristics were performed according to the following steps: (1) translation of the questionnaires from English into Italian; (2) review by a bilingual individual for consistency; (3) proposed version after a mail round between experts; (4) backward translation; (5) comparison with the original English version by the experts; (6) approved version of the questionnaires. One hundred patients were enrolled and completed the two questionnaires administered by a specialist or blinded nursing staff, at the baseline and after 24/48 hours. Internal consistency, stability, validity, and discriminative power were analyzed., Results: Statistically significant differences were reported about the ability of both questionnaires to discriminate between patients affected by neuropathic or nociceptive pain. Internal consistency for the Italian version of the LANSS was 0.76, and for PD-Q, it was 0.80, assessed by Cronbach's α ; LANSS showed a good test-retest reliability with an ICC of 0.76, and PD-Q showed a high test-retest reliability with an ICC of 0.96. For interrater reliability, there was a concordance rate of 83.3% between reference diagnosis and LANSS (Cohen's kappa = 0.67, CI 95% 0.52-0.75)., Conclusions: This study validated the Italian versions of LANSS and PD-Q as reliable instruments with good psychometric characteristics, for pain evaluation, discriminating between nociceptive and neuropathic pain. Our findings were similar to those observed in the original study. Furthermore, we have reported the test-retest reliability for both questionnaires, not addressed in original validation studies., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Alberto Migliore et al.)

In the health sector, the theme of work-related stress is a major issue, representing a significant risk factor on health-care providers which can also affect the quality of health services provided. It is therefore important to adopt a multidimensional evaluation system of work-related stress in order to integrate the results of the analysis of objective and subjective stress indicators. The adoption of a multidimensional validated tool as the one proposed by Inail, allows an integrated analysis of sentinel indicators, objective factors of context and content jointly to direct analysis of the subjective perception of workers through the analysis of the Management Standards developed by Health and Safety Executive. The comparison between three Healthcare Districts, three Mental Health Centers and Administrative Offices of an Healthcare Organization (652 workers involved) revealed the most critical areas which need urgent improvement intervention.

A tree years interventional study to modify smoking habits in health workers in Trieste province was planed in the collaboration of occupational health unit and Tobacco's Dependence Study Center. The aim of this paper is refer about preliminary data of the project started in 2007 regarding smoking habits in health workers of the Azienda per i Servizi Sanitari n.1 "Triestina" (ASS1) and the Azienda Ospedaliera Universitaria Ospedali Riuniti di Trieste (AOUTS). The project consist of several actions. i) information about risks and opportunities of project; ii) pursuance of the law 51 L 3/2003; iii) Occupational Health Unit and Tobacco's Dependence Study Center collaboration; iv) follow-up of the subjects that choose the disaccustom program. During occupational medical surveillance we collected the data related to 492 workers, 37% of the cases were smokers (180). The results of test of dependence to smoke (test di Fagestrom) showed an high dependence in 19% and an high motivation to stop smoke (test di Richmond) in 39% of the smokers. More than fifty percent of this subjects gave their adhesion to the disaccustom program.

Objective: to assess smoking habits, environmental tobacco smoke (ETS) exposure and smoking attitudes of workers toward different possible institutional restrictions before and after the implementation of the new Italian legislation about the public health protection from passive smoking (L 3/2003)., Design: Descriptive study based on self-reported questionnaires (2004 and 2005) and indoor measurement of particulate matter (PM, 2004 and 2006)., Setting: Local health authority n.1 Triestina (1,067 employees)., Participants: 746 workers in 2004, 200 workers in 2005., Main Outcome Measure: percentage of smokers and opinions about different firms of control of smoking (absolute prohibition, smokers' reserved locals). Indoor mean levels of PM2.5 and PM10 in workplaces., Results: smoking employees in 2004 and in 2005 were 28% and 31% (difference non statistically significant). Employees exposed to ETS has been reported decreased from 58% to 47% (p= 0.006). Major reduction has been reported in the offices, while exposure in examination rooms resulted higher in comparison to the offices, both in 2004 and in 2006 Among smokers 43% are available to external helps in order to quit or reduce smoking. Levels of PM2.5 were, in 2006, constantly smaller then those measured in 2004. The same for PM10 (a less specific tobacco smoke indicator) except for the value recorded in one room, slightly higher then in 2004., Conclusion: Our results confirm that ETS in the surveyed Local Health Authority has been reduced but not eliminated. It is necessary to implement further interventions finalized to defend health of not smoking people: a greater respect of the law, specific health promotion campaigns and free therapeutic interventions in workplaces.

Background: Occupational respiratory allergy to green coffee beans (GCB) and to castor beans (CB) was studied in 112 workers in a modern coffee manufacturing plant of Trieste (Italy), where the process is completely automatic, the environmental conditions are good and where exposure to CB can be considered absent because since 1970, only new sacks have been used for coffee transportation., Methods: All subjects were interviewed by a trained doctor using a questionnaire to investigate allergic symptoms and predisposing factors. Sensitization to GCB and to common allergens (pollens, molds, house dust mites) were evaluated by the skin-prick test. The serum of subjects with a positive skin-prick test to CGB or who had symptoms at work was tested for specific IgE (RAST) for GCB and CB. Lung function was evaluated by a Ponigraph spirometer., Results: Sensitization to GCB was found in 25.8% of green coffee workers (31 cases), in 2.7% of roasted coffee workers (37 cases) and in 4.5% of the clerks (44 cases), p < 0.01. The evaluation of IgE specific for CB gave positive results only in 3 of 10 subjects sensitized to GCB. A total of 20% of GCB workers (6 cases) complained of work-related respiratory symptoms (asthma and/or rhinitis) compared with only one subject in the roasted coffee group and one in the control group (p < 0.01). Asthma was reported by 2/31 of the green coffee workers and by 1/44 of roasted coffee workers., Conclusions: There was a significant correlation between sensitization to GCB and work related symptoms (p < 0.01), common allergic symptoms (p < 0.05) and atopy by prick test (< 0.01). These results point to the need to evaluate atopic status in workers and identify the most susceptible subjects, with the aim of informing them of their at-risk status and monitoring their progress. This makes it possible to diagnose sooner those symptoms possibly indicative of a work-related disease, because even in presence of good environmental conditions and even when symptoms are mild, it is almost always the atopic subjects who are affected.

The presence of symptoms connected with the use of latex rubber gloves and sensitization to this allergen was studied in a group of 660 hospital workers who regularly used gloves as a means of protection. Symptoms connected with the use of gloves were reported by 153 subjects (23.2%) and were significantly associated with female subjects length of use and type of medical care. The majority of cases reported irritative symptoms (13.2%) whereas contact dermatitis and rash were reported by 3.6% and 5.5% of cases respectively. Systemic reactions (asthma and/or rhinitis) were reported by 5 subjects. Prick tests for latex were positive in 23 cases (3.5%), 15 of which were symptomatic. Positive skin reaction to latex was significantly associated with family atopy, personal case history and prick test. It is concluded that the presence of symptoms and sensitization to latex requires the implementation of preventive measures in order to reduce the risk of sensitization to a minimum, in addition to removal from exposure of those subjects who are already symptomatic or at risk.

In this paper we propose a fast procedure--stimulation paradigm, data analysis, data presentation--that permits the study of frequency selective enhancements or suppressions of the cortical responses in selected frequency windows. These responses can be used to classify the underlying activity. This novel procedure combines, in one single test, multichannel detection, finely frequency scanned stimulation, a paradigm that permits to study the effect of the stimulation on the underlying activity (during the non-stimulated periods intermingled with the burst of stimuli) and a compact presentation to appreciate the whole rate/frequency/topographical dependency of the spectral responses. In particular we applied this procedure to non-invasively study for the first time the frequency responsiveness within the extended alpha band (6 Hz to 14 Hz) under separate visual and somatosensory stimulation. The test proved robust and the responses quite stationary. We discriminated the lower and higher alpha band through their different topographical and frequency responsiveness features and suggested them to be the same sub-bands recently discriminated via cognitive experiments on the basis of their functional correlates. We measured a rate dependent alpha suppression (both in the somatosensory and visual modality) that is suggested to be linked to the decoding of the stimulus rate. A slight decrease in the frequency of the spontaneous activity following stimulations at any rate is suggested to be connected to attentional load. We stressed the importance of our simple sensorial discrimination of those activities already evidenced on the basis of their functional correlates, as well as the possible clinical uses of the test: on epilepsy, Alzheimer's disease (recently described to have effects on the responsiveness of the cortex to sensory stimuli at different frequencies) as well as other disabling pathologies.

Visual evoked potentials (VEPs) to pattern reversal vertical bar stimuli were recorded from 19 scalp, 2 zygomatic and 3 inion derivations referenced to digitally linked earlobes in 50 controls. 1, 2 and 4 cycles per degree (cpd) patterns were presented as full field (FF) stimuli, on upper and lower hemifields (UHF-LHF), upper and lower quadrants and with the occlusion of central and peripheral UHF and LHF. VEPs to octant stimuli were also recorded with 2 cpd patterns. N1, P1 and N2 components were recorded from posterior and inion derivations with FF stimuli, from posterior derivations with LHF stimuli, only from inion leads with UHF stimuli, from derivations ipsilateral to stimuli with quadrants and octants, and from midline derivations only with lower quadrants. Polarity inverted sequences (iP1-iN1-iP2) were recorded from the other scalp derivations, with similar latency and spatial frequency sensitivity as N1-P1-N2. The orientation of Equivalent Dipoles (ED) was orthogonal with surface coordinates of mesial and occipito-polar calcarine cortex, measured on Magnetic Resonance Imaging. A model of VEP generators is proposed, suggesting that the VEP sequence is elicited only in mesial and occipito-polar surfaces of calcarine cortex.

After outlining the fundamentals of biomagnetism and their possible clinical applications, the authors report the results of a normative study on auditory magnetic fields performed on 18 normally hearing subjects between the ages of 25 and 30. Having presented a thorough review of the literature, they then describe the recording technique employed, the dcSQUID biomagnetic system for signal detection, the shielded room, the characteristics of the stimulus. The auditory magnetic response is characterized by three main waves (P4Om, N100m, P200m) whose latency and amplitude values were calculated. Moreover, in order to localize dipolar activity, certain parameters, such as P and T, were taken into consideration. Localizations were made using a spherical volume conductor or with MRI, which was in any case employed in all the subjects. The waves, especially the N100m recorded contralaterally to the stimulus, showed a reduced latency and an increased amplitude when compared to those recorded ipsilaterally. Moreover, a systematic posterior shift of the N100m source into the left hemisphere with respect to the right one was detected. In conclusion, the authors emphasize the need to study electric as well as magnetic responses in order to better understand auditory cortical functions.