Association between seasonal flu vaccination and COVID-19 among healthcare workers.

BACKGROUND: In next fall and winter, SARS-CoV-2 could circulate in parallel with seasonal influenza. The dual epidemics will result in considerable morbidity and mortality; therefore, influenza vaccination may be essential. Recent studies found increased risk of coronavirus in individuals receiving influenza vaccination. AIMS: Our aim is to analyse the association between influenza vaccination and COVID-19 in a population of healthcare workers (HCWs). METHODS: IgG antibodies against SARS-CoV-2 were detected in 3520 HCWs at a large hospital in Northern Italy. For each participant, we collected data on flu immunization status for the last five flu seasons. Logistic regression was used to test associations between seasonal flu vaccination status and a positive serology tests for COVID-19. RESULTS: During the last five flu seasons, 2492 vaccinations were administered. Serology tests were negative for 3196 (91%) HCWs and residents and only 21 (1%) people had an equivocal test (12.0-15.0 AU/mL). Only 128 (4%) people received a diagnosis of COVID-19, with a positive swab test. No flu vaccinations for the last five flu seasons were specifically associated with diagnosis of COVID-19 or with positive results of serology tests. CONCLUSIONS: Flu vaccinations did not appear to be associated with SARS-CoV-2 infection. Influenza vaccination should continue to be recommended for HCWs and for individuals at increased risk for severe illness from respiratory infection.

[Vaccinal prophylaxis against tetanus and hepatitis B: difficulties in application of law and actual status of workers' protection in Lombardy among workers of building sector]. / La profilassi vaccinale antitetanica ed antiepatite B: problematiche applicative della norma e state attuale della copertura tra i lavoratori del Comparto Edile in Lombardia.

Vaccinal prophylaxis is a preventive action which is compulsory, if available and useful for health protection of workers exposed to biological work risk. Definition andrealization of compulsory vaccinal campaigns is assigned by law to Occupational Health Doctor. We report a research carried out in 135 firms of building sector on 2158 workers exposed to biological work risk and concerning their vaccinal status against Tetanus and Hepatitis B. We found that only in a part of firms a plan of vaccination has been activated among workers exposed to biological work risk and, if activated, these plans frequently were partial and incomplete. Vaccinal protections among workers therefore resulted insufficient especially among foreigners workers and among workers active in first aid and emergency work teams. We think that a more active role of Occupational Health Doctors in promotion and realization of vaccinal campaigns is necessary for medico-legal and scientific reasons.

[Evaluation of residual osteomuscular function using computerised movement analysis for building sector workers: specificity and technical problem]. / La valutazione della funzionalità osteomuscolare residua tramite l'analisi computerizzata del movimento nei lavoratori del comparto edile: specificità e problematicità.

Occupational Health Doctors active in building sector firms frequently have to evaluate residual workers' osteomuscular function in patients coming back to work after an accident happened during work time or free time. Definition of their specific individual work suitability is usually carried out utilizing semeiotic tests in which subjective evaluation of every single Medical Doctor is real important in definition of final results and this fact can cause legal controversies. In our research we describe the application of computerised movement analysis on 10 workers of building sector. In every patient examined this technical method has been able to study objectively the tridimensional ranges of motion of most important osteomuscular districts. The possibility to have an objective evaluation of residual osteomuscular function has a relevant importance both in definition of workers' work suitability at the moment in which they start again their activities and in possible future legal conflicts.

[A survey on dental offices: risk assessment and practicable preventive and protective measures]. / Indagine su un campione di studi odontoiatrici: valutazione dei rischi e misure preventive e protettive attuabili.

The survey was aimed at developing a method and providing valuable tools to be used for risk assessment in dental practices and for the implementation of preventive and protective measures. For these purposes general (inspection card for the definition of risk level for health and safety) and specific tools (check-lists) were used. In each dental office chemical and physical hazards (noise and hand-arm vibration) were assessed. Adequate levels of security were achieved, even if workers' training was evidenced as a critical element. In the 90% of cases, rooms for specific use were available and suitable according the law. The risk of work-related stress was acceptable in almost all the analyzed dental offices. Chemical and specific physical hazards appeared to be below the action level. Biological risk doesn't seem to be a critical element, even though its control could be further improved.

[Work-related stress risk assessment in a home care agency]. / La valutazione del rischio stress lavoro-correlato in una cooperativa di assistenza domiciliare.

The workload, the quality of professional relationships and emotional involvement have a significant impact on distress and burnout in health care-workers; this impact has an hight variability among the different environments and different care facilities (hospital, erderly nursing homes, home care). The risk assessment of work-related stress performed in 2010 in a homecare agency highlighted organizational problems related to the content/context of work and risk factors for health and safety. High turn-over is evidenced as critical among the "sentinel events". The level of job-strain was moderate, even if some critical issues were evidenced especially in the group of physiotherapists; nurses were configured as a homogeneous group with a low level of job-strain. In informative meetings the workers identified the discomfort related to the time for transferring patients from their homes in a high-traffic metropolitan area was identified as the most critical aspect.

[Hepatitis B vaccination coverage and booster dose: results from a survey on healthcare students]. / Copertura vaccinale anti-epatite B e dose di rinforzo: risultati di uno studio su una popolazione universitaria.

This study assessed the immunisation status against hepatitis B in healthcare students and residents, before their hospital internship, as suggested by the "National Immunization Prevention Plan 2012-2014". The concentration of antibodies against hepatitis B was measured in 2,491 subjects (70.90% women), born between 1980 and 1993 and visited between January 1st 2000 and July 15th 2012. Personal and serologic data were collected for each subjects. Individuals with antibody less than 10 mIU/mL (327, 13.3%) were given a booster dose and re-tested 2 months later. The multivariate logistic regression evidenced that immunization is influenced by the gender, the age at first vaccination, the time elapsed between first vaccination and antibody measurement. This study confirms the importance of measuring the concentration of antibodies against hepatitis B among healthcare students, even if they have previously been vaccinated, according to the "National Immunization Prevention Plan 2012-2014".

[The movement computerized analysis as instrumental support for occupational doctors in evaluation of upper limb pathologies in engineering workers]. / L'analisi computerizzata del movimento come strumento di supporto al Medico del Lavoro nella valutazione dei disturbi muscolo-scheletrici degli arti superiori nel comparto metalmecanico.

The movement computerized analysis of upper limb is a valid support in the definition of residual functional capability and of specific work suitability in complex cases. This methodology of evaluation is able to correctly and objectively define the tridimensional ranges of motion of every patient's upper limb. This fact can be particularly useful for workers coming back to work after a work-related or a not work-related accident of for handicapped workers at the beginning of a new work activity. We report a research carried out using computerized analysis of motion of upper limbs in 20 engineering workers.

[Sentinel events for work-related stress in hospital and their monitoring in the decade 2001-2010]. / Eventi sentinella stress lavoro-correlati in ambito ospedaliero e lore monitoraggio nel decennio 2001-2010.

This survey was aimed at showing the relationship between some working organizational indicators--work-related stress "sentinel events" such as sick leaves and work accident--and some sociodemographic (gender, age) and organizational (homogeneous tasks, departmental areas) parameters. In the decade 2001-2010 a progressive decrease of the absenteeism and work accident rates was evidenced. The absenteeism rate was inversely related to job-qualification and it was higher among female workers. The highest requests of medical visits by auxiliary personnel showed a lower adaptation to job content, looked upon as low-rewarding in this homogeneous task.

[The regions' contribution to assessment of work-related stress: an operative guide]. / Il contributo delle Regioni sulla valutazione del rischio stress lavoro-correlato: la guida operativa.

In order to formulate indications for work-related stress assessment established by Italian health and safety regulation (D.Lgs. 81/2008), the interregional technical committee has instituted a working group to define an operative guide. The guide indicates the elements that must be considered in the evaluation, criteria and methods for the assessment, the minimum requirements for the evaluation instruments, and the specific contents of the risk assessment document.The medical surveillance and the role of health and safety local authorities are also considered. The risk assessment must examine work organization indicators and the direct or indirect effects of work-related stress, like morbility, frequent accidents, changing job requests, legal actions, etc. Detecting subjective factors is a second step of the assessment, which must be carried out if the work organization indicators show considerable work-related stress problems, and only in the companies which employ more then ten workers.

[Results of Regional Project 'Work related Stress' 2004-2006]. / Risultati del Progetto Regionale "Stress ed Attività Lavorativa" 2004-2006.

The present epidemiological study aimed to investigate prevalence and trends of stress-job-related uneasiness and symptoms on a representative sample of Lombardia's working population. Data on occupational events (absenteeism and accidents at work), psychosomatic symptoms and smoke habit have been collected. Prevalence and trends of stress-job-related uneasiness are similar to those reported by the European Foundation in the Report for Sectorial Profiles (2002). The study confirms higher levels of absenteeism in corporations with high prevalence of women and in low socioeconomic level works.

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

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

[The posturological clinic evaluation in vdt/pc operators: a second level diagnostic instrument in low back pain evaluation]. / La visita specialistica posturologica negli operatori vdt/pc: strumento diagnostico di secondo livello per le lombalgie.

The diagnosis and the therapy of the cases of low back pain in absence of organic spinal column diseases, frequently referred by vdt/pc users in connection with their work activities are frequently unsatisfactory both for the Occupational Doctors and for the patients. The specialized posturological evaluation, composed by a specific clinical examination and by specific instrumental exams, seems to be a valid instrument for a more effective management of patients affected by such clinical cases. The treatments described in this research have eliminated or greatly reduced the pain in these patients, with an efficacy prolonged until at least a year; as it is demonstrated by the few relapses referred by the workers. We think that a more frequent cooperation between Occupational Doctors and Posturologists can improve both the clinical conditions of the patients and the possibilities they have in the years to maintain their complete work ability.

[An integrated prevention intervention for the management of SSUEm118 operator with hearing loss]. / Un intervento di prevenzione integrata per la gestione di un operatore SSUEm118 con disturbi uditivi.

Noise risk is moderate in hospital but there are some areas, as SSUEm118, where the background noise is not negligible. In this context it is important not to underestimate hearing loss even minimal, because the noise interference can cause errors of understanding, as the case in exam: an operator 118. The clinical assessment of this worker with liminar tonal audiometry and vocal audiometry revealed a mild unilateral mixed hearing loss with good voice response. The equivalent sound pressure level (Leq) throughout the SSUEm118 area is under the first attention level, the index NR is comparable to office type environments and the distance between speaker and listener for satisfactory face-to-face communication is suitable. The present study proposes a multi-multidisciplinary approach to define prevention and protection measures and health surveillance plan with audiometric testing and possible judgment of the unfitness to specific work. For this specific case advices given to SSUEm118 administrator allowed a good repositioning of the worker.

[The posturological department as clinical support for occupational medicine: clinical cases and results of a hospital unit]. / L'ambulatorio di posturologia come supporto specialistico per la medicina del lavoro--casistica e risultati della pratica clinica di una struttura ospedaliera.

The posturologic visit is a not widely known medical method for the evaluation and the therapy of low back pain. We describe the clinical and instrumental method followed in our posturological clinical unit organized jointly by hospital and university and the clinical cases evaluated in two years. An individual diagnostic evaluation and a personal therapy allowed an almost generalized complete remission of the symptoms and a very low number of reactivation of low back pain after a follow up of one years.

[The evaluation of work related stress in occupational health: diagnostic experience and therapeutic prospects]. / La valutazione dello stress occupazionale nella pratica clinica di medicina del lavoro esperienza diagnostica e prospettive di interventi terapeutici.

The clinical cases of psychosocial disturbances that the Occupational Doctors find in their daily activity frequently are characterized by difficult differential diagnosis. These cases frequently must be faced with limitations of the work ability not easy to define and with unclear prognosis too. A useful help in the evaluation of these cases can be offered by the Clinical Units for the evaluation of work related stress, for the specialized joined support of Psychologist and of Occupational Doctors these Units can assure. We report the protocols of diagnosis of our clinical unit and the main characteristics of the patients more recently evaluated.

[Low back pain, movement impairement syndromes classification]. / Mal di schiena, classificazione secondo le sindromi da disfunzione del movimento.

According to literature up to 85 percent of low back pain (LBP) cannot match a precise pathoanatomical diagnosis, particularly when the association between symptoms and imaging is weak. Effective diagnostic strategy is mainly needed by occupational and rehabilitation medicine. The present study is based on the hypothesis that cumulative effect of repetitive movements and sustained postures, particularly when the movement deviates from the optimal kinesiologic standard, can lead to tissue damage. Therefore this cross-sectional study answers to lack of standardization for LBP diagnosis by means of the classification proposed from Sahrmann within the Movement Impairment Syndromes (MSI) concept. The classification defines 5 categories of LBP: flexion, extension, rotation, extension-rotation and flexion-rotation. The present study results on 84 health workers with LBP match previous published data on the prevalence of MSI categories: 54.8% extension-rotation, 13% flexion-rotation, 11.9% rotation, 3.5% and 16.6% unclassified. MSI could also contribute to better understand LBP severity and the following restricted duty evaluation. Further studies to increase the sample size and to set up randomized clinical trials are needed.

[Stabilometric parameters associated with musculoskeletal diseases in a group of traffic policemen]. / Parametri stabilometrici associati a disturbi muscoloscheletrici in un gruppo di vigili urbani.

As reported by previous literature, the prevalence of musculoskeletal disorders is high in population of local police officers, due to several risk factors, including awkward posture, jolt/vibrations and stress. The results of our study reveal that the most common musculoskeletal symptoms among local police officers are cervicobrachial pain, low back pain and sciatica. Low-back pain is associated with tasks exposing to awkward posture of the spine (traffic policemen and policemen involved in office-based duties); cervical and upper extremity disorders are related to the exposure to vibrations and to the upper limb posture held by motorcycle police. Among postural parameters, anterior scapular plane, flat back and Barre's vertical resulted possible predictive tests of adaptation of the postural system to the symptom pain in subjects with low back pain. In conclusion, it is necessary to adopt organizational, protective and preventive measures in order to occupational health of local police officers. They include: decrease of time periods during which an awkward posture is held, breaks between duties, prescription of ergonomic shoes, use of low-weight and low-volume duty-packs, and planning of periodical osteopathic check-ups as part of the health program, aimed to uncover initial postural alterations related to musculoskeletal disorders.

Cancer mortality of an Italian cohort of workers in man-made glass-fiber production.

This study was undertaken in order to examine possible long-term effects, particularly cancer, associated with working in the man-made glass-fiber production industry in Italy (glass wool and continuous filament). All male production workers employed for a minimum of one year between 1944 and 1974 were admitted to the study (1,098 subjects), and their mortality was examined in the period 1944-1983 (21,325 person-years). The vital status ascertainment was successful for 98.9%, of the cohort members. An increased risk of cancer of the larynx was noted based, however, on only four deaths. When contrasted with the values of the local population, the increase proved to be statistically significant after 25 years since first exposure. The higher than expected larynx cancer mortality was confined to workers hired before the age of 25 years, exposed for at least 15 years, who started exposure before 1960 (main production: glass wool), and who belonged to the highest cumulative exposure categories. Known confounding factors could not completely account for the excess observed. Among the numerous studies carried out on man-made glass-fiber workers, only one incidence study in France support our findings. No other increased cancer risks have been suggested by the present study.

[Risk evaluation and health surveillance in hospitals: a critical review and contributions regarding experience obtained at the S. Gerardo dei Tintori Hospital in Monza]. / Valutazione del rischio e sorveglianza sanitaria nella realtà ospedaliera: revisione critica e contributi dall'esperienza condotta presso l'Ospedale "S. Gerardo dei Tintori" a Monza.

The incorporation into Italian legislation of the European Community directives on the improvement of health and safety at work has promoted a vast effort in order to revise the surveillance approach in many facilities, including hospitals. At the S. Gerardo Hospital in Monza, the required risk evaluation was performed in 1995. The paper here reports the results of environmental and work organization inspection, literature review and the proposal of a surveillance program. S. Gerardo Hospital is a large facility with 2,547 employees. Major structural problems are associated with fire prevention and the continuous change required for the development of a modern hospital. Relevant risk in health care are: biological risk, in particular hepatitis B and AIDS virus, teratogenic viruses (rubella, cytomegalovirus and varicella-zoster) and the renewed possibility of tuberculosis infection, often multi-drug resistant; chemical hazards, in particular use and exposure to antineoplastic and antiviral agents, sterilants like ethylene oxide and formaldheyde; physical risk, well-known for ionizing radiations, but important also for non-ionizing radiations; manual lifting (patients in particular) which makes nurses one of the occupations most affected by low back pain; psycho-social risk, with particular reference to stress in emergency departments and everywhere a strong psychological engagement is required. Also the risk of non-health personnel, office areas, food preparation, housekeeping, maintenance, central supplies and laundry was assessed. Health surveillance programs for the exposed and preventive medicine programs according international standards for all workers are presented.

[Top medical management and levels of knowledge about the application of the D.lgs. 626/94]. / Dirigenza medica apicale e livelli di consapevolezza circa l'applicazione del D.lgs. 626/94.

The incorporation into Italian legislation of the European Community directives on the improvement of health and safety at work imposes new duties on the department heads of hospital departments. Their level of knowledge and information on several safety problems--occupational infections, exposure to chemical agents, use of antineoplastic and antiviral drugs, use of protective garments and devices, exposure to ionizing and non ionizing radiations, use of electric devices, lifting and loading, fire prevention--was surveyed in a large teaching hospital in northern Italy, via a check-list derived from Italian and international experience. Both knowledge and information resulted rather low, with particular regard to chemical, electric and fire hazards. The ignorance of department heads about common safety and prevention procedures in hospital work does not allow them to carry out their role according to the new requirements of Italian legislation. However, as they "must" know and have criminal responsibility in case of accidents or diseases due to their unawareness, appropriate courses are needed to fulfil law and safety requirements.