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.

Twinning as a risk factor for neonatal acute intestinal diseases: a case-control study.

Introduction: Acute intestinal diseases (AID), including necrotizing enterocolitis and spontaneous intestinal perforation, are a group of conditions that typically present in preterm infants, and are associated with an elevated mortality and morbidity rate. The risk factors for these diseases remain largely unknown. The aim of the study is to identify the correlation between twinning and the development of AID. Methods: A single-center retrospective case-control study was conducted. We recruited all infants with a diagnosis of AID, confirmed by anatomopathology, recovered in NICU between 2010 and 2020. Considering the rarity of the outcome, 4 matched controls for each subject were randomly chosen from the overall population of newborns. Odds Ratio (OR) and 95% Confidence Interval (CI) were calculated using a conditional logistic regression model and a multivariate model by the creation of a Directed Acyclic Graph (www.dagitty.net). Results: The study population resulted in 65 cases and 260 controls. The two groups present similar median gestational age and mean birthweight in grams. The cases have a higher frequency of neonatal pathology (defined as at least one of patent ductus arteriosus, early or late sepsis, severe respiratory distress) (84.6% vs. 51.9%), medically assisted procreation (33.8% vs. 18.8%) and periventricular leukomalacia (10.8% vs. 2.7%), and a lower frequency of steroids prophylaxis (67.7% vs. 86.9%). About 50% of cases needed surgery. The OR for the direct effect were difference from one using logistic regression booth without and with repeated measures statements: from 1.14 to 4.21 (p = .019) and from 1.16 to 4.29 (p = .016), respectively. Conclusions: Our study suggests that twinning may be a risk factor for the development of AID. Due to the small number of cases observed, further studies on larger populations are needed.

[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.

[Workplace campaigns for metabolic syndrome prevention and healthy lifestyles promotion in mechanical engineering industries]. / Interventi per la prevenzione della sindrome metabolica e la promozione di stili di vita salutari in aziende del settore metalmeccanico.

The paper describes 2 years outcome on BMI, smoking habits and physical activity of 2 WHP carried in engineering plants. Three important results were achieved: stationarity of body weight despite ageing of examined population; increase of workers that perform regular physical activity and a slight increase of smoking cessation. NSAS questionnaire showed a marked improvement in life styles compared to the data obtained 2 years before. Our findings suggest that an efficacy on life style modification can be achieved by WHP campaigns with little time and cost consuming. The collaboration between occupational physician, employer and employees but also with external professionals is the key of success.

[Prevalence of obstructive sleep apnea syndrome in a group of obese workers]. / La prevalenza della sindrome delle apnee ostruttive del sonno un gruppo di lavoratori affetti da obesità.

The Obstructive Sleep Apnea Syndrome (OSAS) is a quite diffused in workers disease, mainly in obese or overweight subjects. This syndrome can cause cardiovascular and cerebral complications and have negative effects on job performances. We evaluated 214 obese/overweight workers referred from different job areas. A diagnosis of OSAS was pre-existent in about 5% of the examined subjects, and clinical elements suggesting suspect of OSAS were present in about 15% of the sample. The risk of development Obstructive Sleep Apnea Syndrome seems to be linear correlated with BMI, neck and waist circumference. We did not find any correlation between OSAS risk and job area. We strongly suggest that health surveillance should include the evaluation of the possible presence of sleep disorders to reduce the risks associated and the negative consequences on job performances.

[Applicability of the test SIO on obesity-related disability (TSD-OC) in occupational medicine for the evaluation of work problems linked to overweight-obesity condition]. / Applicabilità del Test SIO sulla disabilità correlata all'obesità (TSD-OC) in Medicina del Lavoro per la valutazione di problematiche lavorative legate al sovrappeso-obesità.

Obesity is frequently associated with functional changes that may affect work capacity, so we administered to a group of 198 overweight-obese subjects with median BMI of 32.7 and median waist circumference of 101 cm, the test-TSD OC which consists of 7 sections (pain, stiffness, activities of daily life, activities of the house, instrumental activities of daily living, work, social relations) for a total of 36 visual analogical scales. After the identification of 4 workers categories (health, services, administration, commerce/industry), resulted homogeneous for age, BMI, CV, we saw that the work section was more compromised for health and services. The overall disability increases especially in relation to BMI and seems influenced by age and sex.

[Comparison of indexes for assessing insulin resistance for the health surveillance among workers]. / Confronto tra indici per la valutazione dell'insulinoresistenza nella sorveglianza sanitaria dei lavoratori.

Night shift workers present a high risk to develop metabolic and cardiovascular disorders for alterations that involve effects on circadian rhythms at the level of insulin resistance (IR). Monitor such parameter in this category of workers, therefore, is a crucial step in health surveillance. To this aim, the currently in use test consists in the calculation of the HOMA index [basal insulin (MU/ml) x basal glycemy(mmol/l)/22.5], a measurement with a considerable cost (about 13 Euros). Recent studies demonstrated that the measurement of TyG index calculated as Ln[Triglycerids (mg/dl) x Glucose(mg/dl)/2] and of the triglycerids/HDL-cholesterol ratio correlates with HOMA index. These analyses cost altogether about 5 Euros, allowing a clear decrease of expenses. Our study, carried out on 217 workers at Centre for Obesity and Occupational Medicine of the Occupational Medicine Clinic of Milan, confirmed such correlation and identified the TyG as the index with the best cost/performance ratio. Our future goal is to establish cut-off values, necessary to adopt the TyG as first choice index.

[The assessment of risk for xylene exposure in a laboratory of anatomy: comparison between computational models and environmental and biological monitoring]. / La valutazione del rischio per esposizione a xilene in un laboratorio di anatomia patologica: confronto tra algoritmi matematici e monitoraggio ambientale e biologico.

Exposure to xylene in a pathology laboratory was evaluated using two algorithms: Stoffenmanager and Archi.me.de. The results were compared with those obtained by applying the environmental and biological monitoring of the exposure. The use of models required a period of self-learning and, for Stoffenmanager, knowledge of the English language. Information on the toxicity and safety of xylene, available from the medial and safety data sheets, and the conditions and amount of use, obtained through a survey and interviews with operators, have been imputed. Stoffenmanager estimated low the inhalation exposure and medium the dermal exposure, with a value of personal exposure during the work shift of 1.4 mg/m3. A.r.chi.me.d.e. estimated negligible the risk to health. These ratings are consistent with those obtained using the experimental approach. This result, combined with the simplicity and low cost, makes the algorithms very interesting tools for the assessment of chemical risk in the workplace.

[Vitamin D as a cardiovascular risk factor in workers]. / La vitamina D come fattore di rischio cardiovascolare nei lavoratori.

Numerous evidence suggests that vitamin D deficiency is implicated in the development of cardiovascular risk. It has been investigated the relationship between cardiovascular risk factors and vitamin D concentrations in 264 consecutive workers from Centro Obesità e Lavoro della Clinica del Lavoro di Milano. For these studies, glicometaboliche analysis, anthropometric measurements and impedance evalutation were performed and questionnaires to estimate nutrient levels in the diet were administered. The levels of vitamin D are found to be deficient in 166 patients (less than 20 ng/mL), insufficient in 63 patients (less than 30 ng/mL) and optimal for the remaining 35 patients. A significant negative association was observed between the concentrations of vitamin D and cardiovascular risk factors (HOMA ratio and TG/HDL) ratios and BMI. Vitamin D is a cardiovascular risk factor "corrected" for example by changing the eating habits of workers.

[Evaluation of the work-related disability in people affected by Ehlers-Danlos syndrome]. / Valutazione della disabilità in ambito lavorativo in soggetti con sindrome di Ehlers-Danlos.

The Ehlers-Danlos syndrome (EDS), inherited disorder of connective tissue, frequently leads to impairment of various functional areas, including employment. In 35 subjects with classic type EDS, 14 hypermobile, 3 vascular was administered 7 visual analogical scales (pain, stiffness, activities of daily living, instrumental activities of daily living, work, social relations). An impairment of particular significance in total score and in individual areas emerges is in the hypermobile group, followed by classic, less for the vasculature. Overall there is a significant alteration of the quality of life that deserves proper evaluation to facilitate the definition of fitness and the improvement of job insertion in patients with EDS.

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.

["EOSS" classification in a group of obese workers]. / Classificazione "EOSS" in un gruppo di lavoratori obesi.

Current classification of obesity, based on BMI, presents some limitations in evaluating work-related impairments. In fact it does not provide information on presence and/or severity of clinical impairments associated with obesity. On the contrary, EOSS classification takes into account metabolic complications and functional limitations with restrictions of daily living and working activities. Aim of our study is to compare, in a group of obese workers, the different utility for precautionary and work-eligibility purposes of these two classifications. Results on our study population suggest that a more systematic use of the EOSS classification might be useful in occupational medicine.

[Intervention for prevention and therapy of overweight-obesity in an engineering company]. / Intervento per la prevenzione e cura del sovrappeso-obesità in un'industria metalmeccanica.

Obesity is often burdensome for workers. A workplace health promotion starts from simple parameters such as height, weight, body mass index (BMI), waist circumference (CV), blood pressure (BP), together with the type of activity and shift work. Such data can be gathered through periodic health surveillance, and are useful to calibrate properly the type of needed intervention. Here is described a program of health promotion aimed at inprouving overweight-obesity settled in an engineering company of northern Italy. During the periodic health surveillance in relation to occupational hazards assessed was found a higher incidence, compared with age and sex, of overweight/obese workers than national average. Plans of action in the company were: meetings of awareness and information on lifestyle and food targeted to shift workers; offer of diagnostic-therapeutic route in the second level outpatients clinic "Obesity and work"; the presence of metabolic syndrome was found in 62.5% of the subjects examined. At the end of multidisciplinary intervention, conducted in concert with the occupational physician of the plant, were carried out two major initiatives: an action on the canteen aimed at preventing the nutritional type of meals offered to suit the dietary needs of overweight/obese workers and the conclusion of an agreement with gyms adjacent the two company locations motivating workers to increase physical exercise.

[Incidence of malignant mesothelioma and asbestos exposure in the Lombardy region, Italy, 2000-2008]. / Incidenza del mesotelioma maligno ed esposizione ad amianto in Lombardia, 2000-2008.

We evaluated the trend of incidence and asbestos exposure of malignant mesothelioma (MM) in 2000-2008 in the Lombardy Region (Italy). We recorded 2,816 MMs (1,793 men, 1,023 women). The age-standardized rates (x 100,000/year) were 3.4 (men) and 1.4 (women) (standard population: Europe). We found a 3.0% and 0.9% increase per year of number of cases and rate, respectively. Exposure was obtained in 2,671 cases (94.9%). Occupational exposure to asbestos was found for 1,296 (72.3%) men and 377 (36.9%) women, non-occupational exposure in 141 (13.8%) women and 58 (3.2%) men. The exposure profile within gender did not vary over years.

[Impact of obesity-related disability in different work categories]. / Impatto dello disabilità correlata all'obesità nelle diverse categorie professionali.

Absenteeism and sick leave are often reported in obese workers. To evaluate disability work related we assess 180 overweight-obese subjects [BMI 34,6 + 6,4, range 26,0-59,0) with TSD-OC questionnaire divided into 7 items (pain; stiffness; ADL; housework; IADL; occupational activities; social life) with a total of 36 visual analogue scales. Among the job categories, health-care workers showed the highest TSD-OC total score (26,9 + 22,5%, ANOVA p < 0,05) and BMI (BMI 37,7 + 6,9 kg/m2). Among the items, pain was statistically significant in health-care workers (16,1 + 13,2%), in Services (16,3 + 14,3%), in Education (15,1 + 11,4%) and in Administration (13,3 +11,0%) ( p <0,05). "Occupational activities" item was statistically significant in health-care (11, 6 +10,6%, p <0,05).

[Obesity and work: proposal for a multidisciplinary intervention model for prevention and its application in an engineering plant]. / Obesità e lavoro: proposta di un modello di intervento multidisciplinare per la prevenzione e sua applicazione in una industria metalmeccanica del Nord Italia.

INTRODUCTION: Obesity is often particularly burdensome for subjects at work and leads to hypertension and diabetes preceded by a low grade of inflammation. Measures to promote health at the workplace can be achieved through periodic health surveillance. Simple parameters such as height, weight, body mass index (BMI), waist circumference (CV), blood pressure (BP), as well as taking into account the type of work and tasks, shift work and smoking, are in fact sufficient to identify the most significant features of the working population so as to adequately design the type of intervention required. The paper describes how a health promotion programme aimed at preventing overweight and obesity was implemented based on analysis of the health surveillance data routinely collected by the occupational physician in an engineering plant in northern Italy. SUBJECTS AND METHODS: Data on weight, height and BMI were collected for 301 workers with different jobs and shifts in an engineering plant; 32 of these workers, (mean age 44+/-8.4) agreed to undergo a diagnosis and treatment programme at the Obesity and Work Centre of the Clinica del Lavoro in Milan. INTERVENTIONS AND RESULTS: A higher incidence of overweight and obesity was found compared to the national average for similar age classes, therefore meetings were organized at the plant on awareness and information on correct lifestyle and diet targeted for shift workers. The workers who had followed the diagnosis and treatment programme had a mean BMI of 32.6 (SD 2.7) and, considering the parameters investigated, the presence of metabolic syndrome was found in a greater proportion of subjects (62.5%) than the average in our practice (46%) and particularly in workers with three day shifts. CONCLUSIONSThe intervention programme began with assessment of the information obtained in the course of routine periodic health surveillance according to the occupational hazards under study. On the basis of this information it was possible to implement the first awareness campaigns. On completion of the multidisciplinary intervention, which was conducted in collaboration with the occupational physician, two major initiatives were taken: one in the canteen with the aim of improving the nutritional content and type of meals offered to suit the dietary needs of overweight or obese workers, and the other consisted of an agreement with local gyms so as to motivate workers to exercise more. A prerequisitefor this type of initiative is the willingness and understanding of the management to recognize the health of the worker as a priority value.

Differences among peritoneal and pleural mesothelioma: data from the Lombardy Region Mesothelioma Register (Italy).

BACKGROUND: The relationship between asbestos exposure and peritoneal mesothelioma (PEM) is under investigation. Some authors suggest that the association could be weaker than that observed for pleural mesothelioma (PLM). OBJECTIVE: To compare individual, clinical and exposure characteristics of peritoneal and pleural mesothelioma cases that occurred in the Lombardy Region (Italy). METHODS: Cases were drawn from the regional mesothelioma registry (base population > 9 million). We selected all PEM cases diagnosed between 2000 and 2007 (N = 110) and all PLM cases that occurred between 2000 and 2001 (N = 515). Asbestos exposure data (occupational, environmental/familial, or both) were collected by a standardized and validated questionnaire administered to each case or case's relative. Based on available chest CT scans, we also investigated the concomitant presence of asbestosis and/or pleural plaques as markers of asbestos exposure. RESULTS: PEM and PLM cases had similar proportions of occupational (around 60%) and environmental/familial (7%) asbestos exposure. The proportion of PEM subjects with co-existent occupational and environmental/familial exposures was, however, twice as high as PLM cases (6.1% vs 3.1%). Asbestosis and pleural plaques were more frequent in PEM than in PLM cases (7.7% and 20.9% vs 0.4% and 12.1%, respectively). No differences were detected for duration of exposure and latency among occupationally exposed cases. CONCLUSION: Our findings from a population-based Registry suggest that high cumulative asbestos exposures are the main risk factors not only for pleural but also for peritoneal mesothelioma.

[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.

[Biological risk. Relevant problems: risk to third parties]. / Il rischio biologico. Problematiche di rilievo: il rischio verso terzi.

Transmission of infections from healthcare workers to patients during clinical activities has been an issue for at least twenty years. Studies and general considerations on this topic have brought to consensus documents, guidelines and public health policies, that were sometimes different depending on which social and cultural backgrounds they referred to. Though crucial, this issue remains nowadays not completely resolved, especially if we consider that no agreement has been found on how to face the problem. In this complex framework a question arises about the potential role of the occupational physician. We are talking in fact about a risk that, though present in the working environment, does not directly involve the workers themselves, but rather the people the healthcare workers get in contact with. We may say it is not only a problem of occupational medicine, but rather an issue involving medicine in working environment. This is a real challenge for those who deal with job healthcare and security, even if it is fundamental to fully understand how to face it. After a synthesis of the problem in its conceptual and quantitative dimensions, we now offer some new food for thought and outline some operating clues for the occupational physician too, as a contribution for a common and effective solution.

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,