La gestione del lavoratore portatore di disabilità psichica

«Mental disability management within occupational health surveillance».Introduction:The management of workers with mental disability is a current topic of great interest. The aim of the article is to report the experience of managing cases of employees with mental disabilities in an Italian university hospital and to describe the preventive measures adopted and the therapeutic programs carried out.Methods:A group of 100 workers suffering from psychiatric disorders has been included in a medical surveillance program lasting at least 6 months. The workers were followed up within a protocol that included psychiatric visits, psychotherapeutic interventions, visits by the occupational physician and medico-legal evaluations. Evaluation scales of disease severity and treatment efficacy (CGI) and overall functioning (GAF) were administered at the baseline and after 6 months of follow-up.Results:The sample was mainly composed of nurses (44%) and nursing assistants (24%) and the most commonly diagnosed disorders were mood and anxiety disorders. Participation in the medical surveillance program with the implementation of specific therapeutic strategies and organizational interventions resulted in a statistically significant reduction in the severity of the disease and an improvement in overall functioning and made it possible to keep the job and place of work in almost all cases.Discussion:The results of this experience allow us to affirm that the integration of skills is a valid tool both for the multidisciplinary diagnostic assessment and for the monitoring and management of workers with mental disability under periodic health surveillance.Key words: Psychic disability, health surveillance, occupational medicine, mental disorders     

Psychosocial consequences of potential overdiagnosis in prostate cancer a qualitative interview study

Background Prostate cancer is a frequently diagnosed cancer and made up 6% of male cancer deaths globally in 2008. Its incidence varies more than 25-fold worldwide, which is primarily attributed to the implementation of the prostate-specific antigen (PSA) test in developed countries. To reduce harm of overdiagnosis, most international guidelines recommend surveillance programmes. However, this approach can entail negative psychosocial consequences from being under surveillance for an (over)diagnosed prostate cancer.Aim To explore men’s feelings and experiences in a surveillance programme.Design and setting Qualitative study with Danish men diagnosed with asymptomatic prostate cancer Gleason score ≤ 6, who are in a surveillance programmeMethods 12 semi-structured, individual interviews were conducted and analysed with systematic text condensation and selected theories.Results Most informants reported that they were astonished at the time of diagnosis. They were aware of the small likelihood of dying from cancer, but in some cases, the uncertainty created ambivalence between knowing and not knowing. The men expressed their risk awareness in different ways: a realization that life does not last forever, uncertainty towards the future, a feeling of powerlessness, and a need for control.Conclusions The men in this study had substantial psychosocial consequences from being labelled with a cancer diagnosis. Bearing these men’s high risk of overdiagnosis in mind, it is important to discuss whether the harms of this diagnosis outweigh the benefits. The psychosocial consequences of being in a prostate cancer surveillance programme should be explored further.

KEY POINTS

• Current awareness: The number of men living with an asymptomatic prostate cancer has increased the last 20 years after the implementation of the PSA test.
• Main Statements: Men living with an asymptomatic, low-risk prostate cancer experience negative psychocosial consequences
• GPs should consider the possible negative psychosocial consequences in their decision-making of measuring the PSA level

     

Baseline Prostate-specific Antigen Level in Midlife and Aggressive Prostate Cancer in Black Men

Background

Prostate-specific antigen (PSA) measurement in midlife predicts long-term prostate cancer (PCa) mortality among white men.

Superconductivity-driven ferromagnetism and spin manipulation using vortices in the magnetic superconductor EuRbFe4As4

Magnetic superconductors are specific materials exhibiting two antagonistic phenomena, superconductivity and magnetism, whose mutual interaction induces various emergent phenomena, such as the reentrant superconducting transition associated with the suppression of superconductivity around the magnetic transition temperature (T_m), highlighting the impact of magnetism on superconductivity. In this study, we report the experimental observation of the ferromagnetic order induced by superconducting vortices in the high-critical-temperature (high-T_c) magnetic superconductor EuRbFe₄As₄. Although the ground state of the Eu²⁺ moments in EuRbFe₄As₄ is helimagnetism below T_m, neutron diffraction and magnetization experiments show a ferromagnetic hysteresis of the Eu²⁺ spin alignment. We demonstrate that the direction of the Eu²⁺ moments is dominated by the distribution of pinned vortices based on the critical state model. Moreover, we demonstrate the manipulation of spin texture by controlling the direction of superconducting vortices, which can help realize spin manipulation devices using magnetic superconductors.

The coexistence of superconductivity and magnetism has been a long-standing issue in the field of superconductivity due to the antagonistic nature of these two ordered states. Therefore, magnetic superconductors, exhibiting both behaviors simultaneously, have played an important role in the study of their interaction. Various novel phenomena have been reported in magnetic superconductors containing rare earth elements (R) such as Ho and Er, for example, RRh₄B₄ (T_c ∼9 K and T_m ∼1 K) (1), RMo₆S₈ (T_c ∼2 K and T_m ∼0.2 to 1 K) (2), and RNi₂B₂C (T_c ∼5 to 10 K and T_m ∼2 to 6 K) (3, 4), including reentrant superconducting transition, anomalous temperature dependence of the upper critical field, and enhanced vortex pinning (or critical current density [J_c]) associated with the magnetic transition. All have contributed significantly to the development of superconductivity research.Recently, iron-based superconductors containing Eu (Eu-IBSs) have attracted attention as a new class of magnetic superconductors (5). Eu-IBSs are characterized by higher T_c (up to 37 K) and T_m (∼15 to 20 K) compared to other magnetic superconductors. The coexistence of superconductivity and magnetism extends over a wider range of temperatures and magnetic fields, allowing us to conduct experiments using various probes. For example, in the case of EuFe₂(As,P)₂ (6) and Eu(Fe,Rh)₂As₂ (7), where the Eu²⁺ moments exhibit ferromagnetic ordering, observations of a spontaneous vortex state, the domain Meissner state, and a vortex-antivortex state were reported using magnetic force microscopy (8) and magnetization measurements (9). Furthermore, for EuRbFe₄As₄ (10, 11) with a Eu²⁺ helical order (12), it was proposed that the Eu-spin subsystem serves as an internal pump for the magnetic flux based on magneto-optical imaging results (13, 14). In addition, optical conductivity measurements (15) and scanning Hall microscopy (16) revealed that the temperature dependence of the superfluid density shows a dip feature around T_m, which was attributed to the weakening of superconductivity at the magnetic transition.Most of these peculiar phenomena in magnetic superconductors are considered to reflect the impact of magnetism on superconductivity. On the contrary, an example of the influence of superconductivity on magnetism is the shrinkage of magnetic domains associated with the superconducting transition (17), which is favorable for superconductivity, as it reduces the internal magnetic field. Meanwhile, in a type-II superconductor, the magnetic flux penetrates the material, and the mixed state is generated. Once vortices are pinned, the superconductor can act as a magnet (known as a trapped-field magnet). In this situation, magnetism is likely influenced by the magnetic field generated by superconductivity. For example, the manipulation of local moments via superconducting vortices has been proposed using superconductor–magnet hybrids (18). To further investigate the impact of pinned vortices on the local moments, a superconductor with strong pinning properties is considered as a suitable target.The IBSs, especially the 122, 1111, and 1144 types, are known to show high critical current densities (J_c) of ∼1 MA/cm²; that is, they have a strong vortex pinning ability (19–26). Based on Bean’s critical state model (27), J_c is proportional to the gradient of the magnetic flux density (μ₀J_c = |dB/dx|). Then, when an IBS with a sample width (t) of 0.1 mm is magnetized in an external field, a large number of vortices are pinned and a strong magnetic field (H_sc = J_ct/2) of ∼5 kOe is estimated to be generated at the center of the sample. Therefore, in the case of Eu-IBSs, the superconductivity and the magnetic subsystem are both a source of strong magnetic fields; consequently, a nontrivial situation, where the magnetic fields generated by each state mutually affect each other, is considered. In this context, EuRbFe₄As₄ with the highest T_c among Eu-IBSs is an optimal material to investigate the influence of superconductivity on magnetism.Fig. 1A shows the crystal structure of EuRbFe₄As₄. Since the Eu and Rb layers are alternately stacked without a solid solution, the Eu layer spacing is approximately twice that of EuFe₂As₂. Fig. 1B illustrates the temperature dependence of the magnetic susceptibility, showing a sharp superconducting transition at T_c = 37 K with perfect diamagnetism at zero-field cooling (ZFC). The kink structure at T_m = 15 K found below T_c corresponds to the magnetic ordering of the Eu²⁺ moments. The arrows in Fig. 1A indicate the direction of the Eu²⁺ moments. In the ordered state, the Eu²⁺ moments align ferromagnetically in the ab plane, and the orientation of the ferromagnetic alignment rotates by 90° in the next layer; that is, the ground state is a helical order (12). Meanwhile, magnetization measurements showed that the Eu²⁺ moments are reoriented to the ferromagnetic alignment at relatively low external fields (the saturation field [H_sat] is estimated to be ∼2 kOe) (28). In the ferromagnetically aligned state, the internal field (H_Eu) calculated from the Eu²⁺ moments (7 μ_B/Eu) is ∼4.5 kOe, which is approximately half of that in EuFe₂As₂, reflecting the Eu layer spacing.Open in a separate windowFig. 1.Crystal structure and magnetic ordering of EuRbFe₄As₄. (A) Crystal structure of EuRbFe₄As₄. Blue arrows indicate the direction of the Eu²⁺ moments. The schematic diagram of the helical magnetic structure is shown on the Right. (B) Temperature dependence of the magnetization of a EuRbFe₄As₄ single crystal measured for ZFC and field-cooling processes. A magnetic field of 10 Oe was applied along the ab plane. The Inset shows a photograph of a EuRbFe₄As₄ single crystal with a black scale bar corresponding to 1 mm.Thus, in EuRbFe₄As₄, the magnitudes of the characteristic magnetic fields related to superconductivity and magnetism, that is, H_sc, H_Eu, and H_sat, are comparable to each other, such that the Eu²⁺ moments cannot neglect the influence arising from superconductivity. In principle, it is possible to control the arrangement of local Eu²⁺ moments using H_sc. Moreover, because the internal field generated by superconducting currents has spatial distributions, the direction of the Eu²⁺ moments is expected to be locally manipulable by controlling the magnetic field profile. In this study, we demonstrate that 1) the orientation of the Eu²⁺ moments in magnetic fields is dominated by the direction of pinned vortices, and 2) the domain structure of the Eu²⁺ moments can be manipulated by the distribution of superconducting vortices.     

Leg ulcers and abscesses caused by Serratia marcescens

Cutaneous infections caused by S. marcescens, a gram-negative bacillus belonging to the family of Enterobacteriaceae, are uncommon but may be predisposed by immunocompromised conditions or pre-damaged skin. A 73-year-old man presented with multiple ulcers and painful nodules on the lower right leg as well as abscesses on the right malleolus lateralis. He had been treated with oral penicillin without success. Due to chronic obstructive pulmonary disease, he was receiving a systemic therapy with corticosteroids. In addition, he had a post-thrombotic syndrome of the lower right leg. Serratia marcescens was the only microorganism isolated from all cultures performed. After a microbial sensitivity test, ertapenem 1 g/day was given intravenously for 10 days, followed by oral administration of ciprofloxacin 500 mg 1-0-1 for a further 7 days. This therapy resulted in the resolution of all lesions. This rare skin infection with S. marcescens needs specific microbiological diagnosis and adapted antibiosis.     

The average age of smoking onset in Germany – trends and correlates

Summary Objectives:  Germany is rated among the countries with the highest prevalence of tobacco use in Europe. This paper analyzes whether the age of smoking onset has decreased in recent years. Methods:  Multivariable event data analyses were performed on the basis of the representative national cross-sectional study “Drug Affinity among Young People in the Federal Republic of Germany 2004”. The survey involved a total net sample of 3032 individuals aged 12 to 25. Results:  Socioeconomic groups starting to smoke at significantly earlier age include those from the economically deprived areas in eastern Germany, low educational achievers and subjects in households with adult smokers. Conclusions:  The average age of smoking onset has decreased further in the 1978–1992 birth cohorts. Submitted: 18 November 2006; Revised: 23 January 2008, 18 March 2008; Accepted: 19 March 2008