Monthly fluctuations in 25-hydroxy-vitamin D levels in day and rotating night shift hospital workers.

PURPOSE: Epidemiological studies have suggested that indoor hospital employees, either day or night shift workers, are at high risk of metabolic and cardiovascular diseases. Interestingly, previous reports have also described a higher prevalence of vitamin D (25OHD) deficiency among these workers. However, few studies have determined the monthly variations in 25OHD levels in indoor hospital employees. METHODS: To address this lack of knowledge, in 2018, during the periodic health surveillance checks at the Service of Occupational Medicine, we measured 25OHD levels in a group of indoor hospital workers (88 rotating night shift workers vs 200 day workers). Each participant received a single annual health surveillance check. RESULTS: The mean levels of 25OHD were consistently below the lower limit of the normal range in both groups throughout the year. Only in the summer, day workers but not rotating night shift workers (mean 25.9 ± 11.3 ng/ml vs 23.1 ± 9.1 ng/ml; p = 0.042) showed levels significantly higher than those in the other seasons. This difference remained statistically significant even after correction for study covariates [ß = -  1.649 (CI - 0.283/- 3.482), p = 0.039]. A cosinor analysis confirmed that the difference in the 25OHD levels between groups was present later in the year. CONCLUSIONS: We found that relatively young healthy hospital workers, especially those with rotating night shifts, in the absence of significant metabolic risk factors, have a high risk of 25OHD deficiency/insufficiency. Because 25OHD deficiency may lead to a progression to more severe conditions such as osteoporosis or bone fractures, our results should be verified in larger cohorts including different ancestries.

Measles immunity in an Italian teaching hospital.

BACKGROUND: Healthcare workers (HCWs) have an increased exposure risk to measles, which can put them, their patients and their relatives at risk of infection. In Italy, 4617 cases of measles were reported in 2017; 302 involving HCWs. According to the Italian National Immunization and Prevention Plan, all HCWs should have demonstrable evidence of immunity to measles. AIMS: To evaluate measles immunization status in HCWs at a large Italian teaching hospital. METHODS: We analysed clinical records and measles-specific IgG antibody titres of HCWs undergoing occupational health surveillance between 1 January and 31 August 2017. RESULTS: Among the 1532 HCWs (mean age 32.7 ± 10.4 years) included in the study, 87% (1328) had protective antibody titres. The proportion of protective titres was highest in those born before 1982. No significant gender differences in mean measles-specific IgG antibody titres were detected. CONCLUSIONS: Our study shows non-protective measles IgG antibody titres in a substantial percentage of HCWs, especially those born in the 1980s and 1990s. Due to the increased risk of measles transmission in the hospital environment, increased prevention strategies are required, including rigorous screening and prompt vaccination of non-immune workers.

Managing the risk of bacterial meningitis among healthcare workers.

BACKGROUND: Meningococcal disease is generally caused by A, B, C, W and Y subgroups of Neisseria meningitidis. In 2015, the Italian mass media focused on this disease due to the death of two nurses. This generated alarm in the general population, especially in healthcare workers (HCWs). The Occupational Medicine department of the Foundation PTV Polyclinic Tor Vergata (PTV) offered free MenACWY vaccine to HCWs and to students of the University of Rome Tor Vergata. AIMS: To analyse the prevalence of N. meningitidis in PTV, a large teaching hospital, and to evaluate preventive measures offered to individuals at risk (i.e. HCWs and students). METHODS: The Hospital Informatic Service provided data about patients admitted to PTV from January 2012 to December 2016. Hospital Discharge Registers were analysed and all cases of meningitis were selected. MenACWY vaccine administered to HCWs and students of PTV in 2017 was analysed. RESULTS: There was just one case of meningococcal disease in 2016. Of the 117 MenACWY vaccines administered, 42% were given to students, 32% to doctors, 8% to nurses, 2% to clerks and 16% to other healthcare professionals. CONCLUSIONS: International guidelines recommend MenACWY vaccine for microbiologists exposed to N. meningitidis isolates. The Italian Legislative Decree 81/2008, however, states that occupational physicians can adopt special protective measures such as vaccination programmes for HCWs. The response rate highlights how perceived risk may influence behaviour even in populations with a higher background knowledge than the general population.

Nasal cytology as a screening tool in formaldehyde-exposed workers.

Background: Workers in pathology and anatomy laboratories may be exposed to formaldehyde. An evaluation of the early effects of this substance is, therefore, paramount. This preliminary study was conducted to evaluate if nasal cytology could be used as a tool to detect changes in nasal mucosa in workers exposed to formaldehyde. Aims: To assess whether nasal cytology was able to reveal any alteration of nasal mucosa in workers exposed to formaldehyde compared to unexposed subjects, and to ascertain whether a specific pattern of alterations correlated with years of exposure in order to evaluate long-term occupational exposure effects. Methods: The study included a group of workers exposed to formaldehyde and a group of non-exposed workers. All subjects underwent clinical examination, followed by nasal cytology. Pathological indices from each rhinocytograms were compared between the two groups. Results: Nasal cytology revealed a chronic inflammatory non-allergic condition in the exposed group. Qualitative analysis of data distribution of neutrophils and mucous-secreting/ciliated cells ratio showed data clustering with a cut-off set at 15 years of exposure. The mean formaldehyde concentrations ranged from <0.04 to 0.15 parts per million (ppm). The maximum levels of formaldehyde concentrations ranged from 0.2 to 0.67 ppm. Conclusions: Our data indicate that nasal cytology may be a promising tool for the health surveillance of workers exposed to formaldehyde and may also represent a useful research tool for the study of the health effects of other chemicals irritants for the upper airways.

Engineered nanoparticles at the workplace: current knowledge about workers' risk.

BACKGROUND: The novel physicochemical properties of engineered nanoparticles (ENPs) make them very attractive for industrial and biomedical purposes, but concerns have been raised regarding unpredictable adverse health effects in humans. Current evidence for the risk posed by ENPs to exposed workers is the subject of this review. AIMS: To perform an in-depth review of the state of art of nanoparticle exposure at work. METHODS: Original articles and reviews in Pubmed and in principal databases of medical literature up to 2013 were included in the analysis. In addition, grey literature released by qualified regulatory agencies and by governmental and non-governmental organizations was also taken into consideration. RESULTS: There are significant knowledge and technical gaps to be filled for a reliable evaluation of the risk posed for workers by ENPs. Evidence for potential workplace release of ENPs however seems substantial, and the amount of exposure may exceed the proposed occupational exposure limits (OELs). The rational use of conventional engineering measures and of protective personal equipment seems to mitigate the risk. CONCLUSIONS: A precautionary approach is recommended for workplace exposure to ENPs, until health-based OELs are developed and released by official regulatory agencies.

[Cardiovascular prevention in the workplace: scientific evidence for the role of health promotion]. / Prevenzione cardiovascolare in ambito lavorativo: evidenze scientifiche per la promozione della salute.

Cardiovascular disorders represent the leading cause of mortality and morbidity in the western world. A large number of working subjects is potentially involved. On this basis, the work environment may be considered an ideal place for health promotion in this field. The recently involvement of Occupational Medicine in health promotion programs represent an ideal condition for the effective implementation of these programs, Scientific literature convincingly show that well characterized interventions, acting on key factors of the cardiovascular risk, such as smoking, diet, physical activity, hypertension, hyperlipidemia, obesity and work-related stress may prevent the development of overt cardiovascular diseases. A proper administration and presentation of these programs is however an essential requisite for their success. Last but not least, the participation of workers, especially of those of low socioeconomic status should be obtained. In order to reach this goal, adequate incentives need to be proposed to workers, including employer-provided paid time off during the work-day for exercise health screenings, or prevention/wellness programs. Although seemingly costly, this approach seems to be fruitful in terms of financial returns in the mid-long term perspective.

Incidence of metabolic syndrome among night-shift healthcare workers.

OBJECTIVE: Night-shift work is associated with ischaemic cardiovascular disorders. It is not currently known whether it may be causally linked to metabolic syndrome (MS), a risk condition for ischaemic cardiovascular disorders. The syndrome presents with visceral obesity associated with mild alterations in glucidic and lipidic homeostasis, and in blood pressure. The aim of this study was to assess whether a causal relationship exists between night-shift work and the development of MS. METHODS: Male and female nurses performing night shifts, free from any component of MS at baseline, were evaluated annually for the development of the disorder during a 4-year follow-up. Male and female nurses performing daytime work only, visited during the same time period, represented the control group. RESULTS: The cumulative incidence of MS was 9.0% (36/402) among night-shift workers, and 1.8% (6/336) among daytime workers (relative risk (RR) 5.0, 95% CI -2.1 to 14.6). The annual rate of incidence of MS was 2.9% in night-shift workers and 0.5% in daytime workers. Kaplan-Meier survival curves of the two groups were significantly different (log-rank test; p<0.001). Multiple Cox regression analysis (forward selection method based on likelihood ratio) showed that among selected variables (age, gender, smoking, alcohol intake, familiar history, physical activity, and work schedule) the only predictors of occurrence of MS were sedentariness (hazard ratio (HR) 2.92; 95% CI 1.64 to 5.18; p = 0.017), and night-shift work (HR 5.10; 95% CI 2.15 to 12.11; p<0.001). CONCLUSIONS: The risk of developing MS is strongly associated with night-shift work in nurses. Medical counselling should be promptly instituted in night-shift workers with the syndrome, and in case of persistence or progression, a change in work schedule should be considered.

[Health effects of engineered nanomaterials]. / Effetti sulla salute dei nanomateriali ingegnerizzati.

Nanotechnology--the manipulation of matter on a near-atomic scale to produce new structures, materials and devices--offers the promise of unprecedented scientific advancement for sectors, such as medicine, consumer products, energy, and materials. Nanotechnology has the power not only to improve existing technologies, but to dramatically enhance the effectiveness of new applications. While nanomaterials present seemingly limitless possibilities, they bring with them new challenges to understanding, predicting, and managing potential safety and health risk to workers. On the basis of available knowledge on ultrafine particles (non-engineered nanoparticles) and on preliminary data on engineered nanoparticles, it may be postulated a potential health risk by these materials. A precautionary approach in occupational setting is therefore needed.

Pulmonary functionality among workers of a Central Italy waste-to-energy plant: a retrospective study.

BACKGROUND: We are observing a growing trend towards the use of waste incineration in waste-to-energy (WTE) plants in Italy. Various authors started to investigate their potential health effects, but without univocal outcomes. The aim of this study is to assess whether or not main pulmonary function indexes could be decreased in a group of workers employed in a municipal solid WTE plant located in Central Italy, and if there's a correlation between the levels of exposure to airborne pollutants and alterations in the pulmonary apparatus. METHODS: The study was conducted with a retrospective cohort approach. We reviewed data from clinical records of 58 waste-to-energy plant workers undergoing annual health surveillance in the period 2010-2015. We considered the exposure to airborne dust and the main parameters of respiratory function (FVC, FEV1, Tiffeneau Index and FEF 25-75%) at time zero and after a period of 5 years. We divided our study population into two groups: low (< 1 mg/m3) and high (> 1 mg/m3) exposure. We estimated odds ratios (OR) with 95% confidence interval (95% CI) adjusted for potential confounders. RESULTS: We observed a decrease in lung function parameters both in high and in low exposure group after a five-years exposure period. FEV1, FEV1/VC ratio and FEF 25-75% were worst in more exposed group, even if this difference resulted not significant at Wilcoxon test. CONCLUSIONS: Active employee in WTE plants is associated to a non-significant worsening in the main parameters of lung function after 5 years exposure. Clinical significant of these variations need to be assessed.

Helicobacter pylori interference with micronutrients and orally administered drugs: a new mechanism explaining its role in extragastric disorders.

There is an increasing evidence that Helicobacter pylori may interfere with gastrointestinal metabolism of micronutrients and drugs such as iron, cobalamin, thyroxine and levodopa, with relevant clinical effects. In this review we examine the strength of the causal association and the plausible pathophysiologic mechanisms underlying these adverse effects.

[Methodology of risk assessment by the occupational physician at the light of new legislative rules]. / Il medico competente e la valutazione del rischio alla luce del decreto legislative 81/2008.

The occupational physician may play a crucial role in the risk assessment of workers in a given occupational environment. In fact, according to the current italian legislation, the document on risk assessment must be produced by the employer, with the cooperation of the responsible for prevention and safety and, in the due contexts, with the contribution of the occupational physician. Therefore, a cooperation between the different figures involved in the process is a pre-requisite for the elaboration of an adequate planning of preventive measures. From the point of view of the occupational physician, it seems necessary a preliminary in-depth knowledge of the plant and of the various steps of the productive process. In particular it is mandatory to have precise data on the number of workers, the mean age, work seniority, and the percentage of disabled workers. As a corollary, it is important to know the frequency of occupational related disorders, the number of accident at work, and the possible presence of contentious procedures with security organisms. Several important open questions remain, however: in particular to establish a causal relationship of any disorder with occupational situtations and to discriminate between distressing situations inside and outside the work environment.

[Role of the occupational health physician in the evaluation of biological risk and cancer in a hospital setting]. / Ruolo del medico competente nella valutazione del rapporto tra rischio biologico e cancro in ambiente sanitario.

OBJECTIVE: Elaborating and proposing a model of behaviour which is useful for any occupational doctor of a hospital in the management of the people exposed to biological risk, with the aim of preventing or early diagnosing neoplasias caused by cancerogenic infective agents. MATERIALS AND METHODS: This study was conducted analyzing the literature data regarding biohazard work accidents which happened in health environment and the scientific evidence of the causal relationship between infective agents and development of neoplasias. RESULTS: Data in literature show that the biohazard work accidents are very numerous and there is high percentage of sub-communication of them; many infective agents that the health workers can get in contact with, after biohazard biological accidents, are cancerogenic: HBV, HCV, HIV, HP belong to group 1 of IARC classification. CONCLUSION: Health workers exposed to biological risk and in particular those who got in contact with infective biological liquids can be considered at risk of neoplasia development; for this reason, we propose a three phases behaviour model: 1. Biological risk accidents prevention; 2. Prevention of infective disease after an accident; 3. Neoplasia prevention and/or early diagnosis after the development of the infective disease.

[Role of screening tests for indirect diagnosis of tuberculosis in health care workers: Mantoux and the new tests on blood ELISA]. / Ruolo dei test di screening nella diagnosi indiretta di tubercolosi negli operatori sanitari: la Mantoux e il nuovo test ELISA su sangue.

The Tuberculosis infection in recent years has become always more a threat. The failure in the attempt to stop it (O.M.S. Millennium Global Plan) brought to the revision of the world control strategy to at least contain this disease (The Global Plan to Stop TB 2006-2015). Due to these severe facts it is even more important now to elaborate more sensitive and specific methods to find out, as fast as possible, the infected cases. As of today, the main TB infection screening test is the Skin PPD test (Mantoux). Recently new tests for the population screening are in use; these tests are based on the evaluation of immunity cell-mediated. They (QFT-G) do not have the typical limits of the Skin Test and they are more suitable as serial tests and therefore more useful, according to us, in the screening programs of the TB infection in low prevalence countries, like Italy.

[Metabolic syndrome and work: identification of populations at risk]. / Sindrome metabolica e attività lavorativa: identificazione della popolazione a rischio.

OBJECTIVE: To assess whether shift work has a cause-effect nexus with the incidence of metabolic syndrome. DESIGN: Retrospective follow-up study, case-control type. RESEARCH METHODS AND PROCEDURES: A total of 202 female and male nurses, aged 23-60 years, having a 1 year minimal follow-up, and without any metabolic syndrome criterion at the first visit were evaluated. The ATP modified criteria were applied for the diagnosis of metabolic syndrome. Moreover smoking habitus, alcohol consumption, educational level and physical activity were considered as bias factors. The sample was divided in two groups doing or not night shifts. RESULTS: The metabolic syndrome incidence resulted significantly greater in shift workers than in other workers (OR: 4.10, 95% CI 1.34-12.55, p = 0.01). The difference was more evident in subjects aged < 40 years (OR = 6.6, 95% CI 1.05-40.85, p = 0.04) the different metabolic syndrome incidence between two groups was detectable even after the multivariate analyse, which considered all the bias factors evaluated. CONCLUSIONS: This study shows for the first time that the night shift work is associated with a greater risk to develop metabolic syndrome in workers healthy in baseline conditions.

[Metabolic syndrome in visual display units users]. / Sindrome metabolica e attività lavorativa al videoterminale.

BACKGROUND: Reports about medical consequences from sedentary work are contradictory. It might be associated with the metabolic syndrome (MS), a collection of cardiovascular risk factors including hypertension, dyslipidemia, insulin resistance and central obesity. No data are currently available on workers using visual display units (VDIU), a potential high risk group, given the sedentariness inherent in this work. PATIENTS AND METHODS: We evaluated MS prevalence in 1547 VDU users with a mean age of 29.7 years and in a control group of 892 individuals with a mean age of 30.2 years who performed non-sedentary work, selected on the basis of similar demographic data. Physical examination and laboratory tests useful for MS diagnosis were performed. RESULTS: MS prevalence was 3.10% in VDU users vs 2.01% in controls (OR 2.048, 95% CI 1.169 to 3.587, p = 0.012). Significance persisted after controlling for confounding factors (e.g, smoking and leisure activity) in a multivariate analysis (OR 1.555, 95% CI 1.03 to 2.690, p < 0.05). CONCLUSIONS: MS should carefully considered when performing health surveillance programmes in VDU users.

[Interaction between carbon nanotubes and cardiovascular autonomic nervous system regulation: proposal of an animal model and preliminary findings]. / Interazione tra nanotubi di carbonio e controllo cardiovascolare del sistema nervoso autonomo: presentazione di un modello sperimentale animale e risultati preliminari.

BACKGROUND: Altered autonomic cardiovascular regulation (ACR) may mediate the association between single-wall carbon nanotubes (SWCNT) exposure and adverse cardiovascular events. MATERIAL AND METHODS: 400 mg of SWCNT in 400 ml of phosphate buffer saline (PBS) or 400 ml of PBS were randomly given to 7 Wystar-Kyoto rats (400 g body wt) previously implanted in abdominal aorta with a telemetry transmitter for recordings of arterial pressure signals. Recordings were performed at baseline, 24 hours and two weeks after intratracheal instillation. The beat-by-beat time series of systolic arterial pressure (SAP) and PR interval were analyzed to identify sequences of three or more consecutive beats in which SAP and PR changed in the same (baroreflex sequences) or in the opposite direction (nonbaroreflex sequences). The mean individual slope of the sequences was calculated and taken as a measure of the baroreflex (BRS) and nonbaroreflex sensitivity for that period. RESULTS: The 24 hour BRS response showed a 100% increase (from 4.6 to 9.2 msec/mmHg) in controls, whereas it was blunted in cases (from 5.1 to 6.1 msec/mmHg) (p < 0.05). CONCLUSIONS: Our study demonstrates that this rat model is suitable to study the ACR during exposure to SWCNT and suggests a blunted BRS response after SWCNT instillation.

Shift work and autoimmune thyroid disorders.

Stress induces autoimmune disorders by affecting the immune response modulation. Recent studies have shown that shift work stress may enhance the onset of the autoimmune Graves hyperthyroidism. On the other hand, the possible association between occupational stress and autoimmune hypothyroidism has not yet been investigated. In order to detect the possible association between shift work and subclinical autoimmune hypothyroidism we investigated the prevalence of isolated anti-peroxidase thyroid (TPO) autoantibodies in 220 shift workers and in 422 day-time workers. Subclinical autoimmune hypothyroidism was diagnosed by the concomitant presence of high anti-TPO values and TSH levels higher than 2.51 mU/l. Anti TPO antibodies were measured by chemiluminescent technology (Advia Centaur) (a value above 60 IU/l was considered altered). Subclinical autoimmune hypothyroidism was diagnosed in 7.7 percent shift workers and in 3.8 percent day-time workers with a statistically significant difference: Odds Ratio (OR) 2.12, 95 percent Confidence Interval (CI) 1.05 to 4.29; p=0.03. The difference persisted after multivariate analysis taking into account age, sex, smoking habits, alcohol intake, familial history of autoimmune thyroid disease and exposure to radiation as possible confounders: OR. 2.24, 95 percent CI.1.01 to 4.94, p 0.05. Altered anti- TPO autoantibodies were found in 13.6 percent shift workers and in 8.6 percent day-time workers OR. 1.64, 95 percent CI.1.03 to 2.74, p=0.05. The significant difference was still detectable after multivariate analysis: OR. 1.95, 95 percent CI. 1.09 to 3.48, p=0.02. Our data show a significant association between shift work and autoimmune hypothyroidism. This finding may have implications in the health surveillance programs.

Shift work increases the frequency of duodenal ulcer in H pylori infected workers.

AIM: To evaluate whether shift work is associated with an increased rate of peptic ulcer in H pylori infected workers. METHODS: During a two year period, consecutive dyspeptic workers underwent non-invasive evaluation of H pylori status by means of urea 13C breath test or stool testing. Those testing positive were included in the study and divided into two main categories: day-time workers and shift workers. An upper gastrointestinal endoscopy was performed in all workers, and biopsy specimens were taken from the stomach to confirm the presence of H pylori infection (culture and histology). RESULTS: A total of 247 day-time workers and 101 shift workers were included. The prevalence of duodenal ulcer was significantly higher in shift workers than in day-time workers (29 of 101 v 23 of 247; OR = 3.92, 95% CI 2.13 to 7.21), and persisted after multivariate analysis, taking into account possible confounding factors (OR = 3.96, 95% CI 2.10 to 7.47). CONCLUSION: Shift work increases the ulcerogenic potential of H pylori infection and should be considered a risk factor for duodenal ulcer in infected shift workers. Treatment of infection in this high risk group may improve the health of workers and may reduce the economic impact of peptic ulcer.

Elemental analysis of histological specimens: a method to unmask nano asbestos fibers.

There is recent mounting evidence that nanoparticles may have enhanced toxicological potential in comparison to the same material in the bulk form. The aim of this study was to develop a new method for unmask asbestos nanofibers from Formalin-Fixed, Paraffin-Embedded tissue. There is an increasing amount of evidence that nanoparticles may enhance toxicological potential in comparison to the same material in the bulk form. The aim of this study was to develop a new method to unmask asbestos nanofibers from Formalin-Fixed Paraffin-Embedded (FFPE) tissue. For the first time, in this study we applied Energy Dispersive X-ray (EDX) microanalysis through transmission electron microscopy to demonstrate the presence of asbestos nanofibers in histological specimens of patients with possible occupational exposure to asbestos. The diagnostic protocol was applied to 10 randomly selected lung cancer patients with no history of previous asbestos exposure. We detected asbestos nanofibers in close contact with lung cancer cells in two lung cancer patients with previous possible occupational exposure to asbestos. We were also able to identify the specific asbestos iso-type, which in one of the cases was the same rare variety used in the workplace of the affected patient. By contrast, asbestos nanofibers were not detected in lung cancer patients with no history of occupational asbestos exposure. The proposed technique can represent a potential useful tool for linking the disease to previous workplace exposure in uncertain cases. Furthermore, Formalin-Fixed Paraffin-Embedded (FFPE) tissues stored in the pathology departments might be re-evaluated for possible etiological attribution to asbestos in the case of plausible exposure. Since diseases acquired through occupational exposure to asbestos are generally covered by workers' insurance in most countries, the application of the protocol used in this study may have also relevant social and economic implications.