Missed nursing care and stoma care: an Italian survey.

BACKGROUND: In Italy, nursing research has paid special attention to 'missed nursing care'. The studies carried out, varying in tools and settings, describe considerable percentages of missed care. In the field of stoma care, the phenomenon has not been investigated to date. AIM: To investigate the prevalence of missed nursing care (MNC) in the Italian ostomy patient population and the most relevant causes suggested for this by stoma care nurses. DESIGN: Cross-sectional study. METHOD: The Italian version of the MISSCARE survey was used with some questions related to the stoma care pathway. The survey was targeted at hospitals in the country with dedicated services and/or pathways for ostomy patients, between February and April 2023. FINDINGS: A total of 461 questionnaires were sent out, 214 (53.3%) were analysed. The majority of the participants were female (160, 76.2%), median age of 50 years (35.0-53.8). The most common qualification was a Bachelor's degree (n=117; 54.9%) and work experience in stoma care was more than 10 years in 95 cases (50.3%). Prominent instances of MNC were identified, with hand washing (score 4.6 out of 5), compilation of nursing documentation and hygiene/skin care (score 4.5 out of 5) and patient/family education (score 4.4 out of 5) emerging as the most prevalent. The most notable omissions in the stoma care process encompassed educational facets, clinical monitoring, a comprehensive discharge plan, and diligent follow-up. Among the most frequent reasons were staff shortages (score 3.1 out of 4), unsuitable nurse-patient ratios (score of 3 out of 4) and insufficient numbers of experienced stoma care personnel (score of 3 out of 4). CONCLUSION: A substantial number of basic and clinically relevant nursing interventions were perceived to be missed, and this may lead to an increase in negative outcomes for ostomy patients.

A close adherence to a stoma-therapeutic pathway improves immediate stoma-related outcomes and reduces the length of hospital stay.

PURPOSE: New stoma creation is related to a wide range of implications and stoma-related complications could occur frequently. The aim was to assess the impact of a close stoma-therapeutic-care pathway (STCP) in terms of length of stay, autonomy in the management of the pouch, readmission rate, and stoma-related complications. METHODS: Patients undergoing surgery for colorectal disease and first stoma creation from January 2017 to December 2020 were analyzed. All patients enrolled had joined the Enhanced Recovery after Surgery (ERAS) protocol. RESULTS: Among 143 enrolled, 56 (40%) did not completely follow the STCP (group A), whereas 87 (60%) demonstrated strict compliance (group B). The hospital stay lasted 8 days in group B and 11.5 in group A (p = 0.001). The first look at the stoma needed 1 day in group B and 3 days in group A (p < 0.001), emptying the pouch 2 days in group B and 5 days in group A (p < 0.001). Finally, the ability to change the pouch was 3 days in group B and 6 days in group A (p < 0.001). Nine (16.1%) stoma-related complications were counted in group A and 16 (18.4%) in group B, and 30-day readmission was 10.1% in group B and 11.5% in group A (p = 0.82 and p = 1, respectively, not significant). CONCLUSIONS: The STCP has been shown to reduce the hospital stay and to have a protective role making the patient autonomous in the management of the stoma.

A global survey on occupational health services in selected international commission on occupational health (ICOH) member countries.

BACKGROUND: The United Nations General Assembly (UNGA), the International Labour Organization (ILO), the World Health Organization (WHO), the International Commission on Occupational Health (ICOH), and the European Union (EU) have encouraged countries to organize occupational health services (OHS) for all working people irrespective of the sector of economy, size of enterprise or mode of employment of the worker. The objective of this study was to survey the status of OHS in a sample of countries from all continents. METHODS: A questionnaire focusing on the main aspects of OHS was developed on the basis of ILO Convention No. 161 and several other questionnaire surveys used in various target groups of OHS. The questionnaire was sent to 58 key informants: ICOH National Secretaries. RESULTS: A total of 49 National Secretaries responded (response rate 84.5%), from countries that employ 70% of the total world labour force. The majority of the respondent countries, 67%, had drawn up an OHS policy and implement it with the help of national occupational safety and health (OSH) authorities, institutes of occupational health or respective bodies, universities, and professional associations. Multidisciplinary expert OHS resources were available in the majority (82%) of countries, but varied widely in quantitative terms. The average OHS coverage of workers was 24.8%, with wide variation between countries. In over two thirds (69%) of the countries, the content of services was mixed, consisting of preventive and curative services, and in 29% preventive only. OHS financing was organized according to a mixed model among 63% and by employers only among 33% of the respondents. CONCLUSIONS: The majority of countries have drawn up policies, strategies and programmes for OHS. The infrastructures and institutional and human resources for the implementation of strategies, however, remain insufficient in the majority of countries (implementation gap). Qualitatively, the content and multidisciplinary nature of OHS corresponds to international guidance, but the coverage, comprehensiveness and content of services remain largely incomplete due to a lack of infrastructure and shortage of multiprofessional human resources (capacity gap). The estimated coverage of services in the study group was low; only a quarter of the total employed population (coverage gap).

Economic impact of malignant mesothelioma in Italy: an estimate of the public and social costs.

BACKGROUND: Despite their considerable interest for public health policies and for occupational disease management and assessment, the economic costs of asbestos-related diseases (ARDs) for society have not been fully estimated or even frequently discussed. OBJECTIVES: The aim of this study was to estimate the economic burden of mesothelioma in Italy by assessing the overall societal cost of the disease, applying an econometric model. METHODS: We analyzed two main cost groups, public and social. The first includes expenditure borne by the State and other public bodies (medical care costs, insurance, tax and benefits), while the latter uses the human capital approach to measure the loss of productivity suffered by the economy as a whole. RESULTS: We provide an estimate of euro 33,000 per patient for medical care costs and euro 25,000 for insurance and compensation; tax and benefits seem to roughly compensate. We estimated a loss of more than euro 200,000 per patient, in terms of loss of production. CONCLUSIONS: This study offers a practical approach for estimating the economic impact of mesothelioma, and provides empirical evidence of the huge economic burden linked to this disease, with its high etiologic fraction.

ICOH International Code of Ethics for Occupational Health Professionals: Historical fortune and future perspectives in Italy. / I1 Codice Internazionale di Etica ICOH per gli operatori di Medicina del Lvoro: fortuna storica e prospettive future in Italia.

The Working Group responsible for the Italian translation of the third edition of the International Code of Ethics, appointed by the President of the International Commission on Occupational Health (ICOH), Dr. Jukka Takala, completed last April the revision work. The final text, already available on the ICOH website, has been printed and distributed by the Italian National Institute for Insurance against Accidents at Work (INAIL) at the 79th National Congress of the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII), in Rome. The curators of this third Italian edition have accomplished the delicate task of adaptation in Italian, taking into account the specificities of the practice of medicine in the Italian work environment. It involves many professionals with diverse roles and responsibilities in the public and private sectors for safety, hygiene, health and environment in relation to work. More than twenty years after the first Italian edition, we trace the evolution of the ICOH International Code of Ethics, in order to focus its birth, national and international distribution, and continuous improvement as well as its ability to direct the stakeholders towards a participatory prevention model, in a legislative framework that has seen over the past two decades a radical change in the Italian world of work.

[Is there a correlation between increasing hospital falls and Covid-19 infection? Retrospective study on the entire hospital population.] / Esiste una correlazione tra l'aumento delle cadute in ospedale e le infezioni da Covid-19? Studio retrospettivo sull'intera popolazione ospedaliera.

Introduction Falls are the second leading cause of accidental or unintentional death worldwide. In hospital falls represent a relevant health problem, in particular after their increasing since Covid year 2020. The aim of this study is to evaluate correlation between falls and Covid infection. METHODS: Risk Management Unit at Mauriziano hospital analyzed in the present observational study possible correlation with Covid Pandemic and falls risk factors, through comparison of patients falls occurred during year 2021 in Covid and no-Covid wards. The primary outcome of the study is the evaluation of relationship between falls and Covid infection. The secondary outcome is identification of falls risk factors. RESULTS: No direct correlation between falls and Covid-19 infection was found. Among falls risk factors, the most interesting emerged is the fall itself that enhances the risk of relapse. DISCUSSION: Increasing in patients falls since 2020 could be affected indirectly by strong hospital organization modifications during Covid pandemic.

[The telephone follow-up by a nurse case manager in major surgery. A prospective observational study]. / Il follow-up infermieristico telefonico nell'ambito del case management in chirurgia maggiore. Uno studio osservazionale prospettico.

. The telephone follow-up by a nurse case manager in major surgery. A prospective observational study. INTRODUCTION: One of the methods used in case management is a structured telephone follow-up, helpful in improving patient satisfaction, supporting autonomy, and addressing information needs post-discharge. OBJECTIVE: To describe the experience of nursing case management and post-hospital telephone follow-up in patients undergoing major abdominal surgery. METHOD: Single-centre prospective observational study. All consecutive patients undergoing major abdominal surgery from April 2021 to May 2022 were included. Symptoms and nursing care needs during the post-discharge period, along with case management interventions, were described. RESULTS: Of the 205 patients included in the study, 89.8% underwent elective surgery and 135 (65.9%) did not develop postoperative complications, with a median hospital stay of 8 days. 182 (88.8%) patients reported at least one postoperative symptom, with fatigue, altered bowel movements, pain, and lack of appetite being the most common. Interventions provided by the case manager decreased progressively over time, from 149 at the first telephone contact (72%) to 44 at the third (25%). A total of 22 patients (10.7%) were readmitted to the hospital, 12 of whom on the recommendation of the case manager. CONCLUSIONS: After discharge, patients experience numerous issues: although the symptoms encountered are common during the post-operative period, they often require support beyond the patient's capacity. The intervention of the case manager with information and support for self-management of symptoms enabled the early identification of risk situations.

Measures of Work-life Balance and Interventions of Reasonable Accommodations for the Return to Work of Cancer Survivors: A Scoping Review.

Background: Nearly half of patients diagnosed with cancer are in the middle of their traditional working age. The return to work after cancer entails challenges because of the cancer or treatments and associated with the workplace. The study aimed at providing more insight into the occupational outcomes encountered by workers with cancer and to provide interventions, programs, and practices to support their return to work. Methods: A scoping review was conducted using the Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping review guidelines. Relevant studies were systematically searched in PubMed/MEDLINE, SCOPUS and Grey literature from 01 January 2000 to 22 February 2024. Results: The literature search generated 3,017 articles; 53 studies were considered eligible for this review. Most of the studies were longitudinal and conducted in Europe. Three macroarea were identified: studies on the impact of cancer on workers in terms of sick leave, employment, return to work, etc.; studies reporting wider issues that may affect workers, such as the compatibility of treatment and work and employment; studies reporting interventions or policies aiming to promote the return to work. Conclusion: There is a lack in the literature in defining multidisciplinary interventions combining physical, psycho-behavioural, educational, and vocational components that could increase the return-to-work rates. Future studies should focus on interdisciplinary return to work efforts with multiple stakeholders with the involvement of an interdisciplinary teamwork (healthcare workers and employers) to combine these multidisciplinary interventions at the beginning of sick leave period.

Prognostic implication of PD-L1 in early-stage non-small cell lung cancer: a retrospective single-centre study.

BACKGROUND: The prognostic role of programmed death-ligand 1 (PD-L1) expression in patients with localised and locally advanced non-small cell lung cancer has not been fully elucidated. This information could help to better interpret recent and upcoming results of phase III adjuvant or neoadjuvant anti-PD-1/PD-L1 immunotherapy studies. METHODS: In a cohort of 146 patients with early or locally advanced non-small cell lung cancer treated with curative intent (by surgery or radiotherapy), we investigated the prognostic value of PD-L1 expression and its correlation with other biological and clinical features. PD-L1 expression was stratified by quartiles. Primary endpoints were overall and disease-free survival. We also analysed the prognostic impact of the presence of actionable mutations, implemented treatment modality and completion of the treatment plan. Neither type of patient received neoadjuvant or adjuvant immunotherapy or target therapy. RESULTS: Of the 146 selected patients, 32 (21.9%) presented disease progression and 15 died (10.3%) at a median follow-up of 20 months. In a univariable analysis, PD-L1 expression ≥25% was associated with significantly lower disease-free survival (hazard ratio [HR]) 1.9, 95% confidence interval [CI] 1.0-3.9, p = 0.049). PD-L1 expression ≥50% did not lead to disease-free survival or overall survival benefits (HR 1.2 and 1.1, respectively; 95% CI 0.6-2.6 and 0.3-3.4, respectively; pnot significant). In a multivariate analysis, a stage >I (HR 2.7, 95% CI 1.2-6, p = 0.012) and having an inoperable tumour (HR 3.2, 95% CI 1.4-7.4, p = 0.005) were associated with lower disease-free survival. CONCLUSION: The population of patients with early-stage non-small cell lung cancer and PD-L1 expression ≥25% who were treated with curative intent during the pre-immunotherapy era exhibited a worse prognosis. This finding provides justification for the utilisation of adjuvant immunotherapy in this subgroup of patients, based on the current evidence derived from disease-free survival outcomes. However, for patients with PD-L1 expression <25%, opting to wait for the availability of the overall survival results may be a prudent choice.

Work-related stress risk assessment in Italy: the validation study of health safety and executive indicator tool.

INTRODUCTION: In compliance with the Italian occupational health and safety regulatory framework, as provided by the Lgs. Decree 81/2008, the "work-related stress" risk assessment should follow the same principles as other risk assessments, in accordance with the European Agreement of 8 October 2004; therefore, validated and scientifically proven methodological tools are needed to conduct an adequate work-related stress risk assessment. The UK's Health Safety and Executive (HSE) Indicator Tool (IT) is used for assessing the risk of work-related stress. The aim of this study is to test the factor structure of IT as a measure of work-related stress in a sample of Italian workers. METHODS: Data collected from 65 Italian organizations (6378 workers) was used for a Confirmatory Factor Analysis (CFA) on the 35-item seven-factor model. RESULTS: The results showed acceptable fit to the data (CFI .90; TLI .89, RMSEA .045). A second CFA was done to test a 35-item six-factor model (CFI .89, TLI .87, RMSEA .047). Both models were tested after removing six items (factor loadings less than .50.), resulting in a 29-item model. Here again, there was an acceptable fit to the data (29-item seven-factor model: CFI .93, TLI .91, RMSEA .044; 29-item six-factor model: CFI .92, TLI .90, RMSEA .046). DISCUSSIONS: These findings show that the HSE model satisfactorily adapts to use in a sample of Italian workers. One of the most important innovations introduced in the assessment of work-related stress with the HSE IT is the global approach for identifying work-related stress risk factors, aimed at establishing the best strategy from the viewpoints of prevention officers and also of workers.

Global Policy Responses to the COVID-19 Pandemic: Results of the ICOH Survey.

Background: On the basis of its role for the development of occupational health research, information, good practices, the International Commission on Occupational Health (ICOH) launched the present survey to collect information on public health and prevention policies put in place by the governments of the countries in the world to contain the pandemic. Methods: A cross-sectional study was conducted through an online questionnaire focused on COVID-19 data, public health policies, prevention measures, support measures for economy, work, and education, personal protective equipment, intensive care units, contact tracing, return to work, and the role of ICOH against COVID-19. The questionnaire was administered to 113 ICOH National Secretaries and senior OSH experts. Collected data refer to the period ranging from the beginning of the pandemic in each country to June 30, 2020. Results: A total of 73 questionnaires from 73 countries around the world were considered valid, with a 64.6% response rate. Most of the respondents (71.2%) reported that the state of emergency was declared in their country, and 86.1% reported lockdown measures. Most of the respondents (66.7%) affirmed that the use of face masks was compulsory in their country. As for containment measures, 97.2% indicated that mass gatherings (meetings) were limited. Regarding workplace closing, the most affected sector was entertainment (90.1%). Conclusion: The results of this survey are useful to gain a global view on COVID-19 policy responses at country level.

The Impact of COVID-19 Pandemics on the Development of Health Risk Communication: Challenges and Opportunities.

Starting from an analysis of communication in Italy during the COVID-19 emergency period (February-June 2020), this paper provides an overview of the main challenges and opportunities for communication during pandemics. The purpose of this study is to perform a literature review contributing to the identification of practical recommendations for the improvement of current risk communication strategies. Given the variety of the parties involved in communication and the peculiarity of the theme, an integrated analysis approach was adopted, based on the connections between institutional, scientific and mass communication. On one hand, the "emotional" character of Italian institutional communication aimed at promoting solidarity and unity among citizens. On the other hand, scientific communication played a key role both as a technical and scientific consultation for the policymaker, and as a guide for mass communication. Nevertheless, a lack of awareness emerged from the institutional and scientific side of the importance of an interface between science and effective, transparent policy. It thus becomes necessary to develop new and effective communication strategies aimed at facing uncertainties and the challenges of risk communication in epidemics and pandemics. Such strategies should consider interaction between public health, human and social sciences, political science, law, ethics, communication and media studies, as each of these areas may give an important contribution to the understanding of the context in which communication occurs.

1-year radiological, functional and quality-of-life outcomes in patients with SARS-CoV-2 pneumonia - A prospective observational study.

All over the world, SARS-CoV-2 pneumonia is causing a significant short and medium-term morbidity and mortality, with reported persisting symptoms, radiological and lung alterations up to 6 months after symptoms onset. Nevertheless, the 1-year impact on affected patients is still poorly known. In this prospective observational study, 39 patients with SARS-CoV-2 pneumonia were recruited from a single COVID-19 hospital in Southern Switzerland. They underwent a 3-month and 1-year follow-ups. At 1 year, 38 patients underwent functional follow-up through lung function tests and six minutes walking test and submitted SF-12 and SGRQ questionnaires about health-related quality of life. At 1 year most of the patients showed a persistence of the radiological and functional abnormalities and a reduction of the health-related quality of life. Thirty patients (96.8%) still presented some residual abnormalities on CT scans (31 patients at 3 months), though with a general reduction of the lesional load in all lung lobes. Twenty patients (52.6%) had persisting lung function tests impairment, with an overall improvement of DLCO. As concerning the functional status, lowest SpO2 during 6MWT increased significantly. Finally, 19 patients (50%) reported a pathological St. George's Respiratory Questionnaire, and respectively 12 (31.6%) and 11 (28.9%) patients a pathological Short Form Survey-12 in physical and mental components. At 1-year follow-up SARS-CoV-2 pneumonia survivors still present a substantial impairment in radiological and functional findings and in health-related quality of life, despite showing a progressive recovery.

[The management of foreign workers in Italy]. / La gestione dei lavoratori stranieri in Italia.

Over the last decades, the globalisation and important geopolitical changes have widened the spatial boundaries of international migrations which have reached a so global scope today that they influence the economic, political and social trend of countries of origin, transit and destination. According to the UN, the international labour mobility involved more than 200 million people in 2010, that is approximately 10% of the world's total population. In Italy, in the beginning of 2010 foreign residents amounted to 4.2 million, that is to say, 7% of the total population (ISTAT, 2011). Host countries have been forced to implement a series of policies aimed at combating illegal immigration and employment of foreign people. Special attention must be given to the issue of migrant workers who have become increasingly important actors in the social and productive sectors and, as a consequence, the need for preventive and protective measures taking into consideration the specific work-related hazards is growing more and more urgent. With this respect, the regulatory framework for occupational health and safety now contains explicit references to migrant workers as provided in the Leg. Decree 81/08 with subsequent integrations and modifications. First of all, the issue of occupational health and safety for migrant workers must take into account of the linguistic, social and cultural problems of the different ethnical groups that are present in our country.

The future of scientific conferences in the era of the COVID-19 pandemic: Critical analysis and future perspectives.

The global spread of COVID-19 pandemic forced the scientific community to identify new ways of exchanging and transferring the scientific knowledge, also considering that the measures taken to combat the pandemic, such as travel restrictions, closed borders and gathering bans, led to cancellations of many conferences, meetings and workshops. The enhancement of the existing digital platforms and the development of new systems to share scientific knowledge has allowed the scientific community to "meet" again in new virtual environments (e.g., Zoom, Cisco WebEx, Live Stream, Demio, GoToWebinar Seminar, Google Hangouts, Skype, Microsoft Teams, etc.), providing an unprecedented opportunity to reform methods of organizing academic conferences in all disciplines.Starting from the review of the existing literature, this study aimed at investigating the impact of the spreading of virtual conferences on the field of research. The SWOT analysis was used to identify strengths and weaknesses of the scientific conferences organized in the new format, as well as opportunities and threats created by the socio-economic and political context in the era of the COVID-19 pandemic.

Risk assessment at work and prevention strategies on COVID-19 in Italy.

The COVID-19 pandemic has spread worldwide, with considerable public health and socio-economic impacts that are seriously affecting health and safety of workers, as well as their employment stability. Italy was the first of many other western countries to implement extended containment measures. Health workers and others employed in essential sectors have continued their activity, reporting high infection rate with many fatalities. The epidemiological trend highlighted the importance of work as a substantial factor to consider both when implementing strategies aimed at containing the pandemic and shaping the lockdown mitigation strategy required for sustained economic recovery. To support the decision-making process, we have developed a strategy to predict the risk of infection by SARS-CoV-2 in the workplace based on the analysis of the working process and proximity between employees; risk of infection connected to the type of activity; involvement of third parties in the working processes and risk of social aggregation. We applied this approach to outline a risk index for each economic activity sector, with different levels of detail, also considering the impact on mobility of the working population. This method was implemented into the national epidemiological surveillance model in order to estimate the impact of re-activation of specific activities on the reproduction number. It has also been adopted by the national scientific committee set up by the Italian Government for action-oriented policy advice on the COVID-19 emergency in the post lockdown phase. This approach may play a key role for public health if associated with measures for risk mitigation in enterprises through strategies of business process re-engineering. Furthermore, it will make a contribution to reconsidering the organization of work, including also innovation and fostering the integration with the national occupational safety and health (OSH) system.

Contribution of ICOH to Address the Different OSH Needs among Countries: Results of a Survey.

The aim of this study is to map the coverage of occupational safety and health (OSH) rules and provisions and their enforcement at a country level worldwide. Members' participation in the International Commission on Occupational Health (ICOH) activities was also investigated. We used a questionnaire-based survey to collect data. An online questionnaire was administered from February 14 to March 18, 2018 to all ICOH members for the triennium 2015 to 2017 (n = 1929). We received 384 completed questionnaires from 79 countries, with a 20% response rate. To synthesize information about the coverage of OSH rules and provisions and their level of enforcement, a synthetic coverage index was calculated and combined with country, gross domestic product (GDP) per capita and the human development index (HDI). We used multiple correspondence analysis (MCA) to analyze the members' participation in ICOH activities. More than 90.0% of the sample declared that in their own country there is a set of rules and provisions regulating OSH in the workplace, and training procedures and tools to improve workers' awareness. However, these rules and training procedures are mainly "partially" enforced and utilized (39.0% and 45.4%). There was no statistically significant association between country and GDP per capita and the synthetic coverage index, whilst controlling for HDI. The level of engagement in ICOH activities is higher in senior members (aged 65 years or older), coming from high-income countries, having held a position within ICOH, with a higher level of education and a researcher position. An integrated and multidisciplinary approach, which includes research, education and training, is needed to address OSH issues and their impact both at global and country level.

Developing a cost-estimation model for work-related stress: An absence-based estimation using data from two Italian case studies.

OBJECTIVES: This paper discusses the development of a cost-estimation model for work-related stress based on psychosocial risk exposure and absence from work. It presents findings from its implementation and evaluation in two organizations in Italy, using national-level tools developed by the Italian Workers' Compensation Authority (INAIL). It also provides recommendations for the development of similar cost-calculation methods in other countries. METHODS: The cost-estimation model was based on the human capital approach using an indirect cost indicator: loss of productivity due to days of absence attributable to work-related stress. Furthermore, the population attributable fraction (PAF) epidemiological measure was used to calculate the impact of exposure to work-related stress on the basis of data collected through validated tools developed by INAIL and salary cost data. RESULTS: The developed model was implemented and evaluated in two organizations, the first in healthcare (N=1014) and the second in public administration (N=534). In the first case, it was found that absence related to work-related stress cost the organization €445 000. In the second case, the cost was €360 000. CONCLUSIONS: The proposed model provides an example of how organizations can incorporate well-established indicators associated with work-related stress (eg, various types of absence, psychosocial risk perception, loss of productivity on the basis of salary costs) in a practical way in cost estimations of work-related stress. Such cost estimation can be applied in other countries and organizations to establish the economic and business case of managing work-related stress.

Impact of tiered restrictions on human activities and the epidemiology of the second wave of COVID-19 in Italy.

To counter the second COVID-19 wave in autumn 2020, the Italian government introduced a system of physical distancing measures organized in progressively restrictive tiers (coded as yellow, orange, and red) imposed on a regional basis according to real-time epidemiological risk assessments. We leverage the data from the Italian COVID-19 integrated surveillance system and publicly available mobility data to evaluate the impact of the three-tiered regional restriction system on human activities, SARS-CoV-2 transmissibility and hospitalization burden in Italy. The individuals' attendance to locations outside the residential settings was progressively reduced with tiers, but less than during the national lockdown against the first COVID-19 wave in the spring. The reproduction number R(t) decreased below the epidemic threshold in 85 out of 107 provinces after the introduction of the tier system, reaching average values of about 0.95-1.02 in the yellow tier, 0.80-0.93 in the orange tier and 0.74-0.83 in the red tier. We estimate that the reduced transmissibility resulted in averting about 36% of the hospitalizations between November 6 and November 25, 2020. These results are instrumental to inform public health efforts aimed at preventing future resurgence of cases.

The effect of occupational exposure to noise on ischaemic heart disease, stroke and hypertension: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-Related Burden of Disease and Injury.

BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large number of individual experts. Evidence from mechanistic data suggests that occupational exposure to noise may cause cardiovascular disease (CVD). In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from CVD that are attributable to occupational exposure to noise, for the development of the WHO/ILO Joint Estimates. OBJECTIVES: We aimed to systematically review and meta-analyse estimates of the effect of any (high) occupational exposure to noise (≥85 dBA), compared with no (low) occupational exposure to noise (<85 dBA), on the prevalence, incidence and mortality of ischaemic heart disease (IHD), stroke, and hypertension. DATA SOURCES: A protocol was developed and published, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies up to 1 April 2019, including International Trials Register, Ovid MEDLINE, PubMed, Embase, Lilacs, Scopus, Web of Science, and CISDOC. The MEDLINE and Pubmed searches were updated on 31 January 2020. We also searched grey literature databases, Internet search engines and organizational websites; hand-searched reference lists of previous systematic reviews and included study records; and consulted additional experts. STUDY ELIGIBILITY AND CRITERIA: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of any occupational exposure to noise on CVD prevalence, incidence or mortality, compared with the theoretical minimum risk exposure level (<85 dBA). STUDY APPRAISAL AND SYNTHESIS METHODS: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. We prioritized evidence from cohort studies and combined relative risk estimates using random-effect meta-analysis. To assess the robustness of findings, we conducted sensitivity analyses (leave-one-out meta-analysis and used as alternative fixed effects and inverse-variance heterogeneity estimators). At least two review authors assessed the risk of bias, quality of evidence and strength of evidence, using Navigation Guide tools and approaches adapted to this project. RESULTS: Seventeen studies (11 cohort studies, six case-control studies) met the inclusion criteria, comprising a total of 534,688 participants (39,947 or 7.47% females) in 11 countries in three WHO regions (the Americas, Europe, and the Western Pacific). The exposure was generally assessed with dosimetry, sound level meter and/or official or company records. The outcome was most commonly assessed using health records. We are very uncertain (low quality of evidence) about the effect of occupational exposure to noise (≥85 dBA), compared with no occupational exposure to noise (<85 dBA), on: having IHD (0 studies); acquiring IHD (relative risk (RR) 1.29, 95% confidence interval (95% CI) 1.15 to 1.43, two studies, 11,758 participants, I2 0%); dying from IHD (RR 1.03, 95% CI 0.93-1.14, four studies, 198,926 participants, I2 26%); having stroke (0 studies); acquiring stroke (RR 1.11, 95% CI 0.82-1.65, two studies, 170,000 participants, I2 0%); dying from stroke (RR 1.02, 95% CI 0.93-1.12, three studies, 195,539 participants, I2 0%); having hypertension (0 studies); acquiring hypertension (RR 1.07, 95% CI 0.90-1.28, three studies, four estimates, 147,820 participants, I2 52%); and dying from hypertension (0 studies). Data for subgroup analyses were missing. Sensitivity analyses supported the main analyses. CONCLUSIONS: For acquiring IHD, we judged the existing body of evidence from human data to provide "limited evidence of harmfulness"; a positive relationship is observed between exposure and outcome where chance, bias, and confounding cannot be ruled out with reasonable confidence. For all other included outcomes, the bodies of evidence were judged as "inadequate evidence of harmfulness". Producing estimates for the burden of CVD attributable to occupational exposure to noise appears to not be evidence-based at this time. PROTOCOL IDENTIFIER: 10.1016/j.envint.2018.09.040. PROSPERO REGISTRATION NUMBER: CRD42018092272.