Transition to retirement impact on risk of depression and suicidality: results from a longitudinal analysis of the Survey of Health, Ageing and Retirement in Europe (SHARE).

AIMS: Depression is among the main contributors to older adults' mental health burden. Retirement, one of the major life transitions, has been claimed to influence mental health substantially. Following up on a previous meta-analysis, the study aims to assess from a longitudinal perspective short- and long-term impacts of transitioning to retirement on depression risk and suicidality in older adults across Europe. METHODS: We conducted a longitudinal study using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), collected between 2004 and 2020 in 27 European countries plus Israel. To estimate relative risks (RR) and 95% confidence intervals (95% CIs) for depression and suicidality at seven time intervals before and after retirement, we fitted adjusted generalized estimating equation models for repeated measures. RESULTS: We included 8,998 individuals employed at baseline and retired at follow-up (median follow-up time: 9 years; maximum: 16 years). Compared to the year of retirement, the risk of depression was 11% lower in the following year (RR 0.89; 95% CI 0.81-0.99), 9% lower after 2 years (RR 0.91; 95% CI 0.82-1.00) and after 3 years (RR 0.91; 95% CI 0.81-1.01). Significant estimates remained among females, married individuals, those with an intermediate or higher level of education, former manual workers and those who retired at or before their country's median retirement age. A significant increase in depressive symptoms emerged from the tenth year after retirement among former non-manual workers (RR 1.21; 95% CI 1.05-1.40) and late retirees (RR 1.37; 95% CI 1.16-1.63). No heterogeneity emerged among strata. As for suicidality, we reported an increase in risk only 5 years or more after retirement, namely +30% 5-9 years after retirement (RR 1.30; 95% CI 1.04-1.64) and +47% 10 or more years after retirement (RR 1.47; 95% CI 1.09-1.98). Sensitivity analyses excluding subjects who reported a diagnosis of depression over the study period and those retirees who declared to receive a disability pension confirmed the results obtained in the overall analysis. CONCLUSIONS: Longitudinal adjusted data suggest an independent effect of retiring associated with a reduction in depression and suicidality risk in the short run, with its effect decreasing in the long run. Such trends are particularly evident among selected subgroups of elderly populations. If greater flexibility in pensionable age may help prevent depression late in life, the transition to retirement is to be accompanied by targeted health promotion interventions. In an ageing society, welfare policies should be evaluated, considering their long-term impact on mental health.

Rituximab in people living with HIV affected by immune-mediated renal diseases: a case-series.

Over the last two decades, rituximab (RTX) has played an important role in the treatment of some lymphoproliferative malignancies and immune-mediated diseases. RTX administration is generally safe and well-tolerated, but side effects including late-onset neutropenia, hypogammaglobulinemia, hepatitis B reactivation and rare cases of progressive multifocal leukoencephalopathy have been observed after its administration. Although there are no absolute contraindications regarding its use in people living with HIV (PLWH), the prescription of this drug has been principally limited in patients with oncohematological diseases. In this report, we described the outcome of four PLWH who underwent RTX therapy after the diagnosis of immune-mediated renal disease. The main RTX-associated adverse effects were leukopenia, late-onset neutropenia and decline of CD4+ and CD8+ T-cell counts. In addition, two of the four patients experienced pneumonia requiring hospitalization within six months from the last RTX infusion. We suggest that RTX should be used with caution in PLWH until further evidence emerges on its safety profile in this vulnerable population.

Diabetes and work: The need of a close collaboration between diabetologist and occupational physician.

AIM: The Italian Society of Occupational Medicine (SIML), the Italian Diabetes Society (SID) and the Association of Diabetologists (AMD) joined a working group that produced a consensus paper aimed to assess the available evidence regarding the interplay between specific working conditions, including shift- and night-time work, working activities at high risk of accidents and work at heights, working tasks requiring high-energy expenditure, working activities at extreme temperatures and diabetes. DATA SYNTHESIS: Diabetes is a group of metabolic disorders caused by defects in insulin secretion and/or action affecting millions of people worldwide, many of whom are or wish to be active members of the workforce. Although diabetes, generally, does not prevent a person from properly performing his/her working tasks, disease complications can significantly compromise a person's ability to work. Therefore, it appears evident the need to understand the relationship between occupational risk factors and diabetes. The working group included in the document some practical recommendations useful to ensure diabetic workers the possibility to safely and effectively undertake their jobs and to adequately manage and treat their disease, also in the workplace. In this perspective concerted action of all the workplace preventive figures, occupational physicians and diabetologists should be strongly encouraged. CONCLUSIONS: Further studies are necessary to define workplace-based interventions, which should be minimally invasive towards the work organization, allowing diabetic workers to fully realize their work skills while improving their wellbeing at work.

Inflammatory and Adipose Response in Solid Organ Transplant Recipients After a Marathon Cycling Race.

BACKGROUND: Organ transplant recipients frequently have chronic inflammation, with a weighty impact on cardiovascular risk. These patients can benefit from exercise, although the role of intense training is unclear. We evaluated the effect of a 130-km cycling race on inflammatory cytokines and adiponectin levels in transplant recipients. METHODS: Circulating interleukin (IL)-6, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and adiponectin were assayed in 35 healthy subjects vs 19 transplant recipients (10 kidney, 8 liver, 1 heart), matched for sex, age, body mass index, and preparation workout. The determinations were performed before the race, at the end, and after 18 to 24 hours. Baseline values of 32 sedentary transplant recipients also were evaluated to explore the possible chronic impact of lifestyle. RESULTS: All cyclists had 6- to 8-fold increased IL-6 levels after the race that decreased, without returning to baseline, the day after. Conversely, serum TNF-α and IFN-γ showed a progressive increase starting during physical performance and enduring for the next 18 to 24 hours in healthy subjects, whereas they were unchanged over time in cyclists with transplants. In transplant recipients who did not perform exercise, all of the analytes were significantly higher in comparison to basal levels of physically active subjects. CONCLUSIONS: Our data suggest that clinically stable and properly trained transplant recipients can safely perform and progressively benefit from exercise, even at a competitive level. The changes in inflammation parameters were temporary and parallel with those of the healthy subjects. The comparison with sedentary transplant recipients revealed an overall amelioration of inflammatory indexes as a possible effect of regular physical activity on systemic inflammation.

Can Solid-Organ-Transplanted Patients Perform a Cycling Marathon? Trends in Kidney Function Parameters in Comparison With Healthy Subjects.

BACKGROUND: Few solid-organ-transplanted patients (TP) perform regular sport activity. Poor data are available on the safety of intense and prolonged physical exercise on this population. The aim of the study was to evaluate kidney function parameters in a group of TP in comparison with healthy volunteers (HV) involved in a long-distance road cycling race: length 130 km and total uphill gradient, 1871 m. METHODS: Nineteen TP were recruited: 10 renal, 8 liver, and 1 heart and compared with 35 HV. Renal function parameters, namely, creatinine, estimated glomerular filtration rate (eGFR), urea, uric acid, urine specific gravity, microalbuminuria, and proteinuria were collected and their values were compared the day before the race (T1), immediately after crossing the finish line (T2), and 18 to 24 hours after the competition (T3). RESULTS: No adverse events were recorded. At baseline, TP showed lower values of eGFR (69 ± 22 versus 87 ± 13 mL/min/1.73 m(2)), lower urine specific gravity (1015 ± 4 versus 1019 ± 6), and higher microalbuminuria (56 ± 74 versus 8 ± 15) and proteinuria values (166 ± 99 versus 74 ± 44) (in mg/L). At T2 in both groups, renal function parameters showed the same trends: decline of eGFR (54 ± 19 versus 69 ± 15 mL/min/1.73 m(2)) and rise in protein excretion. At T3, functional parameters returned to baseline, except for urine specific gravity values remaining stable in TP (1018 ± 6) and growing higher in HV (1028 ± 4). CONCLUSIONS: Selected and well-trained organ-transplanted patients can perform an intensive exercise, displaying temporary modifications on kidney function parameters comparable to healthy subjects, despite differences related to baseline clinical conditions and pharmacological therapies.

Sport activity and health-related quality of life after kidney transplantation.

OBJECTIVE: Considering the importance of sport activity for enhancing quality of life, the aim of this study was to investigate the effects of regular sport activity on quality of life of kidney transplant recipients. METHODS: Health-related quality of life (HRQoL) was assessed with the use of the SF-36 questionnaire on a group of 118 active kidney transplant patients (AKTPs) practicing different sports at low to moderate intensity (5±4 h/wk). Scores were compared with those of 79 sedentary kidney transplant patients (SKTPs) and with 120 active healthy control subjects (AHCs). RESULTS: AKTPs reported higher scores than SKTPs in the SF-36 scales of Physical Functioning (P<.05), Role Limitations due to Physical Problems (P<.05), General Health (P<.01), Vitality (P<.05), Social Functioning (P<.05), Role Limitations due to Emotional Problems (P<.05), and Mental Health (P<.01). AKTPs obtained higher scores than AHCs on the Mental Health (P<.01) and Social Functioning scales (P<.01) and similar scores (P>.05) on all the other scales. The effect of quantity of sport activity was significant on the General Health (P<.01; η2=0.05), and Role Physical scales (P=.04; η2=0.03), with higher sport activity associated with higher HRQoL. The effect of sex was significant for Bodily Pain (P=.05; η2=0.02), Vitality (P=.08; η2=0.06), Social Functioning (P=.08; η2=0.05), and Mental Health (P=.05; η2=0.02), with male participants scoring higher than female participants. CONCLUSIONS: This study indicates that regular sport activity significantly improves different dimensions of HRQoL among kidney transplant recipients. The benefits of sport activity go beyond its impact on physical health to involve psychologic and social components of quality of life. Spontaneous and low to moderate sport activity may play an important role after kidney transplantation that has been largely underestimated in the literature.

Physical activity in solid organ transplant recipients: organizational aspects and preliminary results of the Italian project.

Most of the difficulties when trying to realize the proposal to prescribe physical activity for transplantation patients come from patient attitudes and cultural beliefs that ignore the benefits of exercise, but there also are organizational aspects arising from the difficulties that these patients face in accessing supervised exercise facilities. To address these difficulties, the Italian study project "Transplant … and Now Sport" was developed based on a model of cooperation among transplantation specialists, sports physicians, and exercise specialists organized as a team combining their specific skills to effectively actuate the physical exercise programs. This preliminary report is based on 26 patients (16 male, 10 female; 47.8±10.0 years old; 21 kidney and 5 liver transplantations; time from transplantation 2.3±1.4 years) who performed prescribed and supervised exercises consisting of 3 sessions per week of aerobic and strengthening exercises for 1 year. Preliminary results show a significant decrease in body mass index (t=1.966; P<.05) and a significant increase in peak aerobic power (t=4.535; P<.01) and maximum workload (t=4.665; P<.01) on the incremental cycling test. Also maximum strength of knee extensors (t=2.933; P<.05) and elbow flexors (t=2.450; P<.05) and countermovement jump performance (t=2.303; P<.05) significantly increased. Creatinine and proteinuria tended to decrease, but the differences were not significant. In health-related quality of life assessed by the SF-36 questionnaire, the Bodily Pain, General Health, Vitality, Social Functioning, and Role Emotional scale scores showed a significant improvement (P<.05). Preliminary results of the study protocol "Transplant…and Now Sport" show the positive effects of the model based on cooperation among transplantation centers, sports medicine centers, and gyms in the administration of a supervised exercise prescription. These data should be considered a contribution to developing and promoting further detailed exercise protocols and to fostering improved posttransplantation health and survival, helping to ensure that physical activity becomes a safe routine medical treatment plan of patient management.

Renal transplant in patients with polycystic disease: the Italian experience.

We analyzed the results of kidney transplantation in autosomal dominent polycystic kidney disease (ADPKD) patients in Italy, including 14,305 transplantations performed from January 2002 to December 2010, including: 12,859 first single or double kidneys from cadaveric donors (13% polycystic), 172 combined liver-kidney cases (22% polycystic), and 1,303 living-donor organs (7% polycystic). Among the first transplantations (12,008 single, 851 double), with follow-ups ranging from 16 to 120 months, polycystic patients demonstrated better graft survival compared with other kidney diseases (86% vs 82% at 5 years; P < .01); mortality was not different (92% vs 79% at 1 year). A better trend was obtained also among combined liver-kidney transplantations in ADPKD. Regarding pretransplantation management of polycystic patients, we noticed a conservative attitude in 32/35 transplant centers. The main indication for nephrectomy was for the lack of abdominal space. Regarding instrumental studies, 86% of centers asked for second-level investigations computerized tomography for kidney dimensions. Radiologic investigations for vasculocerebral malformations were required in 97% of the centers: 74% as a routine and 23% in the presence of familial history of cerebral hemorrhage. Polycystic patients are good candidates for kidney transplantation with correct management before transplantation.

[Construction: critical issues and occupational health]. / Edilizia: criticità e tutela della salute.

Construction is strategic in Italy and worldwide, on top for employees number and turnover but also for occupational accidents and diseases. The building site is at high risk and it is difficult to maintain good levels of safety: in recent years they have had an improvement, but the economic crisis did not favour it. The knowledge in the field of prevention is not as widespread as it would be necessary and as requested (OSHA - UE). The Occupational Physician, engaged in risk assessment and management of medical services, must protect the health of workers at high risk for health, aging and performing tiring work, without adequate vocational training and culture, often in precarious conditions of health and lifestyle at risk. There are good experiences around the world and in Italy. Implementation of research in technology and ergonomics, materials and the tools, reduction of workload are needed, improvement of building site organization, of knowledge about health effects, the rehabilitation and reintegration to work. The procedures and processes should improve productivity and at the same time be safer and less dangerous and the lows should be more fitting with the specific characteristics of the construction industry.

[Work-related diseases and the fitness to work in construction industry]. / Malattie lavoro-correlate e giudizio di idoneità lavorativa in edilizia.

The construction industry is characterized by a high number of fatal and nonfatal injuries and even higher prevalence of work-related diseases. The aim of this work is to analyze the results of a research project that has among its objectives the study of the prevalence of work-related diseases and the fitness to work in construction industry. In the period 2003-2011 were evaluated 2069 construction workers, from 218 companies (average age 37.9 years, mean seniority 21.1 years, 17.1 in the construction industry). The prevalence of work-related diseases was 14.06%, in the first place the noise-induced hearing loss, followed by musculoskeletal disorders and entrapment neuropathies. The 24.7% of fitness to work was influenced by the presence of limitations, the 0.6% of the population was not suitable for the specific task. The prevalence of work-related diseases in construction industry is high, with a peak among the elderly, but also significant occurrence among young people. It is important the percentage of the population with health problems that limit the fitness to work.

[Experiences of environmental and biological monitoring in the construction industry]. / Esperienze di monitoraggio ambientale e biologico in edilizia.

After emphasizing the characteristics of the sector and the difficulty of applying traditional industrial hygiene methods for assessing exposure to chemical agents in the construction industry, we have reviewed the major experiences of environmental and biological monitoring that can be derived from the literature. Although the determination of exposure through environmental measures should be considered the most appropriate instrument, it should be paid for the study of specific activities, while it is preferable in many situations the use of simplified tools (such as algorithms and databases) that allow the risk estimation and enable the adoption of safe work procedures and environmental and individual protection devices.

[History of the health protection of construction workers]. / Storia della tutela della salute dei lavoratori edili.

Construction has been one of the first sectors in which an organized system of occupational health protection has been implemented, as shown by the Egyptian physicians caring for workers and artisans in building sites. During the Middle Ages, first examples of accident prevention legislation in this field may be found among the Lombards. In the same period, craft organizations led to greater social recognition of skilled workers, without a improvement in their health conditions. Ramazzini accurately described some risks of stonemasons and brick-makers (chemical and microclimatic hazards). In the following centuries, the Industrial Revolution led to a population growth in metropolitan areas and increased employment as well as accidents in the construction sector, as demonstrated by some ex-voto paintings in churches. This phenomenon became more evident in postwar recovery, forcing Italy to adopt modern accident prevention rules. Nowadays Italian legislation, complying with EU directive, provides new challenges for occupational physician.

[The role of the occupational physician in disabled return to work]. / Il Ruolo del Medico del Lavoro nel reinserimento lavorativo del disabile.

Workers, former workers or unemployed workers with disabilities of various kinds often come to the Occupational Health Hospital Department (UOOML), requiring a report on their fitness for work that often is generic or not suitable for specific situations: a detailed knowledge of both working and health conditions, mainly disabilities and job items are needed. The UOOML was never directly involved in the proceedings of targeted fitting-up of the disabled people, while some Doctors of the Department of Prevention of ASL have an advisory role participating in the Technical Committee under Law 68 and the 'Disabled Commission'. INAIL (the National Insurance Institute for Occupational Accidents and Diseases), in case of allocation of percentages of disability higher than 33% (necessary requirement for the targeted employment) provides an assessment of the 'residual capacity'. The Company Occupational Physician cooperates and intervenes in the management of the employment of the disabled worker in very different ways and at several stages of the path of integration or reintegration. Considering the prolonged and effective cooperation among the Doctors of the UOOML and the Psysiatrists of our Hospital, we are developing a specific out-patients' department where a report on the fitness for job, as close as possible to the patient/work-task compliance, is provided to the disabled.

[Energy expenditure in construction industry]. / Il dispendio energetico in edilizia.

The aim of this study is to show the results obtained from measuring energy expenditure (EE) during work, through portable devices, in a group of male construction workers. After defining cardio-respiratory parameters in laboratory, authors applied to all subjects an heart rate monitor for measuring the heart rate (HR) and, at the same time, a calorimeter for measuring energy expenditure (EE). To analyse data obtained, authors calculate the Relative Aerobic Strain (RAS), both for the measurements of EE and for HR detected. Results confirm that in many of the typical activities of construction industry, in particular in those characterised by an higher component of manual engagement compared to foreman, workloads are exceeding limits of the probable threshold fatigue (33% of RAS), both for energy expenditure than for HR measured.

[Muskuloskeletal disorders in construction industry: hospital cases]. / Le patologie muscoloscheletriche in edilizia: analisi di una casistica ospedaliera.

The authors analyse 493 hospital cases in 356 workers from the construction industry, came to observation for musculoskeletal disorders (average age 48, 2 years, SD 9; work seniority 32, 2 years, SD 9, 7; work seniority in construction industry 27, 3 years, SD 12, 4). The evaluation was required in 305 subjects (85.7% of the sample) to investigate one or more suspected WMDS; in 51 subjects (14.3% of the sample) to express an opinion on fitness to work or residual work capacity. Investigations led to diagnosis of 479 musculoskeletal disorders; the districts most affected are spine and upper limb. 64.7% of the musculoskeletal disorders was evaluated to be work-related, the percentage rises to 68% when considering only cases sent for evaluation of suspected WMDS. The most frequent reasons to exclude relation between the musculoskeletal disorders and work were an high age at diagnosis, presence of comorbidity or outcome of trauma, a disease mismatch exposure.

[Biomechanical overload of the upper limbs and energy expenditure in bricklayers activity]. / Sovraccarico biomeccanico degli arti superiori e dispendio energetico nelle attività di costruzione tavolati e intonacatura in edilizia.

The work explains the method we used for biomechanical overload risk assessment of upper limbs in construction industry, to make boarding with perforated bricks (preparation of mortar and building materials, construction, plastering) and shows the preliminary results obtained. The activity was observed and analysed through simulations of building site; all tasks were filmed with digital cameras; after we applied OCRA check-list to obtain values of biomechanical overload for upper limbs. We found an high risk of biomechanical overload, due to awkward postures and use of strength, for shoulders, elbows and, in particular, for wrists. This data helped us to understand why we found an high prevalence of wrist-WMSD (such as Carpal Tunnel Syndrome) in bricklayers evaluated in health surveillance.

[Ergonomic assessment of main activities in grana padano cheese production]. / Valutazione ergonomica di attività caratteristiche nella filiera di produzione del grana padano.

Aim of this work is to describe results obtained by risk assessment of biomechanical overload for workers involved in grana padano cheese production: from breeding to obtain milk to the finished product in dairy. To analyze operation tasks authors used video recordings, interviewed operators and visited workplaces in order to proceed with evaluation instruments, using internationally recognized technical standards ISO 11228, such as OCRA, NIOSH and Snook and Ciriello's studies. The results show significant risk of biomechanical overload for spine and upper limbs both in breeding and in dairy.

[Exposure to vegetal esters based metal cutting fluids: health effects]. / Esposizione ad oli lubrorefrigeranti vegetali: effetti sulla salute.

The aim of our research is to study respiratory and dermatologic diseases (irritative and allergic) in a cohort of workers exposed to vegetal esters based metal cutting fluids of the latest generation. A cohort of 81 workers (mean age 34.5 years, seniority 17.4 years), with mean exposure to vegetal esters based metal cutting fluids of 2.8 years, has been subjected to clinical evaluations. The investigation did not reveal any disease or disorder of the respiratory system, any folluculitis or any allergic contact dermatitis caused by sensitization to vegetal esters based metal cutting fluids. On the contrary we documented 5 cases of irritant contact dermatitis, even if favored by an improper use of protection devices. According to early results, the introduction of vegetal esters based metal cutting fluids seems to reduce the risk to the worker's health. A longitudinal surveillance is still needed to confirm that even in the medium and long-term sensitizations will not occur.

[Return to work of the cardiac patient: work fitness evaluation in Occupational Medicine Division including an Occupational Cardiology Unit and Work-Physiology Lab in Bergamo]. / Unità Semplice di Cardiologia del Lavoro ed Ergometria degli Ospedali Riuniti di Bergamo: percorso per la valutazione dell'idoneità lavorativa del cardiopatico.

Cardiovascular disease in working age still represent a major cause of morbidity and account for a number of fitness to work certificates expressing several limitations and prescriptions. To present the medical assessment conducted in an Occupational Medicine Division including an Occupational Cardiology Unit and work-physiology lab. It is described the history and the structure of the Occupational Cardiology Unit. Our almost forty years long-lasting experience allow us to point out the precious contribution of the Occupational Cardiology Unit to the Occupational Medicine Division, due to a highly specialised and qualified assessment of cardiac patients.