COVID-19 outbreaks in hospital workers during the first COVID-19 wave.

BACKGROUND: Health care workers (HCWs) are on the frontline, playing a crucial role in the prevention of infection and treatment of patients. AIMS: This study was aimed to evaluate the prevalence of hospital-acquired coronavirus disease 2019 (COVID-19) infection at work and related factors at the University Hospital of Trieste workers exposed to COVID-19 patients. METHODS: From March 1 to May 31, of 4216 employees, 963 were in contact with COVID-19 patients or colleagues and were followed up. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in nasopharyngeal swabs was determined every 3 days, by RT-PCR. RESULTS: During the follow-up period, 193 workers were positive for COVID-19 (5%), and 165 of these (86%) were symptomatic. We identified five major cluster outbreaks of COVID-19 infection in Trieste Hospitals, four of which occurred before the implementation of universal masking for HCWs and patients (1-14 March 2020). COVID-19 infection was significantly higher in high-risk ward workers (Infectious Diseases, and Geriatric and Emergency Medicine, odds ratio [OR] 13.4; 95% confidence interval [CI] 5.8-31), in subjects with symptoms (OR 5.4; 95% CI 2.9-10) and in those with contacts with COVID-19 patients and colleagues (OR 2.23; 95% CI 1.01-4.9). CONCLUSIONS: Hospital workers were commonly infected due to contact with COVID-19 patients and colleagues, mainly in the first 15 days of the pandemic, before the implementation of universal mask wearing of HCWs and patients. Repetitive testing and follow-up permitted the identification of COVID-19 cases before symptom onset, obtaining better infection prevention and control.

International consensus criteria for diagnosing and staging hand-arm vibration syndrome.

PURPOSE: In the 30 years since the Stockholm Workshop Scale (SWS) was published, the scientific literature on hand-arm vibration syndrome (HAVS) has grown and experience has been gained in its practical application. This research was undertaken to develop an up-to-date evidence-based classification for HAVS by seeking consensus between experts in the field. METHODS: Seven occupational physicians who are clinically active and have had work published on HAVS in the last 10 years were asked to independently take part in a three-round iterative Delphi process. Consensus was taken when 5/7 (72%) agreed with a particular statement. Experts were asked to provide evidence from the literature or data from their own research to support their views. RESULTS: Consensus was achieved for most of the questions that were used to develop an updated staging system for HAVS. The vascular and neurological components from the SWS are retained, but ambiguous descriptors and tests without adequately developed methodology such as tactile discrimination, or discriminating power such as grip strength, are not included in the new staging system. A blanching score taken from photographs of the hands during vasospastic episodes is recommended in place of self-recall and frequency of attacks to stage vascular HAVS. Methods with the best evidence base are described for assessing sensory perception and dexterity. CONCLUSIONS: A new classification has been developed with three stages for the clinical classification of vascular and neurological HAVS based on international consensus. We recommend it replaces the SWS for clinical and research purposes.

Effectiveness of a secondary prevention protocol for occupational contact dermatitis.

BACKGROUND: Occupational skin diseases are often responsible for sick leave or job changes, affect mostly young subjects, are costly to society and have been reported as significant predictor of unemployment. OBJECTIVES: To assess, over time, the course of occupational hand dermatitis (OHD) after a specific training, by means of follow-up visits and TEWL measurement, to evaluate skin barrier integrity and if preventive measures for hand skin care provided may influence the course of the disease. METHODS: Workers with a diagnosis of OHD from January 2011 to December 2013 were contacted by telephone, filled in a questionnaire (NOSQ-2002) and were invited to a training course on prevention of skin dermatitis, and to a new clinical evaluation with TEWL measurement. Workers who joined the training programme were asked to undergo a new evaluation after 3 months. A total of 65 subjects without contact dermatitis were recruited as control group. RESULTS: One hundred and one subjects from 143 workers, who were contacted, filled in the questionnaire. Sixty-five of them followed the training course and underwent a new clinical evaluation withTEWL measurements. Ongoing symptoms of subjects decreased from 60.0% to 42.3% 3 months after the training, and the subgroup which strictly adhered to the recommendations given achieved better results (61.9% of symptoms improvement when compared to 29.0% obtained in subjects with partial adhesion to the protocol). TEWL values changed from 21.3 ± 9.6 to 18.6 ± 7.2 g/m²/h (P = 0.001) on the hands and from 16.6 ± 9.0 to 10.5 ± 4.6 g/m²/h (P = 0.001) on the forearm, confirming the skin barrier improvement. CONCLUSIONS: Our secondary prevention intervention was effective, leading to a reduction in clinical signs of dermatitis. TEWL measurement is a useful tool to evaluate skin integrity, mostly in apparently healthy skin, which may have a compromised barrier function, resulting in an exacerbation of the dermatitis.

Diaminodiphenylmethane Sensitization in north-eastern Italy from 1996 to 2012.

BACKGROUND: 4,4'-Diaminodiphenylmethane (DDM) is an aromatic amine used as a hardener, insulator and anticorrosive. Exposure implies risk of being sensitized and developing contact dermatitis. OBJECTIVE: The aim of this study was to determine the occurrence of contact sensitization to DDM among patients with contact dermatitis and the role of occupational exposure. PATIENTS AND METHODS: From 1996 to 2012, 24 056 consecutive patients with suspected allergic contact dermatitis were patch tested in north-eastern Italy. Individual characteristics were collected through a standardized questionnaire in eight departments of dermatology and occupational medicine. RESULTS: The overall prevalence of DDM sensitization was 2.5% (n = 599) with a decreasing trend in considered years. Trieste area had the higher prevalence of sensitization (3.2%). Mechanics and chemical industry workers had a significant higher risk of being sensitized to DDM. CONCLUSION: DDM sensitization is decreasing in years and is associated with some occupational exposures.

Serum dehydroepiandrosterone sulphate, psychosocial factors and musculoskeletal pain in workers.

Background: The serum level of dehydroepiandrosterone sulphate (DHEA-S) has been suggested as a biological marker of stress. Aims: To assess the association between serum DHEA-S, psychosocial factors and musculoskeletal (MS) pain in university workers. Methods: The study population included voluntary workers at the scientific departments of the University of Trieste (Italy) who underwent periodical health surveillance from January 2011 to June 2012. DHEA-S level was analysed in serum. The assessment tools included the General Health Questionnaire (GHQ) and a modified Nordic musculoskeletal symptoms questionnaire. The relation between DHEA-S, individual characteristics, pain perception and psychological factors was assessed by means of multivariable linear regression analysis. Results: There were 189 study participants. The study population was characterized by high reward and low effort. Pain perception in the neck, shoulder, upper limbs, upper back and lower back was reported by 42, 32, 19, 29 and 43% of people, respectively. In multivariable regression analysis, gender, age and pain perception in the shoulder and upper limbs were significantly related to serum DHEA-S. Effort and overcommitment were related to shoulder and neck pain but not to DHEA-S. The GHQ score was associated with pain perception in different body sites and inversely to DHEA-S but significance was lost in multivariable regression analysis. Conclusions: DHEA-S was associated with age, gender and perception of MS pain, while effort-reward imbalance dimensions and GHQ score failed to reach the statistical significance in multivariable regression analysis.

[Laboratory animal allergy: follow-up in a research centre]. / Allergia agli animali di laboratorio: follow-up in un istituto di ricerca.

BACKGROUND: Laboratory animal allergy (LAA) is frequent in exposed workers despite working conditions and exposure to these allergens having improved over the last decade. The aim of this study was to assess LAA in students and workers in a research facility within the framework of a prevention programme. SUBJECTS AND METHODS: Students and researchers working with laboratory animals underwent medical surveillance every year from 2001 to 2012. They filled in a standardized questionnaire for the assessment of allergic respiratory symptoms and exposure conditions. Skin prick tests with common allergens, latex and hair extract from laboratory animals were performed at the first control and after three years of exposure. RESULTS: 198 women and 120 men with a mean age of 29.1 +/- 7.3 years and a work seniority of 3.1 +/- 6.5 years participated in the study. Sensitization to laboratory animals ranged between 11.8 and 14.8% according to work seniority. Sixteen subjects (5%) reported asthma and 25 (7.9%) rhinitis when working with laboratory animals. LAA was associated with the female gender (OR 3.1; IC 95% 2.3-5.8), with atopy by prick test (OR 7.0; IC 95% 2.9-16.9), and with sensitization to laboratory animals (OR 2.7; IC 95% 1.1-6.7). CONCLUSION: This study revealed a low level of sensitization and symptoms of allergy to laboratory animals as a result of the preventive measures adopted to reduce exposure, but there is nonetheless a need to improve prevention so as to completely avoid the onset of LAA in students and workers.

[Occupational risks and health disorders in transport drivers]. / Rischi e malattie nei lavoratori del settore dei trasporti di merci e persone.

This paper presents a review of occupational risks and health disorders in professional drivers employed in public and private transport. Epidemiological studies suggest an excess risk for cardiovascular diseases and musculoskeletal disorders in several categories of professional drivers, such as bus drivers, taxi drivers, truck drivers and forklift truck drivers. Although cardiovascular and musculoskeletal disorders are of multifactorial origin, some characteristics of occupational exposure in transport drivers (stress, workshift, traffic pollutants, awkward postures, exposure to noise and whole body vibration) may exert at least a concausal role for the onset and the development of these disorders. The predominant role of some confounding factors (inappropriate diet, drinking and smoking habits) makes it more difficult to establish causal associations between professional driving and other adverse health effects (respiratory, gastrointestinal, and genito-urinary disorders, and neoplastic diseases).

[The evaluation of occupational contact dermatitis using the information network: the Triveneto experience]. / La valutazione delle sensibilizzazioni professionali utilizzando i risultati multicentrici dei patch test: l'esperienza del Triveneto.

Contact allergy surveillance networks provide information that permits a better evaluation of the role of different haptens in allergic contact dermatitis work related. The Triveneto region network is active since 1996 and comprises 12 center of dermatology and occupational medicine: all centers use a standardized protocol to perform patch test and a questionnaire to obtain information on skin diseases, atopy, occupations. All data are collected from Padua and Trieste and used to evaluate sensitization trends and occupation relevance of haptens. The Triveneto region network participates to the European Network on Contact Dermatitis. Data analysis permit to confirm the increase in sensitization in some occupational groups: construction workers has higher risk to be sensitized to chromium, hairdressers to be sensitized to p-phenilendiamine, mechanics to be sensitized to nickel, epoxy resin and mercaptobenzothiazol. Trend analysis of sensitization permit to evaluate in large scale the benefits of preventive measure and the needs for future.

[Cutaneous allergy in construction workers]. / Allergie cutanee in un gruppo di lavoratori edili.

Nine hundred building trade workers and 4372 office workers (from a database of 16267 patients) with suspected allergic dermatitis, underwent patch tests. The associations between patch test results and occupations were assessed by multivariate logistic regression analysis. As expected, building trade work was significantly associated with chromium sensitization (OR 1.55; 95% IC 1.22-1.97), a well known occupational hapten in this occupational group. An increased risk for epoxy resin sensitization (OR 3.80; 95% IC 2.11-6.86) and thiuram mix sensitization (OR 1.69; 95% IC 1.07-2.65) was also found in the construction workers. Epoxy resin is a strong skin sensitizer widely used in building trade, while thiuram mix is often present as an additive in the rubber gloves used by construction workers. These findings suggest that effective measures to prevent allergic contact dermatitis are needed in the construction workers.

[Work-related injuries in Monfalcone shipyard (2000-2010)]. / Il fenomeno infortunistico nei lavoratori della cantieristica navale del cantiere di Monfalcone (Gorizia) dal 2000 al 2010.

Shipbuilding industry exhibits higher injury rates at the workplace than those reported in other industrial sectors. Work-related injuries (n = 6714) occurred from 2000 to 2010 at the shipyard of Monfalcone (Gorizia-Italy) were considered. Injury frequency incidence (IF = number of accidents/number of workers x 1000) and injury severity rate were estimated. Among permanent (directly employed) shipyard workers, the IF ranged from 294.6 in 2000 to 113.7 in 2010. Injury severity rates showed the same decreasing trend. The IF for contract workers was unchanged over the calendar period (110.5 in 2000 to 110.9 in 2010) with no significant change in the injury severity rate. These findings suggest an improvement of the working condition for permanent shipyard workers as a result of prevention policies (education and surveillance) and the automation of production processes. Further preventative interventions are suggested to minimize work-related injuries and to promote health and safety in the shipbuilding industry.

[Study of peripheral sensorineural function in a cohort of dental hygienists]. / Studio della funzione neurosensitiva periferica in una coorte di igienisti dentali.

The aim of this study was to investigate over time the changes in thermotactile and vibrotactile sensitivity in a cohort of dental hygiene students exposed to high-frequency vibration from dental tools. Thermal perception thresholds for warmth and cold (TPT in degrees C) and vibrotactile perception thresholds (VPT in ms-2 r.m.s) at 31.5 Hz and 125 Hz were measured at the fingertips of the 2nd digit and 5th digit of both hands in 52 controls and 30 dental hygiene students. At baseline, there were no significant differences in either TPT or VPT between the two groups. No significant changes in tactile sensitivity were observed in the dental hygienists over 1-year follow-up period. In conclusion, shortterm exposure to high-frequency vibration from dental tools did not affect tactile sensitivity in a cohort of young dental hygienists.

[Geografic epidemiology of soft tissue sarcomas, Trieste (1995 -2005)]. / Epidemiologia geografica dei tumori del connettivo a Trieste (1995-2005).

Exposure to dioxin has been associated with the development of various kind of cancer. In the town of Trieste there is a contaminated site of national interest (according to law) and the incidence rate of cancer is the highest in Friuli Venezia Giulia. Using "main residence" it was possible to map soft tissues sarcomas (ICD-IX-171), in order to detect possible clusters or incidence gradients. Available data do not point out any statistically significant difference between observed and expected cases, applying pooled means from North Italy Cancer Registers. This work did not highlighted a correlation between residence in supposed polluted areas and rates of incidence of Soft tissue sarcomas.

A prospective cohort study of exposure-response relationship for vibration-induced white finger.

OBJECTIVES: To investigate prospectively the relation between vibration-induced white finger (VWF) and measures of cumulative (lifetime) exposure to hand-transmitted vibration (HTV). METHODS: Two hundred and forty-nine HTV workers and 138 control men of the same companies participated in a 3-year follow-up study. The diagnosis of VWF (Raynaud's phenomenon in the controls) was based on the medical history, the administration of colour charts and the results of a cold test. Tool vibration magnitudes were expressed as root-mean-square (r.m.s.) acceleration, frequency-weighted according to international standard ISO 5349-1 and also unweighted over the frequency range 6.3-1250 Hz. From the vibration magnitudes and exposure durations, alternative measures of cumulative vibration dose were calculated for each HTV worker, according to the expression: dose = Sigmaa(i)(m)t(i), where a(i) is the acceleration magnitude on tool i, t(i) is the lifetime exposure duration (hours) for tool i, and m = 0, 1, 2 or 4. RESULTS: The incidence of VWF varied from 5 to 6% in the HTV workers versus 0 to 1.5% for Raynaud's phenomenon in the controls. After adjusting for potential confounders, measures of cumulative vibration dose derived from total operating hours and high powers of unweighted acceleration (ie, , with m>1) gave better predictions of the occurrence of VWF than dose measures calculated from frequency-weighted acceleration (ie, ). These findings were observed in the entire sample of HTV workers, in those with no VWF at the initial investigation, and in those with normal cold test results at baseline. CONCLUSIONS: This prospective cohort study suggests that measures of cumulative vibration doses constructed from unweighted r.m.s. acceleration perform better for the prediction of VWF than dose measures calculated according to the recommendations of current standards. These findings should contribute to the improvement of the ISO frequency weighting for evaluating the severity of hand-transmitted vibration.

[Neck and upper limb disorders caused by combined exposures to ergonomic risk factors and hand-transmitted vibration]. / Patologie muscolo-scheletriche da esposizione combinata a fattori biomeccanici e vibrazioni trasmesse all'arto superiore.

A review of neck and upper limb disorders caused by combined exposures to hand-transmitted vibration and ergonomic risk factors (repetitiveness, force, posture) suggested the following conclusions: (1) hand-transmitted vibration has a dominant role in the etiopathogenesis of Raynaud's phenomenon and various forms of peripheral neuropathy with sensory impairment (digital, multifocal) in users of vibrating tools; (2) vibration of low frequency and high amplitude from percussive tools concur, together with adverse ergonomic factors, to produce degenerative changes in the bones and joints of the upper limbs, mainly in the wrist and elbow; (3) there is strong epidemiological and experimental evidence that combined exposures to hand-transmitted vibration and physical load are associated with an excess risk of carpal tunned syndrome; (4) there is limited evidence for an association between Dupuytren's contracture and vibration exposure owing to the small number of currently available epidemiological studies; (5) there is insufficient evidence for a contribution of hand-transmitted vibration to the development of chronic pain and clinical syndromes in the neck and upper limb, while excessive physical load and ergonomic stress have a primary role in the etiopathogenesis of these disorders.

[Sex specific differences in physiologic response to stress evaluated by means of salivary cortisol]. / Differenze sesso-specifiche della risposta fisiologica allo stress misurato con il cortisolo salivare.

The psychophysiological mechanism behind the development of stress-related diseases includes a long-term both increase and decrease in circulating cortisol levels, leading to an allostatic disregulation of the hypothalamic-pituitary-adrenal (HPA) axis. This research explores the relationship between perceived stress (assessed by means of the Job Strain Model) and neuroendocrine response quantified by means of repeated measures of salivary cortisol in 46 call-centre operators. Job strain influenced the total amount of cortisol response to waking, but not the cortisol excretion in the remainder of the day. The cortisol response to waking showed gender-specific differences, women excreting greater cortisol than men [AUC(t): coeff (IC 95%) = 16.2 (5.3-27.1); AUC(i): coeff (IC 95%) = 8.3 (2.4-14.2); MnInc: coeff (IC 95%) = 5.2 (1.6-8.9)]. In long run the gender-specific differences of the dis-regulation of the hypothalamic -pituitary-adrenal (HPA) axis can be related to differences on prevalence of autoimmune diseases.

[In vitro percutaneous absorption of silver nanoparticles]. / Assorbimento percutaneo di nanoparticelle di argento in un sistema in vitro.

There is a growing interest in the debate on nanoparticle safety for topical use. The benefits of nanoparticles have been shown in several scientific fields, but little is known about their potential to penetrate the skin lies. This study aims at evaluating in vitro silver nanoparticles skin penetration. Experiments were performed using the Franz diffusion cell method with intact and damaged human skin. Physiological solution was used as receiving phase and 70 microg/cm2 of silver nanoparticles dispersed in synthetic sweat were applied as donor phase to the outer surface of the skin for 24h. The receptor fluid measurements were performed by Electro Thermal Atomic Absorption Spectroscopy (ETAAS). Silver concentration of 0.2 microg/L was found in the receiving solutions of two cells, in which damaged skin membranes were set up. In the other tests, we obtained a silver concentration below the limit of detection in the receiving cells. Our experimental data show that silver nanoparticles permeation through intact and damaged skin is negligible. These findings are consistent with previously published results. Further researches are necessary to explore skin absorption of silver nanoparticles.

[In vitro percutaneous absorption of chromium powder and the effect of skin cleanser]. / Assorbimento percutaneo di polvere di cromo ed effetti della detersione: risultati di una indagine in vitro.

Occupational chromium dermatitis occurs frequently among cement and metal workers, workers dealing with leather tanning and employees in the ceramic industry. The present study, using an in-vitro system, evaluated percutaneous absorption of chromium powder and the effect of rapid skin decontamination with a common detergent. Experiments were performed using the Franz diffusion cell method with human skin. Physiological solution was used as receiving phase and a suspension of chromium powder in synthetic sweat was used as donor phase. The tests were performed without or with decontamination using the cleanser 30 minutes after the start of exposure. The amount of chromium permeated through the skin was analysed by Inductively Coupled Plasma Atomic Emission Spectroscopy and Electro Thermal Atomic Absorption Spectroscopy. Speciation analysis and measurements of chromium skin content were also performed. We calculated a permeation flux of 0.843 +/- 0.25 ng cm(-2) h(-1) and a lag time of 1.1 +/- 0.7 h. The cleaning procedure significantly increased chromium skin content, whereas skin passage was not increased. These results showed that chromium powder can pass through the skin and that skin decontamination did not decrease skin absorption. Therefore, it is necessary to prevent skin contamination when using toxic agents.

[Freedom from smoking for health care workers. A project from Trieste]. / Operatori della sanità liberi dal fumo. Attivazione di un progetto in Provincia di Trieste.

A tree years interventional study to modify smoking habits in health workers in Trieste province was planed in the collaboration of occupational health unit and Tobacco's Dependence Study Center. The aim of this paper is refer about preliminary data of the project started in 2007 regarding smoking habits in health workers of the Azienda per i Servizi Sanitari n.1 "Triestina" (ASS1) and the Azienda Ospedaliera Universitaria Ospedali Riuniti di Trieste (AOUTS). The project consist of several actions. i) information about risks and opportunities of project; ii) pursuance of the law 51 L 3/2003; iii) Occupational Health Unit and Tobacco's Dependence Study Center collaboration; iv) follow-up of the subjects that choose the disaccustom program. During occupational medical surveillance we collected the data related to 492 workers, 37% of the cases were smokers (180). The results of test of dependence to smoke (test di Fagestrom) showed an high dependence in 19% and an high motivation to stop smoke (test di Richmond) in 39% of the smokers. More than fifty percent of this subjects gave their adhesion to the disaccustom program.

Criteria for case definitions for upper limb and lower back disorders caused by mechanical vibration.

BACKGROUND AND OBJECTIVES: This paper provides an overview on the evaluation and assessment of vibration exposure at the workplace, the long-term health effects caused by occupational exposure to hand-transmitted vibration and whole-body vibration, and the criteria for case definitions for vibration-induced upper limb and lower back disorders. Excessive exposure to hand-transmitted vibration from powered processes or tools is associated with an increased occurrence of symptoms and signs of disorders in the vascular, neurological and musculoskeletal systems of the upper limbs. The complex of these disorders is called hand-arm vibration syndrome. Long-term occupational exposure to intense whole-body vibration is associated with an increased risk for disorders of the lumbar spine and the connected nervous system. DISCUSSION AND CONCLUSIONS: The medical tools for the management of cases with suspected vibration-induced disorders include the case history, a complete physical examination, and special diagnostic investigations. The criteria for case definitions for upper limb disorders caused by hand-transmitted vibration (vascular, neurological, and musculoskeletal) and for lower back disorders caused by whole-body vibration are discussed on the basis of the guidelines suggested by the Italian Society of Occupational Medicine and Industrial Hygiene.

A Novel Panel of Serum Biomarkers for MPM Diagnosis.

Exposure to asbestos is the main cause of malignant pleural mesothelioma (MPM), a highly aggressive cancer of the pleura. Since the only tools for early detection are based on radiological tests, some authors focused on serum markers (i.e., mesothelin). The aim of this study was the evaluation of new serum biomarkers to be used individually or in combination, in order to improve the outcome of patients whose disease would be diagnosed at an earlier stage. Serum and plasma were available from 43 subjects previously exposed to asbestos and 27 MPM patients, all being epithelioid type. All the new markers found differentially expressed in MPM and healthy subjects, by proteomic and genomic approaches, have been validated in the serum by the use of specific ELISA. The combined approach, using tools of genomics and proteomics, is found to be highly innovative for this type of disease and led to the identification of new serum markers in the diagnosis of MPM. These results, if confirmed in a larger series, may have a strong impact in this area, because early detection of this cancer in people at high risk could significantly improve the course of the disease and the clinical approach to an individualized therapy.