Occupational Risk for Coronary Artery Disease in Shift Workers - A Systematic Review.

BACKGROUND: Coronary artery disease (CAD) prevention in shift workers (SWs) poses a significant challenge worldwide, as CAD remains a major cause of mortality and disability. In the past, SWs were found at higher risk of CAD than non-s SWs. Nevertheless, the pathogenic mechanism between shift work and CAD to date is unclear. This systematic review aims to enhance understanding of the risk of CAD occurrence in SWs. METHODS: A systematic literature review was conducted from January 2013 to December 2023. MEDLINE/Pubmed databases were used initially, and additional relevant studies were searched from references. Shift work was defined as any schedule outside traditional shifts, including the night shift. RESULTS: Fifteen pertinent papers were categorized into risk assessment or risk management. Findings demonstrated an increased risk of CAD among SWs compared to non-SWs, with an increased CAD risk observed for both shift work and night shift work. DISCUSSION: Duration-response associations indicate that greater shift exposure is linked to higher CAD risk. SWs incur an increased risk of CAD through the atherosclerotic process. As shift work duration increases as the risk of atherosclerosis is higher, workers demonstrate a higher prevalence and severity of coronary artery plaques. CONCLUSIONS: The evidence-based results underscore the increased risk of CAD in SWs and are sufficient for proposing guidelines aimed at reducing the risk of CAD in SWs and at managing people with CAD in return to work characterized by disrupted circadian rhythms.

Right to Occupational Safety: Prevalence of Latent Tuberculosis Infection in Healthcare Workers. A 1-Year Retrospective Survey Carried out at Hospital of Lecce (Italy).

BACKGROUND: Prevention of latent tuberculosis infection (LTBI) in healthcare workers (HCWs) to ensure the "Right to Occupational Safety" is a special challenge globally, as HCWs have a higher risk of acquiring the infection in hospital settings because of frequent close exposure to patients suffering from tuberculosis (TB). METHODS: Aretrospective study was performed with the aim of assessing the prevalence of LTBI related to demographical and occupational risk factors among HCWs employed in a large hospital in Italy. The study involved 1461 HCWs screened for LTBI by Mantoux tuberculin skin test (TST) and then confirmed with Interferon Gamma Release Assay (IGRA) test in case of positivity. Immunosuppressed and BGC-vaccinated workers were tested directly with IGRA. RESULTS: LTBI was diagnosed in 4.1% of the HCWs and the prevalence resulted lower than other studies conducted in low TB incidence countries. The variables significantly linked with higher frequency of the infection were: age ≥40 years (OR = 3.14; 95% CI: 1.13-8.74; p < 0.05), length of service ≥15 years (OR = 4.11; 95% CI: 1.48-11.43; p < 0.05) and not being trained on TB prevention (OR = 3.46; 95% CI: 1.85-6.46; p < 0.05). Not trained HCWs presented a higher risk of LTBI also after adjustment for age and length of service, compared to trained HCWs. CONCLUSIONS: screening of HCWs for LTBI should be always considered in routinely occupational surveillance in order to early diagnose the infection and prevent its progression. Safety policies in hospital settings centered on workers' training on TB prevention is crucial to minimize LTBI occurrence in HCWs.

Health-related quality of life in survivors of severe COVID-19 infection.

BACKGROUND: Long-term effects of Coronavirus Disease 2019 (COVID-19) are increasingly recognized as having a significant impact on Health-Related Quality of Life (HRQoL). Understanding HRQoL status for each patient affected by long COVID-19 and its determinants may have a key role to prevent and treat this condition. METHODS: In this prospective observational study conducted in a large academic COVID-19 hospital in Rome, participants were contacted 2 years after hospital admission for severe COVID-19. To assess HRQoL, EQ-5D-5L and Visual analog scale (EQ VAS) standard questionnaires were administered by interview. Logistic regression model was used to the five health dimensions as dependent variables (0 = no problem, 1 = some/extreme problem). KEY RESULTS: In 137 enrolled patients, the mean pre-COVID and post-COVID EQ-5D-5L index and EQ-VAS score were 0.97 (SD 0.06), 0.79 (SD 0.26) and 72.38 (SD 15.18), respectively. After subdivision of the participants for clinical and social variables, the EQ-5D-5L index resulted significantly lower than in the pre-COVID-19 period. Female gender, unemployed status, and chronic comorbidities were the most common predictors for having any problems in each EQ-5D-5L domain, while also older age and higher Body Mass Index (BMI) showed to be related to a lower EQ-VAS score. CONCLUSION: HRQoL showed to be still low in patients 2 years after acute severe COVID-19. Given the significant impact of SARS-CoV-2 on long-term chronic symptoms, predictors of poor outcomes must be considered during the acute phase of illness to plan a tailored follow-up path for each patient.

Assessing and managing the rotating shiftwork risk in 24-hours hospital wards: An empirical multicenter study.

BACKGROUND: A growing body of literature has showed the need to minimize the impact of rotating shiftwork (RS) on health of shift-healthcare workers (HCWs). OBJECTIVE: The aims of the study were: 1) assessing the occupational risk associated with RS program in HCWs employed in 24 hours hospital wards 2) testing the feasibility of the questionnaire used. METHODS: The Rotating Shiftwork Questionnaire (RSQ) was implemented to assess the RS risk (RSR); the analysis was addressed to: 1) Sentinel events (SE) and 2) Risk factors (RF). The RSQ was administered to the specialist nursing coordinators in eighteen hospitals in Italy with the aim to evaluate the RSR index among nurses in 24 hours hospital wards. RESULTS: Eighteen structures participated in the multicenter study, of which 12 (66.7%) were public. Concerning the Rotating Shiftwork Risk index, there are the 78.8% of observations in the intermediate zone, with RSR scores ranging from 14.1 and 16 and in the high score area (RSR > 26) in which there are 4 observations equal to the 21.2% of the total. The multivariate analysis showed that the only significant variable associated with RF score was the macro-area (for Northern regionsbeta = -0.651; p = 0.008). CONCLUSIONS: RSQ has been shown a feasible and applicable tool to analyze the RSR in healthcare sector through the detection of quantitative data involving indicators of the risk. The questionnaire allowed to identify improvement actions targeted at minimizing specific critical issues through strategic interventions focused on organizational environment.

Occupational health surveillance of healthcare workers during COVID 19 pandemic: a narrative review.

BACKGROUND AND AIMS: Current literature has increasingly highlighted the risk of spreading the SARS-COV-2 infection in healthcare settings and showed the need for occupational health surveillance of HCWs during the current epidemiological emergency from COVID-19, as a preventive measure to minimize the spread of the infection. The purpose of this narrative review was to evaluate the literature and discover what the latest developments are about the management of the occupational health surveillance of healthcare workers (HCWs) during COVID-19 pandemic. METHODS: We searched for publications in MEDLINE, Pubmed and Google Scholar using selected keywords. Each article was reviewed and categorized into one or more of the following three categories based on its subject matter: early diagnosis of COVID-19 in HCWs, detection of worker susceptibility to severe COVID-19, medical examination of HCWs returning to work after COVID-19. RESULTS: Selected articles showed the RT-PCR test for Sars-CoV-2 as the gold standard to enable rapid identification of infected HCWs; an effective schedule of occupational health surveillance allows the identification of the susceptibility of the workers to severe Covid-19 and protect HCWs returning to work from the disease. CONCLUSIONS: The findings of the present narrative review show the need to strenghten the occupational health surveillance of HCWs during the current COVID-19 pandemic, with the aim not only to contain the spread of the infection in healthcare settings, but also to protect HCWs coming back to work after the disease.

Covid-19 sequelae in working age patients: A systematic review.

Despite the SARS-CoV-2 pandemic not yet being under control, post-Covid-19 syndrome is already a challenging topic: long-term multiorgan sequelae, although increasingly described, have not yet been systematized. As post-Covid-19 syndrome can significantly impact both the working capacity and the relationship life of surviving patients, we performed a systematic review of the evidence published over the last year and currently available in medical literature search databases (MEDLINE/Pubmed) and searching clinical trial registries, to evaluate the available evidence among workers. From 31 publications that initially matched inclusion criteria, 13 studies have been considered suitable for relevance and age of subjects. A wide range of patients (16%-87%) have post-Covid syndrome; pneumological and neuropsychological symptoms were the most common disorders reported. The most frequent organic sequel found in post-Covid patients was pulmonary fibrosis. The number of symptoms during acute SARS-CoV-2 infection, severity of the disease, and high serum levels of d-dimer were related to high risk of post-Covid syndrome. In conclusion, post-Covid-19 syndrome can significantly impact the health conditions of surviving patients. Rehabilitation and follow-up in multidisciplinary rehabilitation programs should be considered for working-age patients.

SARS-CoV-2 Among Migrants Recently Arrived in Europe From Low- and Middle-Income Countries: Containment Strategies and Special Features of Management in Reception Centers.

Despite the "migrants and COVID-19" topic has been neglected since felt marginal concerning other aspects of the SARS-CoV-2 pandemic, it represents a relevant public health issue in the European countries. This report describes COVID-19 containment strategies adopted in a large Italian reception center hosting recently arrived asylum-seeker migrants. Risk assessment and prevention measures adopted were described. Geo-spatial epidemiological analysis of the outbreak was reported. Significant gaps in the knowledge of self-protection measures from contagious diseases and in the perception of the pandemic risk were observed in migrants; health promotion activities, targeted to remove cultural barriers and improve behaviors appropriate to individual protection, were able to fulfill this gap. In low-resource settings, especially in closed communities, the implementation of social distancing strategies, the systematic use of individual protection devices, and active syndromic surveillance are essential tools to limit the risk of outbreaks. In the event of an outbreak, it is relevant to rapidly activate containment procedures based on systematic screening, isolation, and quarantine, taking into consideration the limits of tracing contacts within a closed community. Not being able to trace certain contacts, the geo-spatial epidemiological analysis of cases distribution could be key in the management of the outbreak. Interestingly, positive cases identified in our facility were all clinically pauci-symptomatic or asymptomatic. Dedicated strategies are needed to minimize the chance of SARS-CoV-2 transmission in a limited space such as reception centers and a vulnerable population such as migrants.

Minimizing formaldehyde exposure in a hospital pathology laboratory.

BACKGROUND: The safety and health of healthcare workers employed in pathology laboratories and exposed to formaldehyde (FA) is a matter of concern worldwide, as several health effects have been observed in workers resulting from exposure to FA, both short and long-term. OBJECTIVE: The study was aimed to describe the strategy implemented in a hospital pathology laboratory to minimize workers' exposure to FA through interventions to working environment and workforce. METHODS: The NIOSH 2016 method for detecting gaseous FA was adopted to perform personal and area active sampling of FA. The samples were subsequently analyzed by High Performance Liquid Chromatography. The exposure to FA was measured before and after improvement interventions. RESULTS: The pre-intervention step showed FA levels exceeding the threshold limit values (TLV) established by ACGIH, both the time-weighted average (TLV-TWA) and short term exposure limit (TLV-STEL); after the improvement interventions, the median concentrations of personal and area FA sampling were respectively of 0.025 ppm (Range = 0.023-0.027) and 0.023 ppm (Range = 0.022-0.028) and significantly lower than pre-intervention step (p < 0.05) and below the TLV-TWA and TLV-STEL established by ACGIH. CONCLUSIONS: In our study the workers' involvement in the risk management of FA exposure together with engineering improvements revealed a strategic way to minimize the FA pollution in the studied laboratory. Healthcare companies should consider the need to ensure the workers' participation in the management of occupational hazards, including FA, to reach the goal of healthy workplaces.

Post-Traumatic Stress Symptoms in Healthcare Workers Dealing with the COVID-19 Pandemic: A Systematic Review.

Prevention of post-traumatic stress symptoms (PTSS) in healthcare workers (HCWs) facing the current COVID-19 pandemic is a challenge worldwide as HCWs are likely to experience acute and chronic, often unpredictable, occupational stressors leading to PTSS. This review aims to analyze the literature to discover which topics have been focused on and what the latest developments are in managing the occupational risk of PTSS in HCWs during the current pandemic. For the purpose of this review, we searched for publications in MEDLINE/Pubmed using selected keywords. The articles were reviewed and categorized into one or more of the following categories based on their subject matter: risk assessment, risk management, occurrence rates. A total of 16 publications matched our inclusion criteria. The topics discussed were: "Risk Assessment", "Occurrence Rates", and "Risk Management". Young age, low work experience, female gender, heavy workload, working in unsafe settings, and lack of training and social support were found to be predictors of PTSS. This review's findings showed the need for urgent interventions aimed at protecting HCWs from the psychological impact of traumatic events related to the pandemic and leading to PTSS; healthcare policies need to consider preventive and management strategies toward PTSS, and the related psychic sequelae, in HCWs.

Post-traumatic stress disorder symptoms in healthcare workers: a ten-year systematic review.

BACKGROUND AND AIMS: Healthcare workers (HCWs) employed in hospital settings frequently experience many occupational stressors leading to post-traumatic stress disorder (PTSD) symptoms. Literature has increasingly highlighted PTSD as a major issue that involves both staff and healthcare organizations; the consequences of PTSD may include medication errors and lower standards of care. The current COVID-19 pandemic poses the need for preventing PTSD in HCWs working closely with COVID-19 patients. The purpose of this systematic review was to analyze the latest developments in assessing and managing the occupational risk of PTSD symptoms in hospital HCWs. METHODS: We searched for publications in MEDLINE/Pubmed using selected keywords. Each article was reviewed and categorized into one or more of the following four categories based on its subject matter: risk assessment, risk management and occurrence rates. RESULTS: Our search resulted in a total of 32 publications that matched our inclusion criteria.  Increased years of service, older age, previous year exposure to violence, personality traits (i.e. neuroticism), history of mental disorders, being non-graduates, were found to be workers' pre-trauma factors predicting PTSD symptoms. CONCLUSIONS: The findings suggest the need to prioritize preventative interventions aimed to anticipate the effects of traumatic exposure by training HCWs in evidence based anticipatory methods of coping with stressful events. With regard to the current COVID-19 pandemic, we found evidence of the need to strength social support and training targeted at psychological skills of medical staff who treated COVID-19 patients.

Shift work sleep disorder and job stress in shift nurses: implications for preventive interventions.

BACKGROUND: A growing literature has revealed a relationship between shift-work, including night-shift, and the disturbance of sleep-wake cycle, leading to insomnia and/or increased daytime sleepiness in shift nurses; recent findings showed an association between shift work sleep disorders and distress, work accidents, decreased job performance and, consequently, lower quality of health service provision and lower standards of care. OBJECTIVES: To analyze across the gender how shift nurses experience shift work sleep disorders and job stress. METHODS: A cross-sectional study was performed following the STROBE Statement. The Italian version of the Job Content Questionnaire, the Bergen Insomnia Scale and the Epworth Sleepiness Scale were administered to the registered nurses employed in three Departments of General Practice and Elderly Care Medicine. RESULTS: No significant association was found between high job strain and insomnia and daytime sleepiness. Significantly more women than men experienced high job strain, insomnia and daytime sleepiness; among women the level of social support was significantly and negatively associated with insomnia and daytime sleepiness. CONCLUSIONS: The findings of this study suggest that interventions aimed to prevent shift work sleep disorder and job stress in shift-nurses should incorporate the assessment of social support across the gender. Moreover, longitudinal studies are required to evaluate the effectiveness of interventions targeted on social support to minimize the occurrence of insomnia and daytime sleepiness in shift nurses.

Preventing Shift Work Disorder in Shift Health-care Workers.

The occurrence of the shift work disorder (SWD) in health-care workers (HCWs) employed in 24/7 hospital wards is a major concern through the world. In accordance with literature, SWD is the most frequent work-related disturb in HCWs working on shift schedules including night shift. In agreement with the Luxembourg Declaration on workplace health promotion (WHP) in the European Union, a WHP program has been developed in a large Hospital, involving both individual-oriented and organizational-oriented measures, with the aim to prevent the occurrence of SWD in nurses working on shifts including night shift. The objective assessment of rotating shift work risk and the excessive sleepiness were detected before and after the implementation of the WHP program, by using the Rotating Shiftwork-questionnaire and the Epworth Sleepiness Scale. The findings of this study showed the effectiveness of the implemented WHP program in minimizing the impact of shift work on workers' health and in preventing the misalignment between sleep-wake rhythm and shift working.

Job stress and needlestick injuries in nurses: a retrospective observational study.

BACKGROUND: The prevention of needlestick injuries (NSIs) in nurses employed in Emergency Departments (EDs) represents a special issue for healthcare organizations globally. Stressful working conditions, lack of organizational arrangements and lack of supporting one another at work, may contribute to increase the risk of NSIs. METHODS: We conducted an observational study to analyze: 1) the effectiveness of organizational interventions to minimize the occurrence of NSIs in ED nurses; 2) to measure the impact of such interventions on the safety budget. RESULTS: The occurrence of NSIs detected after organizational level interventions was significantly lower than the occurrence observed previously such interventions (p<0,05). By results, cost saving from managing fewer NSIs than the previous period was found. CONCLUSION: The study shows that the proactive, integrated and comprehensive management of organizational features at workplace brings benefits to employees and reduces the burden of the occurrence of NSIs. As result of the reduced NSIs frequency, the overall costs for follow-up of injured workers were reduced. (www.actabiomedica.it).

Preliminary assessment of rotating shiftwork risk in a 24-hours metal industry.

BACKGROUND: Rotational shiftwork (RS) has been linked to increased risk for safety and health of shift workers, globally. A growing literature has revealed a trend toward increased accident and injury rates in shift workers than non-shift workers. AIMS: The present research was aimed: 1) to develop a methodological path for a preliminary objective assessment of occupational risk by RS in a metal industry 2) to detect the consequent effective interventions for moderating the RS risk. METHODS: A modified version of the Rotational Shiftwork Questionnaire was designed by a panel of experts, through a Delphi study; the questionnaire was used for a pilot study to assess the RS risk in a metal industry. RESULTS: The questionnaire was entitled Rotating Shiftwork Questionnaire-Industry (RSQ-I) and was made up of two sections: 1) Sentinel Events; 2) Risk Factors. The assessment of RS risk showed a medium level of risk in the studied metal industry. Organizational level interventions were detected for moderating the impact of RS-risk on workers' safety and health. CONCLUSION: RSQ-I showed a valid and reliable tool to analyze RS risk in a 24-hours metal industry. The pilot study demonstrated the effectiveness and feasibility of the introduced RSQ-I to approach the risk, through the analysis of both sentinel events and shift schedules.

Metabolic syndrome in shift healthcare workers.

BACKGROUND: Shift work including night shifts is generally associated with chronic misalignment between the endogenous circadian timing system and behavior cycles, leading to metabolic disorders including metabolic syndrome (MS). OBJECTIVES: The purpose of this research was to analyze the latest developments in assessing and managing the occupational risk of MS in shift-healthcare workers (HCWs). METHODS: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, the authors used MEDLINE/Pubmed to perform a systematic review of literature from January 2008 to December 2018.  Results: Six studies were selected; the topics, discussed in order of frequency from highest to lowest, were: risk assessment, occurrence rates, and risk management. The main occupational determinants for MS were the cumulative shift work including night shifts and the number of nights worked per month per worker. With regard to cumulative lifetime exposure to shift work, the findings of our review suggest a dose-response relationship between increasing years of shift work history and MS in shift-HCWs. CONCLUSIONS: The findings suggest the need to better investigate the impact of sleep deprivation in the assessment of MS risk in shift-HCWs and clarify the role of such variables as confounders, mediators, or effect modifiers. Moreover, to date the data regarding management interventions focused on the risk of MS are inconsistent and therefore a special effort is required to detect strategic ways to minimize the likelihood of MS occurring in shift-HCWs.

Assessing and preventing low back pain in nurses. Implications for practice management.

BACKGROUND AND AIMS: The prevention of low back pain (LBP) among nurses employed in hospital departments represents a special concern for healthcare organizations globally. A growing literature evidences the need of workplace policy development related to organizational issues as strategic contribution to minimize the occurrence of LBP in healthcare sector. The purposes of this study were: 1) to analyze the relationship between shiftwork and acute LBP among female shift nurses; 2) to detect preventive interventions targeted on organizational issues. METHODS: The authors conducted a cross-sectional nested case-control analysis of data concerning acute LBP and staffing data for 671 nurses employed in the Departments of General Practice and Elderly Care Medicine. The statistical analysis consisted of a logistic regression to calculate incidence odds ratios with 95% confidence intervals. Chi-square test and t-test were used to examine the relationship between categorical and continuous data, respectively. RESULTS: The occurrence of acute LBP resulted significantly related to nightshift, extended shifts, obesity; the adoption of forward rotating schedules was found a protective factor in moderating the occupational risk of acute LBP in shift nurses. CONCLUSIONS: In this study the authors observed an association between shiftwork and acute LBP; improvement interventions should be aimed at: 1) moderating organizational risks linked with shiftwork schedules; 2) promoting healthy lifestyles. These interventions are suggested as a strategic way to effectively manage the phenomenon among female rotating shift nurses.