Hospital workers mental health during the COVID-19 pandemic: methods of data collection and characteristics of study sample in a university hospital in Milan (Italy).

BACKGROUND: The COVID-19 pandemic is currently a severe challenge for healthcare workers, with a considerable impact on their mental health. In order to focus preventive and rehabilitation measures it's fundamental to identify risk factors of such psychological impairment. We designed an observational longitudinal study to systematically examine the psychological wellbeing of all employees in a large University Hospital in Italy, using validated psychometric scales in the context of the occupational physician's health surveillance, in collaboration with Psychiatric Unit. METHODS: The study started after ethical approval in August 2020. For each worker, the psychological wellbeing is screened in two steps. The first level questionnaire collects sociodemographic characteristics, personal and occupational COVID-19 exposure, worries and concerns about COVID-19, general psychological discomfort (GHQ-12), post-traumatic stress symptoms (IES-R) and anxiety (GAD-7). Workers who score above the cut-off in at least one scale are further investigated by the second level questionnaire composed by PHQ-9, DES-II and SCL-90. If second level shows psychological impairments, we offer individual specialist treatment (third level). We plan to follow-up all subjects to monitor symptoms and possible chronicization; we aim to investigate potential risk factors through univariate analysis and multivariate logistic regressions. RESULTS: Preliminary results refer to a sample of 550 workers who completed the multi-step evaluation from August to December 2020, before vaccination campaign started. The participation rate was 90%. At first level screening, 39% of the subjects expressed general psychological discomfort (GHQ-12), 22% post-traumatic stress symptoms (IES-R), and 21% symptoms of anxiety (GAD-7). Women, nurses, younger workers, subjects with COVID-19 working exposure and with an infected family member showed significantly higher psychological impairment compared to colleagues. After the second level screening, 12% and 7% of all workers showed, respectively, depressive and dissociative symptoms; scorings were significantly associated with gender and occupational role. We are currently extending sample size and evaluating subjects over a period of further 12 months. CONCLUSIONS: The possibility to perform a systematic follow-up of psychological wellbeing of all hospital workers, directly or indirectly exposed to pandemic consequences, constitutes a unique condition to detect individual, occupational, and non-occupational risk factors for psychological impairment in situations of prolonged stress, as well as variables associated with symptoms chronicization.

[A clinical case of occupational allergy to piperacilline. A novel diagnostic method: basophil activation test (BAT)]. / Utilizzo del test di attivazione dei basofili (BAT) per la diagnosi di reazione allergica a piperacillina in ambito professionale: descrizione di un caso clinico.

BACKGROUND: Piperacillin, unlike other antibiotics, rarely causes immediate allergic reactions. Only two cases related to occupational exposure are reported in the literature. OBJECTIVES: Adoption of new methods for diagnosis of occupational allergy to drugs. METHODS: An atopic nurse, aged 30 years, was referred to our hospital for an allergic work-related reaction to piperacillin. The patient had suffered two successive episodes with immediate cutaneous reaction, angioedema and dyspnoea after preparing piperacillin. Almost four years previously she had suffered from similar symptoms after taking amoxicillin. She was submitted to a clinical examination and a routine allergic test, performing also specific IgE (Phadia Pharmacia ImmunoCap) and BAT (Basophil Activation Test) for Beta-lactam antibiotics. RESULTS: A positive response to piperacillin was observed in our case using BAT a new non-invasive and safe method, that proved useful for diagnosis of allergy. Moreover, we observed a change from an allergic reaction for therapeutic use of amoxicillin to a work-related adverse reaction to another beta-lactam, piperacillin. CONCLUSIONS: In previous clinical cases cutaneous and specific challenge tests were performed for diagnosis. At present, availability of an in vitro test, such as BAT may provide new diagnostic opportunities, and a useful tool for studying clinical cases other than, in perspective, monitoring exposed workers. Preventive measures were taken in the workplace to lower the risk of sensitization and allergic response. The nurse was transferred to a well controlled job.

Fitness for work in health care workers: state of the art and possible operational recommendations for its formulation and management in relationship to alcohol and drug addiction.

Both chronic and acute alcohol or drug consumption have severe health consequences, alter the subject's cognitive functions and work performance and increase the risk of work-related accidents, for the worker and for third parties (e.g., co-workers and other people subject to negative impact of worker's actions). Limited scientific evidence has suggested that some working conditions present in the health care sector (e.g., high levels of responsibility, competitiveness, burnout, shiftwork, work-related stress) may favour alcohol and drug abuse. The aim of the present report is to describe the problem of alcohol and drug consumption among health care professionals and to evaluate the problem of related fitness for work. The magnitude of this problem remains unclear; recent estimates have reported alcohol abuse and addiction problems in 1-14% and psychotropic, illicit and non-illicit, substance abuse in 6-15% of health care workers. The prevalence of tranquilizer and sedative/hypnotic drug use is high, particularly among physicians. However, it remains unclear whether the incidence of workplace accidents and injuries is higher among drug abusers, and whether the statutory introduction of prevention programmes has led to actual control of this problem in the workplace. Italian legislation identifies the occupational physician as a key figure to prevent psychotropic substance abuse in some work activities, but some difficulties in its application remain. Legislators should issue simple norms that clearly define the responsibilities and skills of each actor involved in safeguarding workplace health and safety, as well as clearly outlining workplace monitoring procedures.

[Medical visits before return to work, after a long lasting absence, above 60 days, for injuries or common diseases in a public transport company. Analysis and discussions of utility and consequences in term of evaluation of fitness to specific job]. / La visita al rientro da una malattia/infortunio di durata superiore a 60 giorni: analisi critica di una casistica relativa ad una grande azienda di trasporti.

The aim of this study is to evaluate the opportunity to do medical visits before return to work, after a long continuous absence, above 60 days, for injuries (occupational and non-occupational) or common diseases. We have examined medical records of 403 workers, in 2010 and 2011, occupied in a public transport company, in order to control the following variables: job, age, clinical conditions related to the absences, classification of the absence as injuries or common disease and conclusions about medical fitness to specific job. Our findings have shown an equal percentage of causes of absences in term of injuries or common diseases. The main cause of absence and of non fit to specific job, after medical evaluation, is depending on orthopaedic post-traumatic diseases. This evidence support the importance to do medical visits after long-lasting absence from work, particularly in case of jobs (bus, tram, subway drivers) at risk for other people.

[Psychotropic substances and driving]. / Sostanze psicotrope e guida.

Consumption of psychotropic substances (alcohol, drugs, medication) has a major impact on complex activity performance such as driving. This issue is of relevant social interest for the high number of potentially involved subjects and the often fatale outcomes, and affects also occupational physicians because of the high number of people whose job is driving. There are still few studies trying to assess the presence of a possible association between increased risk of accident/injury at work and consumption of psychotropic substances and results are not always in agreement. In spite of such uncertainties and some Italian regulations still worth being amended by Legislator, the possible impact of consumption of psychoactive substances on driving is an issue to be still better defined for which occupational physicians may play a basic role in the field of prevention, clinics and rehabilitation.

Asbestos-related diseases in entertainment workers.

OBJECTIVES: To investigate asbestos exposure in 4 patients (3 cases of malignant mesothelioma and 1 case ofpleural plagues) previously employed in the entertainment business. METHODS: The patients were seen at the Occupational Health Unit of the "Clinica del Lavoro Luigi Devoto" in Milan (Italy). Information regarding exposure to asbestos (occupational, environmental, and familial) was collected through a standardized questionnaire administered to the patients by an occupational physician. RESULTS AND CONCLUSION: The presence of asbestos in the building structures and its use were described by all patients. The presence of asbestos in public buildings used for entertainment such as cinemas and theatres was in fact confirmed by the Occupational Health Services of the Local Heath Unit. An occupational aetiology was recognised in all the cases mentioned above, thus leading to the identification of an atypical occupational sector at risk in the past for asbestos exposure,

[Systematic surveillance of occupational cancer: the Lombardy Sinonasal Cancer Registry]. / Ricerca sistematica dei tumori professionali: il Registro Tumori dei Seni Nasali e Paranasali della Lombardia.

BACKGROUND: Sinonasal cancer (SNC) includes uncommon tumours that are characterized by a high occupational etiologic component. For this reason they are an easy target for systematic surveillance by setting up a specific disease registry. The National Registry of these tumours is located at the Italian Institute for Occupational Safety and Prevention (ISPESL) and is based on data from Regional Operating Centres (ROCs). In the Lombardy Region a ROC was established in 2008 at the Clinica del Lavoro "Luigi Devoto" in Milan aimed at making surveillance systematic and thus provide adequate support for scientific research and prevention measures in the high risk work sectors. OBJECTIVES: To estimate the incidence of SNC, to define different sources of occupational exposure both known (wood, leather, nickel, chromium) and unknown. METHODS: The Registry collects all the new incident cases of epithelial SNC occurring among residents ofthe Lombardy Region. The Regional Registry is managed in accordance with the specific National Guidelines and uses the experience already acquired with the organizational and operational management of the Regional Mesothelioma Registry. RESULTS: During the first period of activity (1.1.2008-30.9.2009) 556 cases of suspected SNC were reported to the Registry; only 62 (11.2%) of these actually complied with the inclusion criteria of the Registry and were mainly adenocarcinoma and squamous carcinoma. Occupational exposure to wood or leather dust was ascertained in 50% of cases. CONCLUSION: Data collected up to now confirm that occupational exposure to wood and leather dusts are the most significant risk factors for SNC. The study of occupational sectors and job tasks in cases with as yet undefined exposure might suggest new etiologic hypotheses.

[Upgrade on alcohol abuse]. / Aggiornamenti in tema di abuso di alcol.

Problematic use of alcohol configures an element of interest in the context of preventive interventions aimed to ensuring the performance of any work in safety conditions. To contrast the acute alcohol abuse in the workplace the existing legislation provides alcoholimeters controls and prohibition of recruitment and administration of alcohol. Recent legislation (D.Lgs. 81/08) establishes health surveillance for alcohol dependence and appears still incomplete and difficult to apply. Clinical diagnostic tools available to the physician for alcohol dependence identification are well-defined and recently improved thanks to new laboratory markers with high sensitivity and specificity (CDT) and self-administered questionnaires. In this contest we are awaiting for legislative action to specify conditions and procedures for inspections in the workplace in order to face the problem of alcohol dependence without excessive bureaucracy and with more attention to preventive aspects.

[Validity of carbohydrate-deficient transferrine (CDT) in assessing chronic abuse of ethyl alcohol in urban public transport workers]. / Validità della transferrina decarboidrata (CDT) nell'accertamento dell'abuso cronico di alcol etilico in addetti al trasporto pubblico urbano.

OBJECTIVES: The aim of this study was to verify the ability of some chemical-clinical parameters, with particular emphasis on carbohydrate-deficient transferrin (CDT), in assessing chronic abuse of ethanol in a group of urban public transport workers. METHODS: In the 512 subjects, public transport tram drivers, all males, who entered the study, information on the intake of alcoholic beverages was collected during the periodical health surveillance controls performed according to Italian legislation (DM88/99). In the study subjects the following clinical-chemical parameters were measured: CDT gamma-glutamyltransferase (GGT), mean corpuscular volume of erythrocytes (MCV), aspartate aminotransferase (AST), alanine aminotransferase (ALT). RESULTS: The subjects were divided into five groups according to different levels of alcohol intake: non-drinkers, occasional drinkers, moderate drinkers, habitual drinkers and heavy drinkers. The median values of CDT GGT and MCV were higher in drinkers than in non-drinkers, with an increasing trend in proportion to the amount of ethanol ingested. The validity of each parameter in determining chronic abuse of ethyl alcohol was calculated taking as true the statement on alcohol intake made spontaneously by the subject. CDT was confirmed as the parameter with the best sensitivity and specificity: 90% and 98%, respectively, the negative predictive value was 99%, while the positive predictive power was 45%. The combination of CDT with GGT or MCV led to small improvements in the positive predictive ability, which reached 50% for CDT and MCV and 60% for CDT and GGT. CONCLUSIONS: Our results confirmed that, also in the workplace, CDT is the most important parameter for the diagnosis of chronic abuse of alcohol intake, but also showed that the positivity of this marker cannot be taken as certainty of abuse. The adoption of further diagnostic tools is therefore proposed, such as a specific questionnaire to collect information on alcohol intake, and in case of positive CDT a second-level test with a high specificity.

[Prevention and control of substance abuse in the workplace: a new and significant opportunity for the occupational physician]. / La prevenzione ed il controllo dell'assunzione di sostanze psicotrope o stupefacenti nei luoghi di lavoro: una nuova ed importante opportunità per i medici del lavoro.

OBJECTIVES: Substance abuse is nowadays a recurrent theme in the daily practice of occupational physicians (OP), mainly owing to recent legislation prescribing mandatory assessments for workers performing job tasks involving danger to third parties. While some degree of bureaucracy is inevitable and legislation seems to be inclined towards deterrence, it is recommended to take advantage of the opportunities offered for practical interventions which, in accordance with science and ethics, the OP can carry out in the workplace. Risk assessment, health surveillance, fitness for work, health promotion and cooperation in management issues are the areas of intervention required for the OP to fully accomplish his role in the practice of modern occupational health. CONCLUSIONS: We propose specific activities for the OP so as to highlight roles and obligations, based on available scientific evidence and established codes of ethics. Lastly, we wish to emphasize the overall role of the OP in taking on responsibilities shared jointly with all the parties and in the approach to the substance abuse problem in all workplaces with the ultimate goal of acting for the benefit of workers, enterprises and society in general.

[Acute and chronic alcohol abuse and work]. / Abuso acuto e cronico di alcol e lavoro.

A not moderate alcohol consumption or its abuse have relevant consequences not only on the health of the general population but also on the possibility to carry out any work in safety conditions. These behaviours have focused the attention of the institutions, which have promoted in the last years a growing number of preventive and informative actions and have adopted specific laws that have significantly involved the figure of occupational physician. Over the clinical implications, in fact, those behaviours, in the employment context, are associated with an increased risk of injuries (from 10 to 30% of total), an increase in the number of absences from work, with greater precariousness, with the possible interaction and/or strengthening of other occupational toxics and with the progressive reduction of working capacity. Diagnostic tools available for the detection of alcohol abuse or dependency consist, in acute cases by direct measuring of alcohol on blood, saliva and exhaled air, while in the chronic situations in addiction to the more traditional indicators (AST, ALT, GGT, MCV) there are recently introduced marker (CDT)--or in validation (ethyl glucuronide)--that representing, also with specific questionnaires (AUDIT, MAST, MALT, CAGE), useful integrated tools in the clinical-diagnostic path. The role and contribution of occupational medicine in the management of alcohol related problems is vital and relevant. Must be clear however that these are problems associated with a particular behaviour of the person and not with risks present on work-site.

[Alcohol intake, complex ability and responsibility towards others: experience on a cohort of personnel employed to public transport services]. / Consumo di alcool, idoneità complesse e responsabilità verso terzi: 1'esperienza di una coorte di addetti al trasporto pubblico urbano.

BACKGROUND: The excessive intake or the abuse of alcoholic substances represent an important hazard's source for the individual health and for the carrying out of any complex working activities, above all if characterized by elevated responsibility toward other people. In this context the recent Provision of 16 March 2006 of the Permanent Lecture for the Relationships among the State the Regions and the Autonomous Provinces of Trento and Bolzano, has individualized bus driver among the activities or tasks of which is forbidden the assumption of alcoholic drinks at work and can performed alcoholic controls by the competent physician (art. 15 of the Law March 30 th 2001, n. 125). Within the normative considering the DM 23 February 1999 n. 88s (Rule bringing norms dealing about the check and the control of the physical and psycho-aptitude ability of the personnel employed to public transport services), we introduced experience growing up in the period from January 2005 to August 2006, on about 1500 employees, for over 90% of men, employed in a public transport company of the Lombardy as bus driver or railwayman. METHODS: In order to assess driver's alcoholic abuse the analytical determination of carbohydrate-deficient transferring (CDT) has been used as a marker of alcohol intake. Within the visits of hiring in service (equal to 10% of the total one of the effected visits) the determination of the CDT has always been performed, while in revision visits (equal to 90% of the total one) this analytical determination has been performed only if possible alcohol abuse has been hypothesized by elevated values of gamma-GT before the Provision March 16th 2006 (and eventually of MCV, AST and ALT) and of routine from April 2006. CONCLUSIONS: This experience on this large population has confirmed the importance of a careful behaviours of abuse monitoring in workers with high responsibility toward other people. The CDT values reflect high alcoholic consumption, while is poorly remarkable the contribution furnished by anamnestic questionnaire.

[Health surveillance in workers with a previous exposure to asbestos: a method of retrospective evaluation of exposition]. / La sorveglianza sanitaria degli ex esposti ad amianto come metodo di valutazione retrospettiva dell'esposizione.

The medical surveillance of the previously exposed to asbestos like method of retrospective appraisal of the exposure. The medical surveillance of the previously exposed to asbestos is effected on indication of the Competent Physician by the DL 257/2006. An aspect that often countersigns such typology of surveillance is the lack of relative data about past environmental asbestos exposure. There've been submitted to sanitary controls 140 subject employees in a steel metal company where in past activity of heavy carpentry has been developed. All the subjects have been submitted in the period 1998-2007 to medical visit, PFR with DLCO, radiography of the chest, in some cases TC and BAL. The past exposure has been resulted inclusive between 1962 and 1981. None of these workers has developed asbestosis, while the 10% of the subjects have showed bilateral pleural plaques. 12 subjects have been submitted to close examination through BAL for the determination of the internal dose of asbestos with comparison of middle values of 3.9 ca /ml. Four cases of pulmonary neoplasm and any case of mesothelioma have been diagnosed. This experience shows as the medical surveillance of a homogeneous group of workers can furnish useful data also to frame previous asbestos exposure in absence of environmental data.

[Assessment of the efficacy of limitations and indications issued by the occupational physician regarding the health of the staff working in public transportation vehicles]. / La valutazione dell'efficacia delle limitazioni e delle prescrizioni espresse dal medico del lavoro sulla salute del personale addetto alla guida di automezzi di trasporto pubblico.

In this study we assessed the evidence of some specific, "ad hoc", medical indications for city bus, tram and subway professional drivers. As known, professional drivers have very little chances of modifying shift organization and many chronic degenerative diseases (low back pain, diabetes type 2, cardiovascular diseases, ecc.) are difficult to manage according to job planning. In our study we observed a positive association between introduction of specific shift, in particular when shift is divided in two-piece, on morning "turno spezzato 1(0)/1(0)" or one on morning and the second part on afternoon "turno binato 1(0)/2(0)". Evidence of the real impact on professional drivers health conditions has been found from analysis of sickness leave during two, or in same case, one year before and after such medical indications intoduction. In our occupational drivers cohort a positive association, evidence based on real rates of two years sick absence before and after medical indications, was found between improvement of health general conditions and reduction of sickness leave rates correlated.

[The role of the occupational health physician in smoking cessation programmes: the experience of the "Clinica del Lavoro" of Milan]. / Il ruolo del medico del lavoro nella lotta al tabagismo: l'esperienza della Clinica del Lavoro di Milano.

UNLABELLED: <>. BACKGROUND: The "Centre for the prevention, diagnosis and treatment of tobacco dependency", set up at the Occupational and Environmental Respiratory Diseases Section of the Clinica del Lavoro in Milan in September 2000, can count on multidisciplinary expertise, including occupational health physicians, pneumologists and clinical psychologists. Each step of the diagnostic and therapeutic process is based on an integrated approach that considers both the biological aspects of tobacco dependency and the psychological and behavioural aspects. The Centre, moreover, within the framework of "Health Promotion" programmes, offers advice to businesses as regards the new legislation that prohibits smoking at the workplace. METHODS: The proposed treatment programme is based on psychological and motivational support (personal or team work), that can be associated with pharmacological therapy, either as an alternative or an addition. The drug preferred is slow-releasing buproprione, which has proved to be extremely effective compared to other drugs in increasing the probability of smoking cessation and decreasing side effects. RESULTS: In an occupational population of more than 2000 workers, we succeeded in treating about 51% of the subjects, who had stopped smoking, after one year from the beginning of the programme. The best results were achieved using the association of psychological support and buproprione therapy (54%), compared with the other methods (psychological support alone: 42%; psychological support and free nicotine replacement therapy: 33%).

[Evaluation of the neurotoxic and nephrotoxic effects following long-term exposure to metallic mercury in employed at a chlorine/sodium-hydroxide plant]. / Valutazione degli effetti neurotossici e nefrotossici conseguenti all'esposizione a lungo termine a mercurio metallico dei lavoratori addetti agli impianti Cloro-Soda.

OBJECTIVES: Within the frame work of a wide multicentre study, a sub-study was developed in order to explore the occurrence of early effects on the central nervous system, on the kidney and on the neuro-immune system in the workers of a chloro-alkali production plant exposed to metallic mercury at airborne concentration levels lower than 0.025 mg/m3 (TLV-TWA). They were compared to a control population of employees of the same huge petrochemical plant with different job that did not implicate exposure to mercury vapors. Specifically, the study aimed at revealing the occurrence of early effects on the central nervous system related with mercury exposure, as can be assessed through neurophysiological and neurobehavioral tests. METHODS: The excretion of urinary mercury was measured by atomic absorption spectrometry. The study of renal function was assessed by measurement of the urinary excretion of some high and low molecular weight protein markers (albumin, beta 2-microglobulin, retinol-binding protein, fibronectin, specific proximal tubule brush border antigens, N-acetyl-beta-D-glucosaminidase). The neurobehavioral status of the study subjects was assessed by means of several test parameters (Simple Reaction Time, Color Word Vigilance Test, Symbol Digit, Finger Tapping, Mood Scale of Kjellberg and Iwanowski, Subjective symptoms questionnaire (QSS), Luria Nebraska Motor Scale, Branches Alternate Movement Task and Tremometry). RESULTS: The values of urinary excretion averaged 12 +/- 8 micrograms Hg/g of creatinine for the exposed workers group (n = 38), while for the reference group (n = 34 cases) urinary excretion was statistically lower, averaging 4 +/- 6 micrograms Hg/g of creatinine. Neither the parameters selected for the assessment of renal functions, nor those chosen to probe the neurobehavioral status of the probands revealed statistically reliable differences between the group of exposed workers (length of exposure: range 1-34 years) and the control group. Nevertheless, some minor but still statistically reliable correlations were found between some neurobehavioral parameters and some demographic variables describing the whole group of tested workers, but not to the level of occupational exposure to mercury. CONCLUSIONS: The results of the study confirm the lack of toxic effects of clinical importance on the central nervous system and on the kidney for values of mercury urinary excretion lower than the suggested index of biological exposure (IBE) of 35 micrograms Hg/gram of creatinine.

[Aging and work: health aspects in cleaners]. / Invecchiamento e lavoro: aspetti sanitari nelle attività di pulizia.

Over the last few years, studies on the relationship between ageing and work have attracted growing interest due to the increased probability among workers of developing major health problems as a consequence of ageing workers. Negative outcomes for health are possible when an age-related imbalance appears between physical workload and physical work capacity. Cleaning could be considered as a paradigm for studying the relationship between ageing and physically demanding jobs. Cleaning workers show a high proportion of ageing women who are at the bottom level of the social-status class and are generally poorly educated with low income and social support level. This study, particularly aimed at highlighting the presence of musculo-skeletal disorders, was conducted by means of standardized questionnaires and protocols for collecting anamnestic and clinical data. The results show an increased prevalence of disorders of elbow, wrist/hand and cervical spine which could be caused by work organization and non-ergonomic tools. On the basis of the experience gained it was possible to propose solutions for the ageing working population concerning the workload, health surveillance methods and the ergonomic measures as regards organization, work place and tools.

[The epidemiology of musculoskeletal changes due to biomechanical overload of the spine in the manual lifting of patients]. / Epidemiologia delle alterazioni muscolo-scheletriche da sovraccarico biomeccanico del rachide nella movimentazione manuale di pazienti.

The painful lumbosacral symptoms associated with manual lifting by nursing staff constitutes an increasingly important problem in Occupational Health. This category of workers is in fact particularly exposed to risk situations involving the lumbar region of the spine, due especially to the extreme variability of work on the shift, the nature of what is lifted and not always sufficient knowledge and proper performance of the movements. On the basis of a review of a series of studies made on this topic, it was possible to assess the incidence and prevalence of low back pain in selected populations and identify the postural risk to which nursing staff are exposed at work, stressing also the importance of a correct knowledge of manual lifting techniques, frequency and mode of performing them, and the psychological aspects (perception of the intensity of tasks and osteoarticular strain). It was also observed that the data on painful lumbosacral symptoms were underestimated due to the type of epidemiological investigations carried out (mostly cross-sectional) and that comparison of the data proposed was often difficult due to the different criteria of evaluation used to classify the painful symptoms and also to the various epidemiological parameters used (incidence, cumulative incidence, prevalence).