Health Promotion Interventions in Occupational Settings: Fact-finding Survey among Italian Occupational Physicians.

BACKGROUND:  Occupational Physicians (OPs) are essential for health promotion (HP) at the workplace, although their HP knowledge and perception are still under-searched. METHODS: Between September and December 2022, the Italian Society of Occupational Medicine (SIML) - HP working group performed a cross-sectional survey on SIML-OPs aimed to address their approach, experience, strategies, and needs concerning HP plans. RESULTS: A total of 336 OPs completed the questionnaire. Regarding HP's OP perception, this was reported as a social investment (34.45%) and shared responsibility for all the company's preventive figures (30.18%). Over half of the enrolled OPs declared to have been involved as HP plans' organizers (57.30%) or collaborators (54.80%) in the previous 5 years. The greatest percentage of organizers were in the younger age groups (40-59 years; 50%). Additionally, following a more limited number of companies, prevalently of medium-high dimensions, and more than 500 workers were positively associated with greater OP participation in HP initiatives. Promoting healthy lifestyles was the main target of the HP plans (88.64%). Interdisciplinary collaboration, OP training on HP procedures and information on the targeted population have been reported as effective issues to support an active engagement of OPs in HP. CONCLUSIONS: A general interest of the Italian OPs with respect to HP was demonstrated, however, information on the potential benefits of HP in workplace aligned with OP perceptions and needs seem necessary to successfully implement HP interventions.

Evaluation of the Anti-Spike (RDB) IgG Titer among Workers Employed at the University of Pisa Vaccinated with Different Types of SARS-CoV-2 Vaccines.

With the development of SARS-CoV-2 vaccines, many authors started evaluating the immunization efficacy of the available vaccines mainly through sero-positivity tests or by a quantitative assessment of the IgG against the spike protein of SARS-CoV-2 virus in vaccinated subjects. In this work, we compared the titers resulting from vaccination and tried to understand the potential factors affecting the immune response to the available SARS-CoV-2 vaccines. This study was conducted on 670 volunteers employed at the University of Pisa and undergoing a health surveillance program at the University Hospital of Pisa. For each participant, 10 mL of blood, information about contacts with confirmed cases of COVID-19, age, sex, SARS-CoV-2 vaccination status, previous SARS-CoV-2 infection and symptoms, type of vaccine and the date of administration were collected. In the multivariate analysis, the type of vaccine, the presence of symptoms in SARS-CoV-2 positive individuals, and the distance from the second dose significantly affected the antibody titer; the combined vaccination resulted in a faster decay over time compared with the other types of vaccination. No significant differences were observed between Spikevax and Comirnaty (p > 0.05), while the antibody levels remain more stable in subjects undergoing Vaxzevria vaccination (p < 0.01) compared with mRNA-based ones.

Phenotyping Occupational Asthma Caused by Acrylates in a Multicenter Cohort Study.

BACKGROUND: While acrylates are well-known skin sensitizers, they are not classified as respiratory sensitizers although several cases of acrylate-induced occupational asthma (OA) have been reported. OBJECTIVE: To evaluate the characteristics of acrylate-induced OA in a large series of cases and compare those with OA induced by other low-molecular-weight (LMW) agents. METHODS: Jobs and exposures, clinical and functional characteristics, and markers of airway inflammation were analyzed in an international, multicenter, retrospective cohort of subjects with OA ascertained by a positive inhalation challenge to acrylates (n = 55) or other LMW agents (n = 418) including isocyanates (n = 125). RESULTS: Acrylate-containing glues were the most prevalent products, and industrial manufacturing, dental work, and beauty care were typical occupations causing OA. Work-related rhinitis was more common in acrylate-than in isocyanate-induced asthma (P < .001). The increase in postchallenge fractional exhaled nitric oxide was significantly greater in acrylate-induced OA (26.0; 8.2 to 38.0 parts per billion [ppb]) than in OA induced by other LMW agents (3.0; -1.0 to 10.0 ppb; P < .001) or isocyanates (5.0; 2.0 to 16.0 ppb; P = .010). Multivariable models confirmed that OA induced by acrylates was significantly and independently associated with a postchallenge increase in fractional exhaled nitric oxide (≥17.5 ppb). CONCLUSIONS: Acrylate-induced OA shows specific characteristics, concomitant work-related rhinitis, and exposure-related increases in fractional exhaled nitric oxide, suggesting that acrylates may induce asthma through different immunologic mechanisms compared with mechanisms through which other LMW agents may induce asthma. Our findings reinforce the need for a reevaluation of the hazard classification of acrylates, and further investigation of the pathophysiological mechanisms underlying their respiratory sensitizing potential.

Workplace health promotion.

Workplace Health Promotion (WHP-Workplace Health Promotion) is aimed at improving the workers' well-being and health, so as to guarantee conditions of greater psycho-physical well-being and work capacity for a future elderly population. Cost-benefit analysis studies indicate that the return of profits compared to the invested capital (Return of investment - ROI) can be very good. To conduct WHP's activities successfully, the continuous and convinced commitment of all corporate subjects is required. WHP interventions must not represent alternative paths to those of Prevention and Safety, nor represent "discount" tools with respect to regulatory obligations. It is essential that there be clarity in the roles played by public institutions operators (USL / ASL / ATS) who, in various capacities and in various sectors, are involved. At the moment, in terms of WHP, the regions have responded differently and in any case the difficulties in applying the WHP to SMEs have become evident. Whatever the approach, WHP's actions must take into account the end-point, ie the health gain of the workers involved due to the specific effect of the action promoted and for this reason the programs must provide an adequate follow-up, which becomes an element indispensable for any proposal. Health promotion in the "work" context has, with respect to more traditional contexts (such as school or community), undoubtedly peculiarities, which require a specific training of "health promoters" engaged in this field.

Severe Occupational Asthma: Insights From a Multicenter European Cohort.

BACKGROUND: Although sensitizer-induced occupational asthma (OA) accounts for an appreciable fraction of adult asthma, the severity of OA has received little attention. OBJECTIVE: The aim of this study was to characterize the burden and determinants of severe OA in a large multicenter cohort of subjects with OA. METHODS: This retrospective study included 997 subjects with OA ascertained by a positive specific inhalation challenge completed in 20 tertiary centers in 11 European countries during the period 2006 to 2015. Severe asthma was defined by a high level of treatment and any 1 of the following criteria: (1) daily need for a reliever medication, (2) 2 or more severe exacerbations in the previous year, or (3) airflow obstruction. RESULTS: Overall, 162 (16.2%; 95% CI, 14.0%-18.7%) subjects were classified as having severe OA. Multivariable logistic regression analysis revealed that severe OA was associated with persistent (vs reduced) exposure to the causal agent at work (odds ratio [OR], 2.78; 95% CI, 1.50-5.60); a longer duration of the disease (OR, 1.04; 95% CI, 1.00-1.07); a low level of education (OR, 2.69; 95% CI, 1.73-4.18); childhood asthma (OR, 2.92; 95% CI, 1.13-7.36); and sputum production (OR, 2.86; 95% CI, 1.87-4.38). In subjects removed from exposure, severe OA was associated only with sputum production (OR, 3.68; 95% CI, 1.87-7.40); a low education level (OR, 3.41; 95% CI, 1.72-6.80); and obesity (OR, 1.98; 95% CI, 0.97-3.97). CONCLUSIONS: This study indicates that a substantial proportion of subjects with OA experience severe asthma and identifies potentially modifiable risk factors for severe OA that should be targeted to reduce the adverse impacts of the disease.

Are high- and low-molecular-weight sensitizing agents associated with different clinical phenotypes of occupational asthma?

BACKGROUND: High-molecular-weight (HMW) proteins and low-molecular-weight (LMW) chemicals can cause occupational asthma (OA) although few studies have thoroughly compared the clinical, physiological, and inflammatory patterns associated with these different types of agents. The aim of this study was to determine whether OA induced by HMW and LMW agents shows distinct phenotypic profiles. METHODS: Clinical and functional characteristics, and markers of airway inflammation were analyzed in an international, multicenter, retrospective cohort of subjects with OA ascertained by a positive inhalation challenge response to HMW (n = 544) and LMW (n = 635) agents. RESULTS: Multivariate logistic regression analysis showed significant associations between OA caused by HMW agents and work-related rhinitis (OR [95% CI]: 4.79 [3.28-7.12]), conjunctivitis (2.13 [1.52-2.98]), atopy (1.49 [1.09-2.05]), and early asthmatic reactions (2.86 [1.98-4.16]). By contrast, OA due to LMW agents was associated with chest tightness at work (2.22 [1.59-3.03]), daily sputum (1.69 [1.19-2.38]), and late asthmatic reactions (1.52 [1.09-2.08]). Furthermore, OA caused by HMW agents showed a higher risk of airflow limitation (1.76 [1.07-2.91]), whereas OA due to LMW agents exhibited a higher risk of severe exacerbations (1.32 [1.01-1.69]). There were no differences between the two types of agents in the baseline sputum inflammatory profiles, but OA caused by HMW agents showed higher baseline blood eosinophilia and a greater postchallenge increase in fractional nitric oxide. CONCLUSION: This large cohort study describes distinct phenotypic profiles in OA caused by HMW and LMW agents. There is a need to further explore differences in underlying pathophysiological pathways and outcome after environmental interventions.

Work-related asthma in a sample of subjects with established asthma.

OBJECTIVE: To assess the impact of occupational exposure to irritants or sensitizers on the occurrence, recrudescence and worsening of asthma and to identify unrecognized cases of work related asthma (WRA) including Work-Exacerbated Asthma (WEA) and Occupational Asthma (OA), in a general asthma clinic population sample. SETTING, DESIGN AND PARTICIPANTS: The study was a population-based cross sectional survey. 1289 asthmatic subjects (from 15 to 46 yrs old) living in a vast district of Tuscany (Italy) were identified from the Medical Reimbursement Register of the National Health System. 893 subjects agreed to take part in the study. Subjects who were currently working or had worked in past were classified in different categories of occupational risk exposure (No, Low or High) according to the italian standard classification for industries and job titles, associated with the judgment of occupational hygiene experts. RESULTS: 41% of subjects worked in industries and in job titles at risk for exposure to airway irritants and/or sensitizers, 48.6% reported an occupational exposure to gases, dust and fumes, more males than females. Prevalence of WEA and OA was higher in subjects who worked at higher risk exposure; these subjects reported a higher prevalence of markers of asthma severity (asthma control, level of treatment, FEV1) than subjects without WRA. Risk of WEA was significantly associated to female gender, older age, and self-reported exposure, while risk of OA was associated to job title with higher exposure risk to occupational asthmogens. CONCLUSIONS: Our study shows a high prevalence of WRA (especially WEA) associated with employment in industries and job titles at risk for airways sensitizers and/or irritants; data also support a role for occupational exposure in determining a poor asthma control and a higher level of asthma severity.

Effects of the work limitations on the career path of a cohort of health workers. / Efetti delle limitazioni impartitie dal Medico Competente sul percorso lavorativo di una coorte di lavoratori della sanità.

BACKGROUND: The median age of the workforce, and of healthcare workers in particular, is increasing, resulting in a reduced work capacity. This may prompt the occupational physician to issue fitness for work limitations. OBJECTIVES: To examine the health surveillance data collected over 20 years on the employees of a large healthcare institution to identify the effects of the limitations imposed on their career paths. METHODS: The database of health surveillance records gathered over the years was analysed using the same dedicated software. Fourteen types of limitations were classified via a "text mining" treatment. 3,653 subjects were selected, divided in two groups (A: with a limitation and B: without limitation) comprised of 655 and 2,998 subjects, respectively. The subjects were then ranked on the basis of departments and tasks involved. We also evaluated the number of departmental changes for each worker and the corresponding rate of change for the three groups A, B and B post-limitation. RESULTS: Limitations have been increasing in parallel with the aging of workers, in particular those relating to Manual Load Handling/Posture (MLH/P). The limitations due to Allergy/Latex lasted longer, and in a greater proportion than MLH/P, particularly when compared to the limitation for Shift Work and those for "Other Limitations" that were shrinking faster. CONCLUSIONS: There is a clear relationship between certain types of limitations/prescriptions and workers' ages. It is necessary to carry out an assessment of the association with the work performed in order to implement age management strategies aimed at maintaining work capacity in aging workers.

Sputum eosinophilia is a determinant of FEV1 decline in occupational asthma: results of an observational study.

OBJECTIVE: To evaluate the potential determinants of forced expiratory volume in 1 s (FEV1) decline in workers with occupational asthma (OA) still exposed to the causative agent. We hypothesised that sputum eosinophilia might be a predictor of poor asthma outcome after diagnosis. SETTING, DESIGN AND PARTICIPANTS: In a specialistic clinical centre of the University Hospital of Pisa, we studied 39 participants (28 M, 11 F) diagnosed as having OA, routinely followed up between 1990 and 2009. They were a subgroup of 94 participants diagnosed as affected by OA in that period: 9 had been removed from work at the diagnosis, 21 were excluded for having ceased occupational exposure after few months from diagnosis, and 25 were lost at the follow-up or had no acceptable sputum measurements at the diagnosis. Estimates of the decline in FEV1 were obtained by means of simple regression analysis during the period of occupational exposure after diagnosis. Logistic regression was used to analyse the effects of factors (baseline FEV1 and sputum inflammatory cells, duration and type of exposure) that may potentially influence FEV1 decline. RESULTS: At follow-up (5.7+3.7 years), most participants were still symptomatic despite inhaled corticosteroids (ICS) treatment and had their occupational exposure reduced. Participants with higher sputum eosinophils (>3%) at baseline had a significantly greater decline of FEV1 (-52.5 vs -18.6 mL/year, p=0.012). Logistic regression showed that persistent exposure and sputum eosinophilia were significantly associated with a greater decline in FEV1 (OR 11.5, 95% CI 1.8 to 71.4, p=0.009 and OR 6.7, 95% CI 1.1 to 41.7, p= 0.042, respectively). CONCLUSIONS: Sputum eosinophilia at diagnosis, together with the persistence of occupational exposure during follow-up, may contribute to a greater decline in FEV1 in patients with OA still at work. Further long-term studies are required as to whether intensive ICS treatment may be beneficial for patients with OA and increase ad eosinophilic inflammation.

[The post-mortem external examination in Italy: critical issues and perspectives]. / Il medico necroscopo e la rilevazione delle morti apparenti: criticità e prospettive future.

The purpose of the postmortem external examination is to ascertain death and authorize burial. Requirements regarding external postmortem examinations and the tasks of physicians having this specific duty, vary in different regions of Italy. In this study, we analyzed the rationale and role of physicians performing post mortem external examinations. The role of physicians ascertaining death should be enhanced and they should play a bigger role in the identification and verification of the cause of death. A reorganization of post-mortem procedures also appears necessary.

[The Health Surveillance database of a large hospital enterprise: a 20-year analysis]. / II database della Sorveglianza Sanitaria di una grande azienda ospedaliera: analisi di un ventennio.

To evaluate the aging of the working population and its effects, a 20 years observational study was conducted on health surveillance data of a large healthcare company. The data showed a gradual increase in the mean age of workers, especially among subjects with restrictions/requirements regarding their job title. If no preventive/corrective measures are taken, the socio-economnic situation will get worse with economic and social damages.

Sequential sensitization to different occupational compounds in a young woman.

BACKGROUND: Very few authors have reported sensitization to two or more different occupational sensitizers in a single patient. OBJECTIVE: To describe a subject with occupational asthma caused by sensitization to two different agents, exposure to which occurred in dierent time periods. METHODS: We studied a young woman with asthma-like symptoms predominantly in relationship to a sequential occupational exposure, first to methylene diisocyanate (MDI) and later to flour dust. In the first and second periods of occupational exposure, the patient was subjected to metbacholine challenge test (MCT), sputum analysis, and specific challenge test (SCT). RESULTS: At the first observation, MCT (PD20FEV1: 0.109 mg) and SCT with MDI were positive and induced sputum analysis showed a high percentage of eosinophils (32%). The patient reduced exposure to MDI but symptoms worsened with continuing occupational exposure. After one year, she started another job exposed to flour dust. After four years, asthma symptoms persisted despite treatment with inhaled corticosteroids and bronchodilators, and bronchial byperreactivity and sputum eosinophbilia were still present (PD2OFEV1: 0.067 mg; sputum eosinophils: 5.3%). The patient also developed rhinitis symptoms associated with dermatitis. A SCT with flour dust showed an immediate response (deltaFEV1: 33%). The subject left work and a year later was still symptomatic:pulmonary function was within normal limits under regular therapy and induced sputum showed absence of eosinophilia. CONCLUSIONS: This was an unusual case of double sensitization to different occupational compounds to which the patient was exposed in different time periodsj suggesting the role of a pre-existing occupational aSthma in the development and/or worsening of sensitization to other occupational agents.

One-year longitudinal study of young apprentices exposed to airway occupational sensitizers.

BACKGROUND: The prevalence of diagnosed asthma and wheezing in young subjects is increasing; among environmental risk factors, occupational exposure can play a relevant role. STUDY OBJECTIVES: The purpose of the study was to evaluate the effects of occupational exposure to a large variety of irritants and/or sensitizers on the incidence of respiratory symptoms and pulmonary function impairment in a group of young apprentices during the first year of work exposure, and to determine the prevalence of asthma-like symptoms and the role of different risk factors (gender, smoking habit, atopy and occupational exposure) in this young population. DESIGN AND METHODS: We studied 448 young apprentices at the first pre-employment evaluation with a standardized questionnaire, spirometry and skin prick tests; in 244 of them clinical and functional evaluation was repeated after 1 year exposure to respiratory irritants or sensitizers. RESULTS: At the first examination, males had higher prevalence of attacks of shortness of breath with wheeze, diagnosis of asthma, smoking habit and atopy than females. At the second examination there was no significant increase in the prevalence of respiratory symptoms. However, incident cases for cough, phlegm, wheezing, shortness of breath with wheeze (SOBWHZ) and asthma were all higher than remittent cases. Incidence of respiratory symptoms was associated with atopy and smoking habit. CONCLUSIONS: Respiratory symptoms slightly increase over 1 year occupational exposure to sensitizers or irritants. The loss at the follow-up of subjects with higher smoking habit suggests a small "health worker effect" and could underestimate the effect of occupational exposure in apprentices.