Prevalence of work related musculoskeletal disorders in Italian workers: is there an underestimation of the related occupational risk factors?

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) represent an important socio-economic burden. The current risk assessment and management involved in the ethiopathogenesis of WMSDs is based on observational tools and checklists, which have some limitations in terms of accuracy and reliability. The aim of this study was to assess WMSD prevalence and identify possible correlations with several socio-demographic and work-related variables in a large cohort representative of Italian workers in order to improve our understanding of the WMSD phenomenon. METHODS: This study includes data from INSuLa, a cross-sectional nationally representative survey of health and safety at work, developed by the Italian Workers' Compensation Authority. A total of 8000 Italian workers were included. Multivariate logistic regression analyses were performed to evaluate the association of independent variables, such as workers' perceptions of exposure to biomechanical/ergonomic and video display unit (VDU) risks (Risk Perceived) and the actual risk exposure (Risk Detected) on Back, Lower and Upper limb pain. Socio-demographic, occupational and other health-related variables were included to investigate possible association with musculoskeletal disorders. RESULTS: Workers perceiving a significant exposure to biomechanical/ergonomic and VDU risks but not included in a health surveillance program for them (Risk Perceived/No Risk Detected) have had significantly higher odds of reporting musculoskeletal disorders. Regarding the biomechanical/ergonomic risk these workers are in the 19-24 age range (39.9%), transportation, warehousing/information and communication sectors (38.9%) and are employed in companies with more than 250 workers (35.8%). Regarding VDU risk, workers are in the 45-54 age range (24.5%), professional, financial and business services (38.0%) and come from companies with more than 250 employees (25.6%). CONCLUSIONS: Within the occupational safety and health management systems an appropriate assessment of occupational risk factors correlated to musculoskeletal disorders (mainly biomechanical/ergonomic and VDU) and the correct definition of their exposure levels is essential to adequately prevent the onset of WMSDs. In this regard, our findings provide useful information to design novel approaches, aimed at improving our understanding of emerging risks, identifying gaps in current risk assessment strategies and enhancing workplace interventions are mandatory to improve the occupational risk assessment and management process and therefore implement the subsequent health surveillance systems.

[Validation of surgical masks during COVID19 emergency: activities at the University of Napoli Federico II]. / Validazione di maschere chirurgiche nella fase di emergenza COVID19: l'esperienza dell'Università degli Studi di Napoli Federico II.

SUMMARY: During COVID-19 pandemic crisis, Italian Government has approved Law Decree no. 18 of 17 march 2020, in which art. 15 allows enterprises to produce, import and commercialize surgical masks notwithstanding the current rules of product certification. It is just required that the interested enterprises send to the Italian National Institute of Health a selfcertification in which they declare the technical characteristics of the masks and that masks are produced according to the safety requirements. In this context, a technical-scientific unit was established at the University of Napoli Federico II to provide interested enterprises with state-of-the-art consultancy, testing and measurement services, adhering to rigorous scientific protocols. Characterization tests were carried out on 163 surgical masks and/or materials for their construction and they have enabled the identification of pre-screening criteria to simplify the procedure for evaluating surgical masks using methods for assessing the filtration efficiency of particles and aerosols. Based on experimental results, it has been observed that a filtration efficiency for particles with sizes larger that 650 nm (PFE>650) exceeding 35% might guarantees a bacterial filtration efficiency (BFE) higher than 95% while BFE values higher than 98% are obtained when the PFE>650 is larger than 40%. PFE measurement is extremely simpler with respect to BFE, the latter being time-consuming and requiring specific equipment and methods for its realization. Many tested materials have shown the capability to assure high filtration efficiencies but Spundonded-Meltblown-Spunbonded (SMS), that are layers of non-woven fabric with different weights of Meltblown, can simultaneously guarantee high particle filtration efficiencies with pressure drop values (breathability) in the limits to classify the surgical masks as Type II/IIR. In fact, the fabric products analyzed so far have not been able to simultaneously guarantee adequate BFE and breathability values. On the contrary, Spunbonds of adequate weights can virtually verify both requirements and accredit themselves as possible materials for the production of surgical masks, at least of Type I. Further studies are needed to verify the possibility of producing low-cost, reusable surgical masks that could meet the criteria of circular economy.

Sub-chronic palladium nanoparticle effects on the endocrine reproductive system of female Wistar rats: Preliminary data.

The technologically interesting properties of palladium nanoparticles (Pd-NPs) allowed their widespread industrial application, although concerns emerged on increasing general and occupational levels of exposure. In this context, to assess the toxicological behavior of Pd-NPs, and particularly their endocrine disruptive potential, has become a public health priority. Therefore, we evaluated Pd-NP impact on the female endocrine reproductive system of Wistar rats sub-chronically treated for 90 days with increasing doses of this xenobiotic (0.12, 1.2, and 12 µg/kg, administered at days 1, 30, and 60 for cumulative doses of 0.36, 3.6, and 36 µg/kg) via the intravenous route. In this regard, we investigated potential alterations in different sex hormone, for example, estradiol, follicle-stimulating hormone (FSH), luteinizing hormone, progesterone, and testosterone, serum concentrations. All treated groups showed significantly greater levels of FSH compared to controls, suggesting a possible impact of Pd-NPs on the regulatory system that controls the normal physiology of female reproductive function. Although relevant, since obtained under sub-chronic, low-dose conditions of exposure resembling those encountered in real-world scenarios, the present results are preliminary and require confirmation as well as identification of the possible underlining molecular mechanisms. From a public and occupational health perspective, implications for the reproductive health of exposed subjects and the next generations of women exposed during their childbearing age or pregnancy should be elucidated. This information is essential to elaborate adequate preventive strategies for assessing and controlling possible Pd-NPs adverse effects on the endocrine system.

[Nanoparticle exposure in research laboratories.] / Esposizione a nanoparticelle nei laboratori di ricerca.

SUMMARY: Aims. A growing number of workers are employed in research laboratories where nanomaterials (NMs) are synthesized, characterized, processed and investigated for their physico-chemical and toxicological properties. To adequately evaluate occupational risks in such contexts, a suitable exposure assessment is necessary. Methods. A critical review of the scientific and grey literature on NM exposure in laboratories has been performed. Results. The evaluation of the exposure, in general, includes a preliminary analysis of the working processes and of the features of NMs employed. Environmental and personal monitoring can be used for a quantitative assessment of the exposure, although the current uncertainties relating to the metrological parameters to be measured and the occupational exposure limits to be compared with collected data make the interpretation of the results and the definition of shared sampling strategies a challenging issue. Conclusions. To date, qualitative information on NM exposure can be used in "control banding" instruments useful for the precautionary assessment and management of risks in research laboratories involved with NMs. Future NM environmental and personal exposure assessments should be pursued to define appropriate monitoring strategies and guide the adoption of appropriate preventive measures to protect the health of workers.

The reference values in the interpretation of toxicological data.

The worldwide gradual expansion of industrialization has led to a dramatic increase in the production and use of chemical substances. This has resulted in a greater dispersion of these elements in the environment and in an increased exposure of the general population and workers. In this scenario, a thorough knowledge of exposure levels is needed in order to assess chemical risks in environmental and occupational settings. Biological monitoring is among the most useful tools for assessing exposure. However, in order to provide really effective guidance in the application/implementation of risk management measures, biomonitoring results need to be compared with appropriate references. Reference values (RVs) are an excellent resource since useful information for a correct interpretation of toxicological data can be obtained by comparing them with biomonitoring results. In the field of public health, this may enable us to identify potential sources of exposure, define the principal and most frequently exploited routes of exposure, and outline chemical absorption. Similarly, in occupational medicine, RVs can be used to give meaning to biomonitoring findings, especially when a biological limit value is not available for the chemical in question. Furthermore, these values are a valid tool for assessing exposure to chemical carcinogens. Therefore, by integrating reference values in an appropriate and complete system of guide values that also includes action levels and biological limit values, we could obtain both an adequate assessment of exposure and a better understanding of toxicological data.

Nanomaterial exposure and sterile inflammatory reactions.

"Sterile inflammation" is a type of pathogen-free inflammation which may be induced by various physical, chemical, or metabolic insults, including environmental particles e.g. silica dioxide crystals and asbestos. The possible role of nanomaterials as danger signals able to trigger sterile inflammatory responses is not yet fully understood. Therefore, the aim of this review was to investigate conditions of sterile inflammation induced by nanomaterial exposure with a specific focus on possible modes of action. Metal-, metal-oxide- and carbon-based nanomaterials may trigger a sterile inflammatory cascade by means of different damage-associated molecular patterns, including chromatin associated protein high-mobility group box-1 secretion, ATP, ADP and adenosine purinergic signaling, interleukin-1α alarmin, and NLPR-3 inflammasome activation. However, such preliminary results do not enable us to draw definite conclusions regarding the sterile inflammatory potential of nanomaterials and possible underlying molecular mechanisms. Therefore, further research is required to understand the complex "interplay" between the multitude of nanomaterial intrinsic or acquired physico-chemical properties and the extremely changeable immunological competence of organisms. The identification of possible nanomaterial modes of action in sterile inflammation could provide early indicators of the biological reactivity of nano-sized chemicals and could direct "safe by design" efforts for improving occupational safety and that of the general population. Moreover, the possible pathological consequences of nanomaterial-induced sterile inflammatory reactions need to be clarified in order to define suitable preventive measures to protect the health of chronically exposed subjects.

Nanoparticle Exposure and Hormetic Dose-Responses: An Update.

The concept of hormesis, as an adaptive response of biological systems to moderate environmental challenges, has raised considerable nano-toxicological interests in view of the rapid pace of production and application of even more innovative nanomaterials and the expected increasing likelihood of environmental and human exposure to low-dose concentrations. Therefore, the aim of this review is to provide an update of the current knowledge concerning the biphasic dose-responses induced by nanoparticle exposure. The evidence presented confirmed and extended our previous findings, showing that hormesis is a generalized adaptive response which may be further generalized to nanoscale xenobiotic challenges. Nanoparticle physico-chemical properties emerged as possible features affecting biphasic relationships, although the molecular mechanisms underlining such influences remain to be fully understood, especially in experimental settings resembling long-term and low-dose realistic environmental exposure scenarios. Further investigation is necessary to achieve helpful information for a suitable assessment of nanomaterial risks at the low-dose range for both the ecosystem function and the human health.

The occupational health and safety dimension of Industry 4.0.

BACKGROUND: In recent years, an increase in the worldwide demand for consumer goods and the need for a sustainable type of manufacturing have led to the so-called "fourth industrial revolution" or Industry 4.0. This 4.0 technological revolution, designed to make industrial production more efficient, more flexible and of higher quality, is characterized by greater automation and computerization. This trend will inevitably affect the way work is organized and carried out, and may affect the health and safety of workers. OBJECTIVES: To provide a comprehensive overview of the opportunities and problematical aspects of Industry 4.0 in relation to the health and safety of workers. METHODS: We conducted a critical review of the literature currently available on this topic. RESULTS: Automated machines and robots can either replace workers or sustain them by making their tasks more flexible, safer, and socially more inclusive. On the other hand, workers will be engaged in tasks requiring decision-making, responsibility and management, as well as man-machine interaction that will expose them both to health and safety risks intrinsically related to automated tools and to greater psychosocial stress. DISCUSSION: Occupational health professionals, responsible for safeguarding health in the workplace, should make an adequate assessment of the risks attributable to 4.0 tools and should promote and protect the health and safety of workers through careful risk management based on continuous occupational training and information.

The effects of nanoparticles on the renal system.

Through a process of translocation across biological barriers, nanoparticles can reach and deposit in secondary target organs where they may induce adverse biological reactions. Therefore, a correct assessment of nanoparticle-induced adverse effects should take into account the different aspects of toxicokinetics and tissues that may be targeted by nanoparticles. For this reason, a comprehensive evaluation of renal nanotoxicity is urgently needed as kidneys are particularly susceptible to xenobiotics and renal excretion is an expected and possible elimination route of nanoparticles in living organisms. On one hand, summarizing the findings of in vitro and in vivo studies that have investigated the adverse effects of nanoparticles on the kidney, this review intends to provide a thorough insight into the nephrotoxicity of these substances. The evaluation of the in vitro studies revealed that different types of nanoparticles (carbon, metal and/or silica nanoparticles) are able to exert significant cytotoxic effects (i.e., decreased cell viability, induction of oxidative stress, mitochondrial or cytoskeleton dysfunction and cell membrane and DNA damage). On the other hand, in vivo studies demonstrated that nanoparticles exhibited an important nephrotoxic potential both at tubular (i.e., degeneration of tubular epithelial cell, cellular fragments and proteinaceous liquid in tubule lumen, renal interstitial fibrosis) and glomerular level (i.e., swollen glomeruli, changes in Bowman's space and proliferation of mesangial cells). Although the data currently available indicate that nanoparticles may adversely impact the renal system, further studies are needed in order to clarify all the potential molecular mechanisms of nephrotoxicity induced by these xenobiotics, in particular at glomerular level.

[Airport related air pollution and health effects]. / Inquinamento atmosferico prodotto dagli aeroporti ed effetti sulla salute.

Airport is an extremely complex emission source of airborne pollutants that can have a significant impact on the environment. Indeed, several airborne chemicals emitted during airport activities may significantly get worse air quality and increase exposure level of both airport workers and general population living nearby the airports. In recent years airport traffic has increased and consequently several studies investigated the association between airport-related air pollution and occurrence of adverse health effects, particularly on respiratory system, in exposed workers and general population resident nearby. In this context, we carried out a critical evaluation of the studies that investigated this correlation in order to obtain a deeper knowledge of this issue and to identify the future research needs. Results show that the evidence of association between airport-related air pollution and health effects on workers and residents is still limited.

[Airports and air quality: a critical synthesis of the literature]. / Aeroporti e qualità dell'aria: una sintesi critica della letteratura scientifica.

This work reviewed existing literature on airport related activities that could worsen surrounding air quality; its aim is to underline the progress coming from recent-year studies, the knowledge emerging from new approaches, the development of semi-empiric analytical methods as well as the questions still needing to be clarified. To estimate pollution levels, spatial and temporal variability, and the sources relative contributions integrated assessment, using both fixed point measurement and model outputs, are needed. The general picture emerging from the studies was a non-negligible and highly spatially variable (within 2-3 km from the fence line) airport contribution; even if it is often not dominant compared to other concomitant pollution sources. Results were highly airport-specific. Traffic volumes, landscape and meteorology were the key variables that drove the impacts. Results were thus hardly exportable to other contexts. Airport related pollutant sources were found to be characterized by unusual emission patterns (particularly ultrafine particles, black carbon and nitrogen oxides during take-off); high time-resolution measurements allow to depict the rapidly changing take-off effect on air quality that could not be adequately observed otherwise. Few studies used high time resolution data in a successful way as statistical models inputs to estimate the aircraft take-off contribution to the observed average levels. These findings should not be neglected when exposure of people living near airports is to be assessed.

[Air pollution in an urban area nearby the Rome-Ciampino city airport]. / Inquinamento atmosferico in un'area urbana limitrofa all'aeroporto di Roma-Ciampino.

OBJECTIVES: to assess air pollution spatial and temporal variability in the urban area nearby the Ciampino International Airport (Rome) and to investigate the airport-related emissions contribute. DESIGN AND SETTING: the study domain was a 64 km2 area around the airport. Two fifteen-day monitoring campaigns (late spring, winter) were carried out. Results were evaluated using several runs outputs of an airport-related sources Lagrangian particle model and a photochemical model (the Flexible Air quality Regional Model, FARM). MAIN OUTCOME MEASURES: both standard and high time resolution air pollutant concentrations measurements: CO, NO, NO2, C6H6, mass and number concentration of several PM fractions. 46 fixed points (spread over the study area) of NO2 and volatile organic compounds concentrations (fifteen days averages); deterministic models outputs. RESULTS: standard time resolution measurements, as well as model outputs, showed the airport contribution to air pollution levels being little compared to the main source in the area (i.e. vehicular traffic). However, using high time resolution measurements, peaks of particles associated with aircraft takeoff (total number concentration and soot mass concentration), and landing (coarse mass concentration) were observed, when the site measurement was downwind to the runway. CONCLUSIONS: the frequently observed transient spikes associated with aircraft movements could lead to a not negligible contribute to ultrafine, soot and coarse particles exposure of people living around the airport. Such contribute and its spatial and temporal variability should be investigated when assessing the airports air quality impact.

[The INSuLa Project: the knowledge survey of company physicians]. / Progetto INSuLa: I'indagine conoscitiva sui medici competenti.

The technological advancements, the occurrence of new emerging occupational risks and diseases, and the changes in the regulatory framework for occupational health and safety induce a constant evolution of occupational medicine. Consequently, the skills and training needs of the occupational physicians should be periodically revalued and upgraded in order to identify technical and operational issues and problems of this discipline. In this context, the aim of this national survey, carried out using a self-administered questionnaire submitted to a sample of 1,237 occupational physicians, has been to gain helpful information to ensure a continuous improvement of the quality and effectiveness of measures aimed at protecting the health and safety of workers. The questionnaire, that consists of 43 questions divided into 5 different areas (personal and professional information, training and updating needs of occupational physicians, professional activities and relationships with the corporate prevention system, relationships with the supervisory board of the Local Health Authority, relationships with the National Health Service), allowed to obtain personal and professional data, to assess the training needs and demands of occupational physicians and to evaluate their relationships with the other stakeholders of the Italian prevention system and with the National Health Service. The preliminary results of this survey appear extremely important. In fact, this findings, highlighting the current problems of occupational physician, constitute the starting point to identify, develop and implement management methodologies, operative procedures and training programs that are effective and modern.

The effects of nanomaterials as endocrine disruptors.

In recent years, nanoparticles have been increasingly used in several industrial, consumer and medical applications because of their unique physico-chemical properties. However, in vitro and in vivo studies have demonstrated that these properties are also closely associated with detrimental health effects. There is a serious lack of information on the potential nanoparticle hazard to human health, particularly on their possible toxic effects on the endocrine system. This topic is of primary importance since the disruption of endocrine functions is associated with severe adverse effects on human health. Consequently, in order to gather information on the hazardous effects of nanoparticles on endocrine organs, we reviewed the data available in the literature regarding the endocrine effects of in vitro and in vivo exposure to different types of nanoparticles. Our aim was to understand the potential endocrine disrupting risks posed by nanoparticles, to assess their underlying mechanisms of action and identify areas in which further investigation is needed in order to obtain a deeper understanding of the role of nanoparticles as endocrine disruptors. Current data support the notion that different types of nanoparticles are capable of altering the normal and physiological activity of the endocrine system. However, a critical evaluation of these findings suggests the need to interpret these results with caution since information on potential endocrine interactions and the toxicity of nanoparticles is quite limited.

Validation of the NIOSH Worker Well-Being Questionnaire in Italian Language.

OBJECTIVE: This study aimed to validate in Italian the Worker Well-Being Questionnaire developed by US National Institute for Occupational Safety and Health. METHODS: The questionnaire was independently translated into Italian by two authors. Translations were compared with obtain a synthesis that was back-translated. Back translations were submitted to an expert committee to produce a final version of the questionnaire. The Italian version, after being pretested, was administered guaranteeing anonymity to a total sample of 206 health care workers. RESULTS: Findings obtained are satisfactory, indicating excellent fit (CFI and TLI values ranged from 0.96 to 0.99, RMSEA values ranged from 0.03 to 0.07), sound internal consistency of scales (Cronbach's α values exceeded 0.7) and factor structures consistent with theory. CONCLUSIONS: Italian version of the questionnaire is faithful to the original and allows for efficient and robust measurement of workers' well-being.

Occupational Exposure to Metal Engineered Nanoparticles: A Human Biomonitoring Pilot Study Involving Italian Nanomaterial Workers.

Advances in nanotechnology have led to an increased use of engineered nanoparticles (ENPs) and the likelihood for occupational exposures. However, how to assess such exposure remains a challenge. In this study, a methodology for human biomonitoring, based on Single Particle Inductively Coupled Plasma Mass Spectrometry (SP-ICP-MS), was developed as a tool to assess the ENPs exposure of workers involved in nanomaterial activities in two Italian Companies. The method was validated for size and number concentration determination of Ag, Au, In2O3, Ir, Pd, Pt, and TiO2 NPs in urine and blood samples. The results showed the presence of In2O3 NPs in blood of exposed workers (mean, 38 nm and 10,371 particles/mL), but not in blood of controls. Silver, Au, and TiO2 NPs were found in urine (mean, Ag 29 nm and 16,568 particles/mL) or blood (mean, Au 15 nm and 126,635 particles/mL; TiO2 84 nm and 27,705 particles/mL) of workers, though these NPs were found also in controls. The presence of ENPs in both workers and controls suggested that the extra-professional exposure is a source of ENPs that cannot be disregarded. Iridium, Pd, and Pt NPs were not detected neither in blood nor in urine. Overall, the findings provided a rational basis to evaluate the exposure assessment to ENPs in cohorts of workers as part of risk assessment and risk management processes in workplaces.

The challenges of defining hormesis in epidemiological studies: The case of radiation hormesis.

In the current radiation protection system, preventive measures and occupational exposure limits for controlling occupational exposure to ionizing radiation are based on the linear no-threshold extrapolation model. However, currently an increasing body of evidence indicates that this paradigm predicts very poorly biological responses in the low-dose exposure region. In addition, several in vitro and in vivo studies demonstrated the presence of hormetic dose response curves correlated to ionizing radiation low exposure. In this regard, it is noteworthy that also the findings of different epidemiological studies, conducted in different categories of occupationally exposed workers (e.g., healthcare, nuclear industrial and aircrew workers), observed lower rates of mortality and/or morbidity from cancer and/or other diseases in exposed workers than in unexposed ones or in the general population, then suggesting the possible occurrence of hormesis. Nevertheless, these results should be considered with caution since the identification of hormetic response in epidemiological studies is rather challenging because of a number of major limitations. In this regard, some of the most remarkable shortcomings found in epidemiological studies performed in workers exposed to ionizing radiation are represented by lack or inadequate definition of exposure doses, use of surrogates of exposure, narrow dose ranges, lack of proper control groups and poor evaluation of confounding factors. Therefore, considering the valuable role and contribution that epidemiological studies might provide to the complex risk assessment and management process, there is a clear and urgent need to overcome the aforementioned limits in order to achieve an adequate, useful and more real-life risk assessment that should also include the key concept of hormesis. Thus, in the present conceptual article we also discuss and provide possible approaches to improve the capacity of epidemiological studies to identify/define the hormetic response and consequently improve the complex process of risk assessment of ionizing radiation at low exposure doses.

The Hospital of Tomorrow Case Study: Multidisciplinarity, Inclusiveness and Holistic Approaches to Foster Innovation in Complex Organizations.

BACKGROUND: This case study describes and analyses an action research initiative undertaken by management, staff and WHO at the St. Orsola-Malpighi Polyclinic in Bologna, Italy. The initiative utilised staff engagement approaches developed during the COVID-19 pandemic to rethink and reshape future development plans. The initiative provides a 'how-to' case study for complex health facilities on ways to create similar multisectoral, inclusive and holistic processes in planning structural, functional and organizational solutions for their 'hospitals of tomorrow'. METHODS: The case study utilised an action research approach coordinated by a team of WHO facilitators in close collaboration with the Board of Hospital Directors. Heterogeneous and multidisciplinary working groups were created, with members from different levels of the hospital staff. In the context of facilitated group meetings held weekly over a one-year period, participants were asked to review topics of interest to future plans of the hospital and make recommendations on effective/innovative ways of addressing these in the short and long term. Working groups focused on different challenges. RESULTS: The initiative was successful in creating and sustaining broad staff engagement in the future planning processes. 80% groups maintained high staff participation throughout the entire project year. Participating staff reported enhanced communication and cooperation between departments represented in different groups. 87% of the proposed plans suggested by the working groups were approved by the Board for implementation. CONCLUSION: Key factors contributing to the high approval rate of plans, strong engagement record of staff and enhanced cooperation between involved departments; included: multisectoral/cross hierarchal staff involvement, group attention to defining time-bound contextual goals, flexible implementation monitoring approaches, personnel skills and profiles of participants, direct and open communication at all levels and times, member commitment and clear exit strategy. The case study is presented as a model to stimulate similar actions in other complex health care facilities.

The challenges of managing patients with cancer in the workplace: Needs, opportunities and perspectives of occupational physicians.

Cancer is a global major public health problem since it is a leading cause of death, accounting for nearly 10 million deaths in 2020 worldwide and the most recent epidemiological data suggested that its global impact is growing significantly. In this context, cancer survivors have to live for a long time often in a condition of disability due to the long-term consequences, both physical and psychological. These difficulties can seriously impair their working ability, limiting the employability. In this context, the occupational physician plays a key role in the implementation and enforcement of measures to support the workers affected by cancer, to address issues such as the information on health promotion, the analysis of work capacity and the management of disability at work and also promoting a timely and effective return to work and preserving their employability. Therefore, the aim of this study was to gather useful information to support the occupational physicians in the management of workers affected by cancer, through a survey on 157 Italian occupational physicians. Based on the interviewees' opinions, the most useful occupational safety and health professionals in terms of job retention and preservation of workers affected by cancer are the employers and the occupational physicians themselves, whose role is crucial in identifying and applying the most effective reasonable accommodations that should be provided to the workers affected by cancer. The provision of these accommodations take place on the occasion of mandatory health surveillance medical examination to which the worker affected by cancer is subjected when he returns to work. Results on training and information needs showed that the management of the workers affected by cancer is essentially centered on an appropriate fitness for work judgment and on the correct performance of health surveillance. However, an effective and successful management model should be based on a multidisciplinary and integrated approach that, from the earliest stages of the disease, involves the occupational physicians and employers.

Impact of Covid-19 pandemic on psychological well-being of firefighters.

Background: Covid-19 pandemic represented a unique stressful event that affected the physical health and the psychological well-being (PWB) of individuals and communities. Monitoring PWB is essential to clarify the burden on mental health effects but also to define targeted psychological-supporting measures. This cross-sectional study evaluated the PWB of Italian firefighters during the pandemic. Methods: Firefighters recruited during the pandemic period filled out a self-administered questionnaire the Psychological General Well-Being Index during the health surveillance medical examination. This tool is usually used to assess the global PWB and explores six subdomains: anxiety, depressed mood, positive well-being, self-control, general health, and vitality. The influencing role of age, gender, working activities, Covid-19 and pandemic restrictive measures was also explored. Results: A total of 742 firefighters completed the survey. The aggregate median PWB global score was in the "no distress" range (94.3±10.3) resulting higher than that observed in studies conducted using the same tool in the Italian general population during the same pandemic period. Similar findings were observed in the specific subdomains thus suggesting that investigated population was in good PWB condition. Interestingly, significantly better outcomes were detected in the younger firefighters. Conclusion: Our data showed a satisfactory PWB situation in firefighters that could be related to different professional factors such as work organization, mental and physical training. In particular, our results would suggest the hypothesis that in firefighters, the maintaining of a minimum/moderate level of physical activity (consisting of even just going to work) might had a profoundly positive impact on psychological health and well-being.