10.59987/ads/2014.4.123-127
Introduction. Over the past 10-15 years, Italy has undergone a social transformation, and the class of employees and workers has become more economically stable with a higher buying power. Along with the increased expectations of patients on the quality of life, it has now become a priority to make health and social services ready to face users bearing new requirements and different needs. Objectives. To provide a description of the state of health of the operating personnel of the Finance Police (Guardia di Finanza), including elements for planning the most appropriate interventions for health promotion and prevention.
Methods. The study analyzed the health condition of a group of soldiers (178 subjects, divided into different age classes) by evaluating the effectiveness of a training and information program and subsequently the level of benefit.
Results. The study population showed a good state of health correlated to the quality of life. Although the population voluntarily submitted to health assessment, the rigour of the calls and briefings carried out in the military health unit and the attention of the group to follow instructions on prevention underlined a positive trend, even in behaviours considered as health-risky.
Conclusions. Socio-cultural components and the work environment influence the quality of life. In the case of military health care, the specific military organization was useful to monitor the health condition of the population, maximizing the effectiveness of services, enhancing the information and carrying out prevention strategies and demand of care, which should be an example for the public health services.
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Annali di stomatologia
questionnaire on health
Multitarget survey on the Finance Police personnel: assessment of the health condition
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Original Article
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B. Colagrosso 
2014
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Multitarget survey on the Finance Police personnel: assessment of the health condition
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                                                                                                  Original article



    Multitarget survey on the Finance Police personnel:
    assessment of the health condition




                                                                                                    i
                                                                                                  al
                                                                                               on
    Giancarlo Barraco, MD, DDS1                              work environment influence the quality of life. In the
    Stefano Pagano, DDS1                                     case of military health care, the specific military or-
    Grazia Lupoli, DDS1                                      ganization was useful to monitor the health condi-
    Alessandro Dolci, DDS2                                   tion of the population, maximizing the effectiveness
    Beniamino Colagrosso, MD3                                of services, enhancing the information and carrying




                                                                                       zi
                                                             out prevention strategies and demand of care, which
                                                             should be an example for the public health services.
    1 Surgical and Biomedical Sciences Department, Uni-




                                                                          na
      versity of Perugia, Italy                              Key words: general health, prevention pro-
    2 University of Tor Vergata, Rome, Italy                 gramme, life quality, questionnaire on health.
    3 Operative Health Unit of the General Command of

      the Finance Police, Rome, Italy
                                                             Introduction




                                                               er
    Corresponding author:                                    In the past 10-15 years Italy has changed from being
    Giancarlo Barraco, MD, DDS                               a nation with an entrepreneurial middle-class. The
    Surgical and Biomedical Sciences Department, Uni-


                                                       t     employee and working class has become economical-
    versity of Perugia, Italy
    Phone: +39 075 585 3516
                                                    In       ly more stable and with a higher buying power. Upon
                                                             this transformation the health condition of this social
    Fax: +39 075 585 5809                                    class could be defined as “tailor made” by describing
    E-mail: giancarlo.barraco@unipg.it                       its demand of health care (1-3). In this respect, to-
                                                             gether with increased expectations of patients and life
                                                  ni
                                                             quality, it became a priority to prepare the social-
    Summary                                                  heath services to cope with new demands and differ-
                                                             ent needs. The scientific literature and the epidemio-
                                    io

    Introduction. Over the past 10-15 years, Italy has       logical analyses have shown that, on the whole, a
    undergone a social transformation, and the class         middle-high socio-economic and cultural level, in as-
    of employees and workers has become more eco-            sociation with an increase of high level specialized
    nomically stable with a higher buying power.             performances, determines a better preservation of the
                           iz



    Along with the increased expectations of patients        health condition compared to subjects with low socio-
    on the quality of life, it has now become a priority     economic and cultural level (2, 4, 5).
    to make health and social services ready to face         This work, to be considered as preliminary, provides a
          Ed




    users bearing new requirements and different             description of the health condition of a population sam-
    needs.                                                   ple yielding indications for planning the most appropri-
    Objectives. To provide a description of the state        ate interventions in health promotion and prevention.
    of health of the operating personnel of the Fi-
    nance Police (Guardia di Finanza), including ele-
    ments for planning the most appropriate interven-        Methods
IC




    tions for health promotion and prevention.
    Methods. The study analyzed the health condition         The General Command of The Finance Police, med-
    of a group of soldiers (178 subjects, divided into       ical district service, and a team of the University of
    different age classes) by evaluating the effective-      Perugia and the University of Tor Vergata, Rome,
C




    ness of a training and information program and           have carried out a project (2009-2012) to promote
    subsequently the level of benefit.                       health improvement of the operational personnel of
    Results. The study population showed a good              the Finance Police through the adoption of social and
    state of health correlated to the quality of life. Al-   health protocols and the prevention activity of educa-
©




    though the population voluntarily submitted to           tion and information by the health operators in charge
    health assessment, the rigour of the calls and           of the control of the afore mentioned personnel.
    briefings carried out in the military health unit        The subjects took part to the project on a voluntary
    and the attention of the group to follow instruc-        base, filled an initial self-evaluation questionnaire of
    tions on prevention underlined a positive trend,         their health status, and received information on epi-
    even in behaviours considered as health-risky.           demiology and health hygiene concerning the opera-
    Conclusions. Socio-cultural components and the           tional protocol of the study (6, 7).

    Annali di Stomatologia 2014; V (4): 123-127                                                                  123
    G. Barraco et al.


    Thereafter, all the subjects underwent a medical visit       compared to the national mean, underlining that the
    including anamnesis data with a digital record (record       group showed a perception of excellent health condi-
    of the general health profile) that was integrated with      tions, as it actually was (Fig. 1) (6, 7, 9).
    data coming from medical charts, radiodiagnostic             Most subjects were admitted to hospital only once.
    analyses and analyses provided by the subjects               Therefore, the analysed group would ensure a re-




                                                                                                             i
    themselves.                                                  markable working continuity as only 1/3 of the sub-




                                                                                                           al
    Following the analyses to provide and define a set of        jects have been admitted to hospitals more than once
    indicators for the construction of the health profile of     (Figs. 2, 3). From the available data (unfortunately
    the population to be examined, the subjects of the           the results are not reliable) it was not possible to




                                                                                                        on
    study were reduced to 178 (eliminating those sub-            identify whether the new admission to hospital was
    jects presenting gaps or incorrect data) (8, 9).             due to the same pathology so to correlate it to a pos-
    This final sample underwent follow-up actions and the        sible deficit of the health service of reference.
    final compilation of the self-evaluation questionnaire.
    Once the study sample was defined, the remaining




                                                                                              zi
    Italian population was considered as control refer-
    ence (data obtained by ISTAT and epidemiological
                                                                    not in
    sources), assuming that the socio-economic condi-




                                                                              na
                                                                    good
    tions of the Italian citizens, and therefore the risk fac-      health
    tors, were similar among them, but different from                1%
    those of the study sample (10, 11).
                                                                                                                good health
                                                                                            good




                                                                   er
                                                                                            health
    Results                                                                                  99%
                                                                                                                not in good
    The comparison between the national data and those                                                          health
    of the study sample showed a remarkable divergence


                                                           t
    for all the general health indicators.
    For example, the oncological assessments concern-
                                                        In       Figure 1. Perception of the health condition of the study
    ing the local plans of screening estimating the inci-        population.
    dence and prevalence of oncological diseases
    strongly diverged from those of the analysed group.
                                           ni
    In fact, in the sampled population there was only one
    subject with oncological pathology (specifically,
    prostate cancer).                                                     DayH 32%
                                  io

    The 178 subjects had a biased gender distribution                                                       never
    with a female proportion of 6% and a male proportion                                                   admitted
    of 94%; the percent distribution in the work environ-                                                    52%
    ment was considerably below the national mean
                         iz



    (ranging between 10 and 16%). The lowest value                       standard
    recorded in the national data is the total absence of               admission
                                                                           16%
    women (as among ambassadors, the Court of Ac-
          Ed




    counts and the general power of attorney), while in
    the public administration as well as in the legal sys-
                                                                 Figure 2. Percent of subjects with standard admissions and
    tem the range lies between very low levels around
                                                                 day hospital.
    7.4% and a value that is higher in politics (16%) and
    in between at University level. Within public health,
    among medical doctors of a complex structure the
IC




    proportion of women is 10% (head physician women
    were 6.1% in 1993).                                                                                                multiple
                                                                                                                      admission
    The study population was mature, with an average
                                                                                                                        32%
    age of 46 in men and 60 in women.
C




    Although the population was homogeneous concern-
                                                                               single
    ing work and life environment, it was heterogeneous
                                                                             admission
    concerning geographic origin: 5% came from North-                           68%
    ern Italy, 54% from Central Italy, 36% from Southern
©




    Italy, and 5% from abroad.
    Sixty percent of women came from Central Italy and
    40% from Southern Italy.
    Ninety nine percent of the subjects declared a good
    general health condition, and an accurate analysis of
    hospital admissions and therapies for ongoing                Figure 3. Percent of single and multiple admissions to hos-
    pathologies actually highlighted a very low proportion       pital.

    124                                                                              Annali di Stomatologia 2014; V (4): 123-127
    Finance Guard corps health survey


    The causes of admission to hospital were analysed
    according to the ICD9-CM.
    The most common causes of standard admission to                                                27%
                                                                          Dust
    hospital in men were represented by traumatic events
    (21%), for which the most frequent age classes in-




                                                                                                          i
                                                                         Drugs         9%
    volved were between 20 and 40, followed by dis-




                                                                                                        al
    eases of the digestive and respiratory trait for which     Nickel and metal      5%
    the most frequent age classes were those between
    50 and 60.                                                        Seasonal
                                                                                                                  59%




                                                                                                     on
    Day hospital admissions were instead referred to in-
    terventions of rhinoplasty followed by hernia and
    varicocele. For women the comparison with the Ital-
                                                               Figure 5. Prevalence of allergic sensitizations.
    ian population showed the highest proportion of hos-
    pitalizations due to pathologies correlated to preg-




                                                                                            zi
    nancy, parturition and postpartum, followed by dis-        It must be pinpointed that initially the prevalence of
    eases of the urogenital and digestive system, while        lung pathologies was attributed to pathologies linked
    for men the most common cause of admission to hos-         to smoking habits, but indeed the prevalence high-




                                                                             na
    pital were cardiovascular diseases followed by dis-        lights cases specifically correlated to allergic and al-
    eases of the digestive system.                             lergic-asthmatic pathologies, with subsequent BPCO
    We analysed the distribution of the pathologies. Since     (bronco pneumonitis obstructive pathology).
    the prevalence of hospital admissions was due to trau-     There were a proportion of subjects with dust allergy,




                                                                 er
    matic events, we assessed if there was a correlation       which significantly diverged from the national base-
    with traumas associated to place and type of work.         line. The analyses of the respiratory pathologies high-
    Most traumas were due to car and sport accidents,          lighted that in the study population bronchial asthma
    the latter only involving men of young age classes         constituted about one third of the pathologies, while
    (Fig. 4). It must be however noticed that a very low


                                                            t  dust allergies the remaining 2/3.
    number of work traumas occurred (two in total).
                                                         In
    In relation to the aetiology of admissions for traumatic
    events the project of the present work had purpose-        Discussion
    fully preventive aims including evaluation and identifi-
    cation of risky behaviours in order to reduce the so-      The aim of this work was to analyse a population
                                                  ni
    cial and health costs represented especially by the        from the health point of view, evaluating its health
    numerous cases of day hospital.                            condition.
    An interesting result regards the prevalence of lung       The goal was to adequately predispose interventions
                                    io

    diseases with asthmatic-allergic manifestations, es-       of health education and prevention in an age class
    pecially those involving dust (Fig. 5), that diverged      that could take advantage of such preventive pro-
    from the national mean and could be attributed to a        grams, modifying where possible risky behaviours
    not ideal work environment, such as archives, dusty        and lifestyles.
                           iz



    environments, warehouses, unhealthy rooms with in-         The adequate assistance within the military district
    adequate air turnover, represented by those places         under investigation towards patients with respiratory
    where for work reasons (investigations, inspections)       diseases, mediated by careful prevention and health
          Ed




    the personnel of the Finance Police must carry out         and hygiene education has certainly determined the
    his duties; moreover, the increase with age of respi-      natural course of diseases, showing that a good coor-
    ratory chronic pathologies is exponential, not linear,     dination among general and specialized medicine al-
    and this strongly supports this hypothesis (12).           lows improving the general profile of the patient and
                                                               long-term prognosis.
                                                               It is therefore evident that in the field of prevention it
IC




                                                               would be useful to monitor the work environments to
         n° of admissions for traumas/n° di admissions*100     reduce at most the possible presence of contami-
                                                               nants with a particular attention to the reduction of
                                                               risky behaviours and conditions.
C




                                                               However, owing to the nature of the respiratory
                                     2%
        ligaments                                              pathologies emerging from the results, among the ob-
                                                               jectives at the health military level, it was started a
                                                               programme of prevention and information with inter-
                                     2%
©




         fractures                                             ventions aimed at contrasting the smoking habits as
                                                               pathogen cofactor, also in relation to the fact that
                                                               23% of the subjects analysed were smokers (against
                            1%
         meniscus                                              22.7% in 2011 and 20.8% in 2012 at national level)
                                                               (13-16).
                                                               The number of smokers, showing a higher propor-
    Figure 4. Prevalence of traumatic events on lower limbs.   tion than in the Italian population, is probably due to

    Annali di Stomatologia 2014; V (4): 123-127                                                                      125
    G. Barraco et al.


    a work situation characterized by stress correlated         Conclusion
    to the type of tasks, typically investigative and ac-
    counting, and to the often unhealthy environmental          Selecting a homogeneous worker group has the ad-
    conditions during inquiries, and this could justify the     vantage of examining a population with similar needs,
    contrast with the acquisitions emerging from the lit-       common working habits and similar circadian rhythms.




                                                                                                                  i
    erature. Indeed, as highlighted by research carried         In spite of an heterogeneous geographic provenience,




                                                                                                                al
    out in Italy before 2003, the “employee” was the            an homogeneous working life is commonly present
    high smoking category. Currently, the strict smoking        (due o similar food and environmental habits). This
    ban in work environments has actively contrasted            study aimed at analysing the health condition and al-




                                                                                                             on
    the working habit at workplaces with positive conse-        lowed planning a standardization of the therapeutic pro-
    quences not only on the health and welfare of the           cedures and prevention with a high cost-benefit ratio.
    workers, but also on the company budgets; howev-            The improvement of the health condition is facilitated
    er, for an investigative company as the Finance Po-         by: rigorous checks and respect of rules that have di-
    lice the actual work place is the place where the vio-




                                                                                                  zi
                                                                minished risky behaviours; efficacy of the military
    lation with which the investigation is dealing, not the     pyramidal structure with well defined roles, compe-
    office.                                                     tencies, organization, active presence at meetings,
    The other worrying result, strongly diverging from the




                                                                                na
                                                                and distribution of informative materials; more effec-
    national mean and other administrative public envi-         tive execution of therapeutic and preventive protocols
    ronments, is the number of gastric and duodenal             with a consequent improvement of the assistance.
    pathologies that were crossed with more generic data        The preliminary assessments already allowed modu-
    in order to verify the stress condition of the study        lating the assistance response by orienting the activi-




                                                                   er
    population with evaluations on incorrect habits, ony-
                                                                ties depending on the specific requests and the pre-
    cophagy, insomnia, anxiety, and other behaviours
                                                                dictable needs of the workers.
    with an important mental load on the subjects.
                                                                The continuous improvement of the quality of the
    For obvious reasons, we can’t conclude that the
                                                                health assistance with technological instrumental in-
    causes originating the psychophysical discomfort un-


                                                          t     novations at the frontiers of medicine, the fund raising
    work conditions, since there could be environmental
                                                       In
    derlined by the indicators should be attributed to the
                                                                for the implementation of specialized units, the possi-
                                                                bility to offer trained personnel and specific perfor-
    confounds and individual personality differences in
                                                                mances with particular attention to the prevention and
    resistance. However, we believe that such prelimi-
                                                                conformity to healthy lifestyles proved to be points of
    nary data deserve to be confirmed with a deeper in-
                                           ni
                                                                excellence of the health service offered to the per-
    vestigation especially focussed on psychological and
                                                                sonnel of the Finance Police.
    stress assessments.
                                                                The recommendations of clinical behaviour constitut-
    The presence of chronic pathologies, constituting a
                                                                ed a fundamental part in the project scheme together
                                 io

    major indicator to evaluate health condition in terms
    of worsening of life quality showed a lower frequency       with the University team. The identification of “process
    of arthrosis-arthritis (the most common disorders in        indicators” and “final result” provided an immediate
    advanced age) compared to the national mean but al-         and evident validation; the individual performances of
                        iz



    so of less common diseases with high impact such as         the health district of the Finance Police in association
    diabetes and heart pathologies (4, 6, 7). In the evalu-     with the activities of the university team, against the
    ations we inserted the currently present pathologies        initial information recorded at time zero have shown a
          Ed




    and pharmacological therapies. We can conclude that         validity of the informative activity of the members of
    only a minor proportion (10%) assumed drugs (anti-          the project and was evident in the comparison be-
    hypertensive, antacid, intestinal antispasmodic, oral       tween the self-evaluation forms.
    hypoglycemic, thyroid hormones, anxyolitic).                The recommendations of medical preventive behav-
    In the study population 13% of the subjects reported        iours and those more truly clinical have been checked
    migraine, differing from most epidemiological studies       thanks to the epidemiological evaluations for compar-
IC




    reporting proportions ranging from 18% in women             ison with the control visits carried out with extreme ef-
    and 6% in men between age 25 and 55 and causing             ficiency by the Head of the Health Service.
    work inability.
    It is therefore imperative an early and correct identifi-
C




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    Annali di Stomatologia 2014; V (4): 123-127                                                                                                      127
