Fabrizio Scafa

Publications of Fabrizio Scafa

• Work-related stress and bullying: gender differences and forensic medicine issues in the diagnostic procedure.

  Authors: Stefano Tonini, Andrea Lanfranco, Antonio Dellabianca, Diego Lumelli, Ines Giorgi, Fulvio Mazzacane, Camilla Fusi, Fabrizio Scafa, Stefano M Candura

  Journal of occupational medicine and toxicology (London, England). 11/2011; 6(1):29.

  ABSTRACT: The attention of international agencies and scientific community on bullying and work-related stress is increasing. This study describes the gender differences found in victims of bullyingABSTRACT: The attention of international agencies and scientific community on bullying and work-related stress is increasing. This study describes the gender differences found in victims of bullying and work-related stress in an Italian case series and analyzes the critical issues in the diagnostic workup. Between 2001 and 2009 we examined 345 outpatients (148 males, 197 females; mean age: 41 ± 10.49) for suspected psychopathological work-related problems. Diagnosis of bullying was established using international criteria (ICD-10 and DSM-IV). After interdisciplinary diagnostic evaluation (Occupational Medicine Unit, Psychology and Psychiatry Service), the diagnosis of bullying was formulated in 35 subjects, 12 males and 23 females (2 cases of Post-Traumatic Stress Disorder and 33 of Adjustment Disorder). Fifty-four (20 males, 34 females) suffered from work-related anxiety, while work-unrelated Adjustment Disorder and other psychiatric disorders were diagnosed in 7 and 112 subjects, respectively. Women between 34 and 45 years showed a high prevalence (65%) of "mobbing syndrome" or other work-related stress disorders. At work, women are more subject to harassment (for personal aspects related to emotional and relational factors) than men. The knowledge of the phenomenon is an essential requisite to contrast bullying; prevention can be carried out only through effective information and training of workers and employers, who have the legal obligation to preserve the integrity of the mental and physical status of their employees during work.

• Irritant vocal cord dysfunction and occupational bronchial asthma: differential diagnosis in a health care worker.

  Authors: Stefano Tonini, Antonio Dellabianca, Cristina Costa, Andrea Lanfranco, Fabrizio Scafa, Stefano M Candura

  International journal of occupational medicine and environmental health. 01/2009; 22(4):401-6.

  Vocal cord dysfunction (VCD) is an uncommon respiratory disease characterized by the paradoxical adduction of vocal cords during inspiration, that may mimic bronchial asthma. The pathogenesis of VCDVocal cord dysfunction (VCD) is an uncommon respiratory disease characterized by the paradoxical adduction of vocal cords during inspiration, that may mimic bronchial asthma. The pathogenesis of VCD has not been clearly defined but it is possible to recognize non-psychologic and psychologic causes. The majority of patients are female but, interestingly, a high incidence of VCD has been documented in health care workers. A misdiagnosis with asthma leads to hospitalisation, unnecessary use of systemic steroids with related adverse effects, and sometimes tracheostomy and intubation. In a subset of VCD patients, the disease can be attributed to occupational or environmental exposure to inhaled irritants. We report the case of a 45-year-old woman, working as a nurse, who complained of wheezing, cough, dyspnoea related to inhalation of irritating agents (isopropylic alcohol, formaldehyde, peracetic acid). She underwent chest radiography, pulmonary function assessment both in the presence and in the absence of symptoms, bronchial provocation with methacholine and bronchodilation test with salbutamol to recognize asthma's features, allergy evaluation by skin prick tests and patch tests and video-laryngoscopy. VCD diagnosis was made on the basis of video-laryngoscopy, that visualized the paradoxical motion of the vocal cords during symptoms, in the absence of other pathologic processes. This case fulfils the proposed criteria for the diagnosis of irritant VCD (IVCD). This is the first report of VCD onset following exposure to several irritants: formaldehyde, glutaraldehyde, sopropylic alcohol, peracetic acid-hydrogen peroxide mixture. These substances are used as cleaning and antiseptic agents in healthcare settings and some ones can also be found in many indoor environments. A correct diagnosis is important both to give the appropriate treatment and for medical legal implications.

• Ocular Argyrosis in a Silver Craftsman.

  Authors: Gianni Pala, Aldo Fronterré, Fabrizio Scafa, Mario Scelsi, Roberto Ceccuzzi, Elisabetta Gentile, Stefano Candura

  Journal of occupational health. 11/2008;

• Anaemia and abdominal pain due to occupational lead poisoning.

  Authors: Rodolfo Fonte, Antonio Agosti, Fabrizio Scafa, Stefano M Candura

  Haematologica. 03/2007; 92(2):e13-4.

  We describe a 47-year-old patient with chronic anaemia with basophilic stippling of erythrocytes, recurrent abdominal colics, discoloration of gums, sensitive polyneuropathy to the four limbs,We describe a 47-year-old patient with chronic anaemia with basophilic stippling of erythrocytes, recurrent abdominal colics, discoloration of gums, sensitive polyneuropathy to the four limbs, hyperuricaemia, hepatosteatosis with raised transaminases, and a long ignored history of lead exposure in a battery recycling plant. The diagnosis of poisoning was confirmed by high lead levels in the blood and urine, decreased erythrocyte delta-aminolevulinic acid dehydratase (ALA-D), raised erythrocyte zinc protoporphyrin (ZP), and elevated urinary excretion of porphyrins. Chelation with EDTA resulted in increased urinary lead excretion, gradual improvement of the clinical picture, and progressive normalization of lead biomarkers. The case highlights the importance of occupational anamnesis for the diagnosis of lead poisoning, an uncommon condition which may mimic a variety of internal and surgical diseases. Since antiquity, lead has been extensively mined, produced, and utilized in a variety of industrial settings, such as metallurgy, construction, production of plastics, ceramics, paints and pigments. Lead and its compounds are systemic toxicants, and a wide range of adverse health effects (including haematological, gastrointestinal, neuropsychiatric, cardiovascular, renal, endocrine, and reproductive disorders) has been observed in exposed workers. The general population (particularly children) may also be exposed to toxic lead levels due to air, soil, food and water contamination. Thanks to the improvement of workplace hygienic conditions, the pathological picture of occupational lead poisoning (plumbism, saturnism) has gradually become less serious, at least in the most industrialized countries, and has progressively changed into aspecific, subclinical manifestations. We describe here an unusual case (nowadays) of anaemia and recurrent abdominal pain due to lead poisoning from battery recycling.

• [Work-related stress and mobbing: case series and gender differences].

  Authors: Stefano Tonini, Andrea Lanfranco, Maria Cristina Costa, Diego Lumelli, Ines Giorgi, Fulvio Mazzacane, Fabrizio Scafa, Stefano M Candura

  Giornale italiano di medicina del lavoro ed ergonomia. 33(4):409-13.

  The attention of international agencies and scientific community on mobbing (bullying) and work-related stress is increasing. However, research on gender differences and etiologic agents is stillThe attention of international agencies and scientific community on mobbing (bullying) and work-related stress is increasing. However, research on gender differences and etiologic agents is still limited. This study describes the gender differences found in victims of mobbing and work-related stress in an Italian case series. Between 2001 and 2009, at the Occupational Medicine Unit of our Institution we examined 345 outpatients (197 women and 148 men) for suspected psychopathological work-related problems. After interdisciplinary diagnostic evaluation, the diagnosis of "mobbing syndrome" was formulated, according to international criteria (ICD-I0 and DSM-IV), in a minority of cases: 35 subjects. In the other workers, we found pre-existing psychiatric conditions (not related to work), or altered relationships dynamics with the colleagues. Significant gender differences emerged among people with "mobbing syndrome": there was a high prevalence of women (65%), with medium to high level of education; the most affected age group was between 34 and 45 years; several occupations were involved, with a clear preponderance of office workers. Women are mostly harassed for personal aspects related to emotional and relational factors; men for the content of their work. The knowledge of the phenomenon is an essential prerogative to contrast mobbing; this can be realized, at a preventive level, only through effective information and training for workers and employers, who have the legal obligation to preserve the integrity of the mental and physical status of their employees during the work.

• [Stress risk evaluation in health personnel: framework and applicative experiences].

  Authors: Piergiorgio Argentero, Alessandra Bruni, Elena Fiabane, Fabrizio Scafa, Stefano M Candura

  Giornale italiano di medicina del lavoro ed ergonomia. 32(3):326-31.

  The Italian legislative decree 81/08 requires stress risk evaluation for all the workers, including health personnel. The present paper compares two different occupational stress evaluationThe Italian legislative decree 81/08 requires stress risk evaluation for all the workers, including health personnel. The present paper compares two different occupational stress evaluation procedures, tested in two North Italy sanitary structures: a) the first through subjective methods, based on self report questionnaires and focus groups; b) the second through an objective approach, utilizing the OSFA (Objective Stress Factors Analysis) method. The comparison of the two experiences indicates that the subjective approach may present several limitations, since it gives a measure of the "felt" stress, not directly related to the nature of the job. On the other hand, the objective approach, and particularly the OSFA method, allows an analysis of the work conditions and the identification of single and specific aspects that can be ameliorated in order to eliminate or reduce the occupational stress sources.