Big Data in occupational medicine: the convergence of -omics sciences, participatory research and e-health.

BACKGROUND: New occupational hazards and risks are emerging in our progressively globalized society, in which ageing, migration, wild urbanization and rapid economic growth have led to unprecedented biological, chemical and physical exposures, linked to  novel technologies, products and duty cycles. A focus shift from worker health to worker/citizen and community health is crucial. One of the major revolutions of the last decades is the computerization and digitization of the work process, the so-called "work 4.0", and of the workplace. OBJECTIVES: To explore the roles and implications of Big Data in the new occupational medicine settings. METHODS: Comprehensive literature search. RESULTS: Big Data are characterized by volume, variety, veracity, velocity, and value. They come both from wet-lab techniques ("molecular Big Data") and computational infrastructures, including databases, sensors and smart devices ("computational Big Data" and "digital Big Data"). CONCLUSIONS: In the light of novel hazards and thanks to new analytical approaches, molecular and digital underpinnings become extremely important in occupational medicine. Computational and digital tools can enable us to uncover new relationships between exposures and work-related diseases; to monitor the public reaction to novel risk factors associated to occupational diseases; to identify exposure-related changes in disease natural history; and to evaluate preventive workplace practices and legislative measures adopted for workplace health and safety.

Chlorhexidine-induced anaphylaxis occurring in the workplace in a health-care worker: case report and review of the literature.

BACKGROUND: Chlorhexidine has been widely used in the occupational field as an effective antiseptic and disinfectant, especially in the health-care services. Several cases of allergic reactions to chlorhexidine have been reported, both in the general population and in workers. OBJECTIVES: To describe a case of occupational chlorhexidine-induced severe anaphylaxis that occurred in the workplace in a health-care worker (HCW) and to update the literature on chlorhexidine as a possible occupational allergen. METHODS: We report a case of a severe anaphylactic reaction that occurred in the workplace in a 63-year-old man, who had worked as a dentist for over 20 years. We also carried out a systematic review of the literature according to the PRISMA guidelines. No time or language filters were applied. Only occupational case-reports and case-series were included. RESULTS: The causative role of chlorhexidine was suspected owing to the presence of chlorhexidine-containing products in the workplace. Positive results on the Basophil Activation Test confirmed the diagnosis of immediate chlorhexidine-induced hypersensitivity reaction and excluded a role of other disinfectants. No other causes of anaphylaxis were suspected. Our systematic literature review identified 14 cases of occupational chlorhexidine-induced allergy among HCWs; in these cases, the clinical presentation was mild and the symptoms resolved. No cases of systemic reactions in the workplace were reported. CONCLUSIONS: This is the first report of chlorhexidine-induced severe anaphylaxis occurring in the workplace. This case report underlines the importance of investigating and being aware of individual and environmental risk factors in the occupational field, which can cause, albeit infrequently, severe reactions with serious consequences.

A reliability and readability analysis of silicosis-related Italian websites: implications for occupational health.

BACKGROUND: Silicosis represents a "classical" occupational disease characterized by a renewed interest. New risk factors are emerging, such as sandblasting in the jeans industry or hydrofracking, leading to clusters of acute or massive cases. OBJECTIVES: Given that the Internet could represent a worker education and empowerment tool, and considering the increase in popularity of silicosis-related information, we aimed at systematically analyzing the reliability and readability of online silicosis-relevant information. METHODS: The search term "silicosi" was used to query 5 top search engines. The first 3 pages of results were screened using two validated readability tools: namely, the Gulpease and the ReadIt DyLanLab grade level scores. RESULTS: Seventy sites were analyzed. The Gulpease score differed among the types of websites: academic websites differed from institutional websites, as well as encyclopedia/dictionary pages from institutional sites. The Lexical Model - ReadIt DyLanLab grade level differed among the types of websites. Encyclopedia/dictionary pages differed from academic, commercial, health-related, institutional and news sites. Approximately, half of the websites were intended/designed for workers. Only the Global Model - Read-It DyLanLab grade level differed according to the intended/designed target. Only 1.4% of websites adhered to Health on the Net Foundation Code of Conduct. CONCLUSIONS: Our findings may have important practical implications for occupational physicians and health agencies/authorities. They should make efforts in strengthening their online presence, and producing appropriate material. This could lead to positive outcomes in term of occupational health promotion, potentially enabling workers to increase and to improve their work-related health and its determinants.

Protocol of a scoping review assessing injury rates and their determinants among healthcare workers in western countries.

INTRODUCTION: Healthcare workers (HCWs) are exposed to various risk factors and risky behaviours that may seriously affect their health and ability to work. The aim of this protocol is to detail the steps to follow in order to carry out a scoping review to assess the prevalence/incidence of injuries among HCWs. METHODS AND ANALYSIS: The study will be carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols guidelines. Studies will be selected according to the following criteria: P (HCWs), E (exposure to injuries), C (different types of exposure and different categories of HCWs) and O (prevalence/incidence and determinants of injuries). A time filter has been set (literature between 2000 and 2018) to enable updated, direct comparison between the findings and the epidemiological data available at national and local 'Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro' (National Institute for Insurance Against Accidents at Work) centres in Italy. No language restriction will be applied. ETHICS AND DISSEMINATION: Formal ethical approval is not required; primary data will not be collected, as they have already been published. The results will be disseminated through peer-reviewed publication(s), conference presentation(s) and the press.

Influenza vaccination in healthcare workers: A comprehensive critical appraisal of the literature.

Influenza imposes a significant burden worldwide from the healthcare and socio-economic standpoints. This is also due to suboptimal vaccination coverage among the target population, even though immunization is recommended since many years and still remains the fundamental tool for its prevention. Healthcare workers (HCWs) are at increased risk of exposure to respiratory pathogens compared with the general population, including flu, with potential threat for their health and for patients' safety. Nevertheless, despite recommendation for immunization of this work-category in most of Western Countries, inadequate flu vaccine uptake is reported during the last decade in the European area. According to recent systematic reviews on this topic, the main determinants of vaccine acceptance among HCWs have been largely investigated and include desire for self-protection and to protect family rather than absolute disease risk or desire to protect patients, among the main drivers. On the other hand, concerns regarding safety of the vaccines resulted in decreased vaccine uptake. Moreover, influenza vaccine hesitancy among HCWs was also associated with several issues such as low risk perception, denial of the social benefit of influenza vaccination, low social pressure, lack of perceived behavioral control, negative attitude toward vaccines, not having been previously vaccinated against influenza, not having previously had influenza, lack of adequate influenza-specific knowledge, lack of access to vaccination facilities, and socio-demographic variables. The topic of influenza vaccination among HCWs is challenging, full of ethical issues. Systematic reviews of randomized controlled trials (RCTs) investigating the effectiveness of interventions for improving vaccine uptake among HCWs found that combined strategies were more effective than isolate approaches. Mandatory policies are currently under debate in several countries. High quality studies would help policy-makers and stake-holders to shape evidence-based initiatives and programs to improve the control of influenza.

Patterns of Harmful Alcohol Consumption among Truck Drivers: Implications for Occupational Health and Work Safety from a Systematic Review and Meta-Analysis.

Alcohol consumption is one of the main causes of productivity losses arising from absenteeism, presenteeism, and workplace injuries. Among occupational categories most affected by the use of this substance, truck drivers are subject to risk factors and risky behaviors that can have a serious impact on their health, their work, and the general road safety. The use of alcohol during truck-driving activities is, indeed, an important risk factor for traffic accidents. The present systematic review and meta-analysis aims at synthesizing the literature regarding harmful alcohol consumption patterns among truck drivers in a rigorous way. A 'binge drinking' prevalence of 19.0%, 95% confidence interval or CI (13.1, 26.9) was present. An 'everyday drinking' pattern rate of 9.4%, 95% CI (7.0, 12.4) was found, while the rate of alcohol misuse according to the "Alcohol Use Disorders Identification Test" (AUDIT)-"Cut down-Annoyed-Guilty-Eye opener questionnaire" (CAGE) instruments was computed to be of 22.7%, 95% CI (14.8, 33.0). No evidence of publication bias could be found. However, there is the need to improve the quality of published research, utilizing standardized reliable instruments. The knowledge of these epidemiological data can be useful for decision makers in order to develop, design, and implement ad hoc adequate policies.

Infodemiological data concerning silicosis in the USA in the period 2004-2010 correlating with real-world statistical data.

This article reports data concerning silicosis-related web-activities using Google Trends (GT) capturing the Internet behavior in the USA for the period 2004-2010. GT-generated data were then compared with the most recent available epidemiological data of silicosis mortality obtained from the Centers for Disease Control and Prevention for the same study period. Statistically significant correlations with epidemiological data of silicosis (r=0.805, p-value <0.05) and other related web searches were found. The temporal trend well correlated with the epidemiological data, as well as the geospatial distribution of the web-activities with the geographic epidemiology of silicosis.

Insomnia is associated with road accidents. Further evidence from a study on truck drivers.

BACKGROUND: Sleep-related problems are known risk factors for road accidents. However, very few studies have investigated the role played by insomnia and its components, and no data are available for a population of occupational drivers at risk, such as the truck driver category. OBJECTIVE: To measure the prevalence and impact of insomnia on motor vehicle accidents (MVAs) and near-miss accidents (NMAs) in 949 truck drivers. DESIGN: Cross-sectional survey. RESULTS: Insomnia affected 27.5% of the sample. Compared to other drivers, in the 3 years prior to the study, truck drivers with insomnia had reported a significantly higher number of MVAs; they had also reported a greater number of NMAs in the previous 6 months. After correction for the presence of obstructive sleep apnea, excessive daytime sleepiness, short sleep duration, and other concurrent diseases, insomniac truck drivers had an almost two-fold risk of driving accidents (OR: 1.82, CI 95%:1.33-2.49) and a more than three-fold increased risk of near-miss accidents (OR: 3.35, CI95%:2.06-5.45) compared to non-insomniac drivers. CONCLUSION: Insomnia emerged as an independent risk factor for MVAs and NMAs. We strongly advise screening commercial drivers for signs and symptoms of insomnia in order to improve health and safety on the road.

Susceptibility to vaccine-preventable diseases and vaccination adherence among healthcare workers in Italy: A cross-sectional survey at a regional acute-care university hospital and a systematic review.

Healthcare Workers (HCWs) have an increased risk both to acquire and to spread vaccine preventable diseases (VPDs) both to their colleagues and, especially, to vulnerable patients. The prevention of occupational hazards among HCWs is based on proper adoption of the standard and additional precautions, immunizations, and secondary preventive measures, such as post-exposure prophylaxis. Moreover, HCWs are often referred to as the most trusted source of vaccine-related information for their patients. In the present article, we report the findings of a cross-sectional study investigating the compliance to vaccinations among HCWs employed at the Obstetric Unit of a regional acute-care University Hospital in Northern Italy. Furthermore, a systematic review of the literature for some VPDs (i.e., HBV, measles, rubella, varicella and influenza) was performed, over a 17-year period, in order to update the socio-demographic and professional characteristics, the susceptibility status and the vaccination rates among HCWs in Italy.

Hymenoptera venom allergy in outdoor workers: Occupational exposure, clinical features and effects of allergen immunotherapy.

OBJECTIVES: To describe (i) the clinical characteristics of workers, exposed to hymenoptera stings, with an ascertained diagnosis of Hymenoptera Venom Allergy (HVA), (ii) the specific role of occupational exposure, (iii) the effect of Venom Immunotherapy (VIT) in reducing the severity of allergic episodes in workers exposed to repeated stings of hymenoptera, and (iv) the management of the occupational consequences caused by allergic reactions due to hymenoptera stings. METHODS: Between 2000 and 2013 an observational study, including patients referred to the regional reference hospital of Liguria, Italy, with an ascertained diagnosis of HVA and treated with VIT, was performed. A structured questionnaire was administered to all patients to investigate the occupational features of allergic reactions. These were graded according to standard systems in patients at the first episode, and after re-stings, during VIT. RESULTS: One-hundred and 8four out of the 202 patients referred had a complete data set. In 32 (17.4%) patients, the allergic reaction occurred during work activities performed outdoor. Of these, 31.2% previously stung by hymenoptera at work, and receiving VIT, were re-stung during occupational activity. The grades of reaction developed under VIT treatment resulted clinically less severe than of those occurred at the first sting (p-value = 0.031). CONCLUSION: Our findings confirmed the clinical relevance of HVA, and described its occupational features in outdoor workers with sensitization, stressing the importance of an early identification and proper management of the professional categories recognized at high risk of hymenoptera stings. The Occupational Physician should be supported by other specialists to recommend appropriate diagnostic procedures and the prescription of VIT, which resulted an effective treatment for the prevention of episodes of severe reactions in workers with a proven HVA.

Persistence of protective anti-HBs antibody levels and anamnestic response to HBV booster vaccination: A cross-sectional study among healthcare students 20 years following the universal immunization campaign in Italy.

Vaccination against Hepatitis B Virus (HBV) became mandatory in Italy for all newborns and 12 years-old individuals in the 1991. The immunogenicity of HBV vaccine and the effectiveness of the universal immunization strategy have been widely demonstrated. However the need to assess the antibody concentrations above the well known serological correlate of protection for HBV infection (≥10 mIU/mL), established in individuals immunized with a 3 doses vaccination course, is still recommended in subjects exposed to occupational risks in different settings, particularly the healthcare services. This practice has to be performed during the preventive medical examination, before the worker's exposure to biological hazards, as a fundamental part of Occupational Health Surveillance Programs in several Countries, including Italy: the goal is to assure individual protection, also providing booster doses when needed, after many years following the primary vaccination. During the 2011-2013 period, an observational study was performed in Healthcare students (HCSs) trained at a regional university acute-care hospital in North-Western Italy, properly immunized against HBV during infancy or adolescence, in order to evaluate the persistence of seroprotection and to assess the anamnestic response to booster vaccination. Data from 717 subjects undergoing HbsAg Ab and HBc Ab testing during the preventive medical examination, and receiving a booster dose of HBV vaccine when resulting with a non-protective titer (<10 mIU/mL), were collected and analyzed. Most of the HCSs (74.6%) included in the survey, mean age 24.8 y ( ± 4.6 SD), had received the primary vaccination course during the first year of life (3-5-11 months). Globally, 507 (70.7%) HCSs showed protective antibody titres, and an anamnestic response was observed in more than 95% subjects receiving the booster dose. Our study demonstrated the long-term persistence of protection of HBV vaccine, more than 20 y following the primary immunization, in HCSs who are exposed to occupational health risk. The anamnestic response observed in non-seroprotected subjects who received the booster further confirms the capability of the HBV vaccine to create a strong immunological memory.

Leveraging Big Data for Exploring Occupational Diseases-Related Interest at the Level of Scientific Community, Media Coverage and Novel Data Streams: The Example of Silicosis as a Pilot Study.

OBJECTIVE: Silicosis is an untreatable but preventable occupational disease, caused by exposure to silica. It can progressively evolve to lung impairment, respiratory failure and death, even after exposure has ceased. However, little is known about occupational diseases-related interest at the level of scientific community, media coverage and web behavior. This article aims at filling in this gap of knowledge, taking the silicosis as a case study. METHODS: We investigated silicosis-related web-activities using Google Trends (GT) for capturing the Internet behavior worldwide in the years 2004-2015. GT-generated data were, then, compared with the silicosis-related scientific production (i.e., PubMed and Google Scholar), the media coverage (i.e., Google news), the Wikipedia traffic (i.e, Wikitrends) and the usage of new media (i.e., YouTube and Twitter). RESULTS: A peak in silicosis-related web searches was noticed in 2010-2011: interestingly, both scientific articles production and media coverage markedly increased after these years in a statistically significant way. The public interest and the level of the public engagement were witnessed by an increase in likes, comments, hashtags, and re-tweets. However, it was found that only a small fraction of the posted/uploaded material contained accurate scientific information. CONCLUSIONS: GT could be useful to assess the reaction of the public and the level of public engagement both to novel risk-factors associated to occupational diseases, and possibly related changes in disease natural history, and to the effectiveness of preventive workplace practices and legislative measures adopted to improve occupational health. Further, occupational clinicians should become aware of the topics most frequently searched by patients and proactively address these concerns during the medical examination. Institutional bodies and organisms should be more present and active in digital tools and media to disseminate and communicate scientifically accurate information. This manuscript should be intended as preliminary, exploratory communication, paving the way for further studies.

Prevalence and predictors of latent tuberculosis infection among Italian State Policemen engaged in assistance to migrants: a national cross-sectional study.

OBJECTIVES: Better knowledge about tuberculosis (TB) and latent TB infection (LTBI) epidemiology is a crucial step for the development of effective strategies towards the control and elimination of this deadliest and persistent health threat. No study has investigated LTBI epidemiology in policemen who act as an interface with cross-border migrants. METHODS: A survey to measure the LTBI prevalence and assess the demographic, professional and clinical features potentially associated with tuberculin skin test (TST) positivity was performed in Italian State Police (ISP) employees engaged, even occasionally, in relief activities, hospitality, photographical identification, escorting and accompanying of migrants, regardless of contact with active TB cases. Variables potentially associated with TST positivity were evaluated with univariate and multivariate analysis. RESULTS: From September to December 2014, 4225 ISP workers underwent TST screening and completed the questionnaire for data collection, according to study procedures. The TST was positive in 9.9% of individuals: no active TB cases were registered among the entire study population. Age, previous BCG vaccination and work category resulted independently associated with TST positivity. CONCLUSIONS: This is the first study providing updated data about LTBI epidemiology among ISP employees engaged in assistance to migrants and furnish preliminary evidence of possible associations between TST positivity and different conditions that need to be deeply investigated with prospective studies.

Sleep Apnea, Sleep Debt and Daytime Sleepiness Are Independently Associated with Road Accidents. A Cross-Sectional Study on Truck Drivers.

BACKGROUND: Recent research has found evidence of an association between motor vehicle accidents (MVAs) or near miss accidents (NMAs), and excessive daytime sleepiness (EDS) or its main medical cause, Obstructive Sleep Apnea (OSA). However, EDS can also be due to non-medical factors, such as sleep debt (SD), which is common among professional truck drivers. On the opposite side, rest breaks and naps are known to protect against accidents. STUDY OBJECTIVES: To investigate the association of OSA, SD, EDS, rest breaks and naps, with the occurrence of MVAs and NMAs in a large sample of truck drivers. METHODS: 949 male truck drivers took part in a cross-sectional medical examination and were asked to complete a questionnaire about sleep and waking habits, risk factors for OSA and EDS. RESULTS: MVAs and NMAs were reported by 34.8% and 9.2% of participants, respectively. MVAs were significantly predicted by OSA (OR = 2.32 CI95% = 1.68-3.20), SD (OR = 1.45 CI95% = 1.29-1.63), EDS (OR = 1.73 CI95% = 1.15-2.61) and prevented by naps (OR = 0.59 CI95% = 0.44-0.79) or rest breaks (OR = 0.63 CI95% = 0.45-0.89). NMAs were significantly predicted by OSA (OR = 2.39 CI95% = 1.47-3.87) and SD (OR = 1.49 CI95% = 1.27-1.76) and prevented by naps (OR = 0.52 CI95% = 0.32-0.85) or rest breaks (OR = 0.49 CI95% = 0.29-0.82). CONCLUSIONS: When OSA, SD or EDS are present, the risk of MVAs or NMAs in truck drivers is severely increased. Taking a rest break or a nap appear to be protective against accidents.