Workplace ethical climate and its relationship with depression, anxiety and stress.

BACKGROUND: Ethical climate in the workplace has been highlighted to have an important impact on workers' mental health; the evaluation of workplace ethics and its impact on workers' health should be considered an occupational health issue. AIMS: The present study aims to investigate ethical climate as perceived by workers, and its correlation with mental health outcomes, in particular, symptoms of depression, anxiety and stress. METHODS: A cross-sectional study was performed by administering an online survey, investigating socio-demographic variables, workplace ethics (through the Italian short version of the Corporate Ethical Virtues questionnaire) and mental health outcomes (using the short version of the Depression, Anxiety and Stress Scale). Descriptive analyses, analyses of variance and regression models were performed; P-values were considered significant for values ≤0.05. RESULTS: The sample included 176 workers; the mean age of participants was 46.22 years and 44% were males. The most represented job sector was health care (37%), and 42% of participants had college-level education. Ethical climate was significantly correlated with all mental health outcomes investigated in the study: anxiety (P ≤ 0.001), depression (P ≤ 0.05) and stress (P ≤ 0.05). CONCLUSIONS: Results from this study highlighted a significant correlation between workplace ethical climate and depression, anxiety and stress. This study underlines the importance of evaluating and improving ethical climate to prevent the onset of psychological distress in workers. Furthermore, results from this study should be a starting point for future research investigating the role of ethics and mental health in employees' turnover intention and job satisfaction.

Assessing the Great Resignation phenomenon: voluntary resignation of young Italian workers during the COVID-19 pandemic.

Introduction: The COVID-19 pandemic has determined a radical change in workplace dynamics, with a reported increase in voluntary resignation from employment at a global level, especially among the young-est workers. The aim of this study is to investigate the social, demographic, and cultural characteristics of young people aged between 25 and 45 years who voluntarily resigned from their previous jobs during the COVID-19 pandemic. Methods: This is a cross-sectional observational study; an ad hoc questionnaire was designed and admin-istered via an online link. Descriptive analyses were performed to describe the sample, and the Pearson analysis was performed to investigate statistically significant correlations; p values ≤ 0.05 were considered statistically significant. Results: A total of 72 valid responses were gathered. Mean age was 32.6 years; 43.1% participants were males, 54.2% were married, and 80.6% had no children; most participants (68.1%) had a college level education. The most reported cause of job resignation was work dissatisfaction (38.9%), followed by inadequate remuneration (27.8%). The most reported perspective for people who had resigned or were planning on resigning, was a better salary (27.8%), followed by the pursuit of a higher work-life balance (25.0%). The perception that having resigned was the right choice was significantly correlated with the timeframe of resignation (p<0.01), with having suffered from COVID-19 (p<0.05), and with a close relative having suffered from COVID-19 (p<0.01). Conclusion: This study highlighted that voluntarily resigning was significantly correlated to having suffered from COVID-19, or a close relative having suffered from it; 84.9% of participants who had resigned thought that it had been the right choice. The COVID-19 pandemic could have changed workplace perception, making employees feel more at risk; the indirect impact of the pandemic should be further investigated, and prevention strategies should be implemented to ensure the safety and wellbeing of employees.

Workplace violence against healthcare workers: an umbrella review of systematic reviews and meta-analyses.

OBJECTIVES: The aim of this umbrella review of systematic reviews and meta-analyses was to address workplace violence (WPV) against healthcare workers (HCWs). Several systematic reviews exist in the literature, but the diversity of settings, population considered, and type of violence investigated make it difficult to gain insight and use the vast amount of available data to implement policies to tackle WPV. With this in mind, we conducted an umbrella review of systematic reviews and meta-analyses on WPV against HCWs to examine the global prevalence of the phenomena and its features. STUDY DESIGN AND METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Scopus, and ISI Web of Science were searched for relevant systematic reviews and meta-analyses published in English up to November 2022. Data on authors, year, country, violence type, prevalence (pooled and not), setting, population, and specific considerations were extracted. RESULTS: A total of 32 systematic reviews were included, 19 of which performed a meta-analysis, investigating overall, physical, and non-physical violence. Even considering the variability of the data, the COVID-19 pandemic has exacerbated the scale of the problem. From our review, we found that overall violence prevalence among HCWs was reported to be as high as 78.9%, and nurses working in psychiatric wards were the professionals most impacted. CONCLUSION: In conclusion, this umbrella review revealed a high prevalence of WPV among HCWs, which varies between countries, population subgroups, and detection methods. Strengthening recognition of the problem could lead to appropriate local and international strategies to address it.

Occupational exposure to work-related stress, a proposal of a pilot study to detect psychological distress in collar-workers.

Introduction: Work-related psychosocial risks have been identified as significant occupational health and safety risks; the occupational physicians must assess and monitor the health status of workers in order to verify that work is not a source of harm to exposed operators. The aim of the study was to investigate the outcomes related to anxiety and depression traits in workers exposed to stress-related work. Methods: A questionnaire was administered to a large population of Italian public administration workers; the Centre for Epidemiologic Studies - Depression Scale questionnaire was used to measure depression, the Self rating Anxiety Scale was used to measure anxiety, the UK Management Standards Indicator tool questionnaire was used to assess work adjustment. A descriptive analysis, a multivariate analysis, as well as logistic regression models were used to assess the health outcomes related to stress. Results: A total of 292 workers participated in the study; 100% of participants had a Centre for Epidemiologic Studies - Depression Scale score over the cut-off; 41.78% had a Self rating Anxiety Scale score over the cut-off; the results support a correlation between the Centre for Epidemiologic Studies - Depression Scale results and the UK Management Standards Indicator tool results; and a correlation between Self-rating Anxiety Scale results and the UK Management Standards Indicator tool results. Conclusions: The Demand, Management, Support and Relationship results were associated with mental health outcomes, and it could be a useful tool in occupational medicine, to identify workers at risk for negative mental health outcomes, becoming an essential tool in workers' health assessment and for prevention of mental health disorders.

[Position statement of the Latin American Dysphagia Society for the management of oropharyngeal and esophageal dysphagia during the COVID-19 pandemic]. / Posicionamiento de la Sociedad Latinoamericana de Disfagia para el manejo de la disfagia orofaríngea y esofágica durante la pandemia COVID-19.

INTRODUCTION: The SARS-CoV-2 virus that causes the COVID-19 disease is transmitted through the inhalation of droplets or aerosols and inoculation via the oronasal or ocular routes, transforming the management of swallowing disorders into a challenge for healthcare teams, given their proximity to the aerodigestive tract and the high probability of aerosol generation during patient evaluation and treatment. AIM: To provide essential guidance for Latin American multidisciplinary teams, regarding the evaluation and treatment of oropharyngeal and esophageal dysphagia, at the different levels of healthcare. The position statement was formulated for the purpose of maintaining medical service continuity, in the context of a pandemic, and minimizing the propagation and infection risks of the virus. METHODS: Thirteen experts in swallowing disorders were summoned by the Latin American Dysphagia Society to formulate a series of clinical suggestions, based on available evidence and clinical experience, for the management of dysphagia, taking the characteristics of Latin American healthcare systems into account. RESULTS: The position statement of the Latin American Dysphagia Society provides a series of clinical suggestions directed at the multidisciplinary teams that manage patients with oropharyngeal and esophageal dysphagia. It presents guidelines for evaluation and treatment in different contexts, from hospitalization to home care. CONCLUSIONS: The present statement should be analyzed by each team or healthcare professional, to reduce the risk for COVID-19 infection and achieve the best therapeutic results, while at the same time, being mindful of the reality of each Latin American country.

Analogies Between the Cracking Noise of Ethanol-Dampened Charcoal and Earthquakes.

We report on an extensive characterization of the cracking noise produced by charcoal samples when dampened with ethanol. We argue that the evaporation of ethanol causes transient and irregularly distributed internal stresses that promote the fragmentation of the samples and mimic some situations found in mining processes. The results show that, in general, the most fundamental seismic laws ruling earthquakes (the Gutenberg-Richter law, the unified scaling law for the recurrence times, Omori's law, the productivity law, and Båth's law) hold under the conditions of the experiment. Some discrepancies were also identified (a smaller exponent in the Gutenberg-Richter law, a stationary behavior in the aftershock rates for long times, and a double power-law relationship in the productivity law) and are related to the different loading conditions. Our results thus corroborate and elucidate the parallel between the seismic laws and fracture experiments caused by a more complex loading condition that also occurs in natural and induced seismicity (such as long-term fluid injection and gas-rock outbursts in mining processes).

[Alcohol and work. Consensus Document of the La.R.A. (Workers representing a risk for others) group]. / Alcol e Lavoro. Documento di consenso del gruppo La.R.A.

AIM: Current Italian legislation obliges employers to prevent workers who are occupationally at risk or who perform jobs that may be hazardous for the safety or health of third parties from consuming alcohol. The LaRA Group undertook to assess whether the law fully safeguards the health and safety of both workers and third parties, without impinging upon the civil rights of workers. METHOD: A written document expressing agreement was produced following discussions between doctors, lawyers, bioethicists and social partners. RESULTS: There are gaps and inconsistencies in current laws; the differences in local and regional provisions prevent authorities from applying a single strategy at national level. There should be a change in existing rules under which the employer's obligation to enforce the ban on consumption alcohol in the workplace is enacted solely by the "competent" physician whose institutional role is to safeguard and promote health. Some occupational categories that are subject to a ban on alcohol consumption do not currently under-go health surveillance. For example, if road transport drivers are not exposed to a specific occupational risk foreseen under another law, they can be placed under health surveillance only in those regions where the local laws contemplate this type of control. In other cases, the practice of assessing the risk to third parties and providing for compulsory health surveillance in the Risk Assessment Document, is considered by some jurists to be a "consuetudo praeter legem" and therefore acceptable in a field not yet covered by a specific law, but to be "contra legem" or unlawful by other jurists. Moreover, the competent physician who uses a breathanalyser or tests for alcohol addiction faces an ethical dilemma, since by communicating the results to an employer or authorities responsible for the issuing of licenses, he may be violating his professional oath of secrecy. Furthermore, the emphasis placed on testing has induced companies and inspectors to overlook educational and rehabilitation aspects. It is essential to involve general practitioners, educators and specialist services in addressing the problems of alcohol abuse so as to inform/train, recover and rehabilitate. The few studies available indicate that the rules are poorly enforced and that non-compliance may go unobserved. CONCLUSIONS: The Group urges all employers to assess the risk for third parties caused by alcohol abuse and to devise a policy on alcohol. Controlling alcohol-related risks in the workplace calls for a better definition of the roles of Vigilance Bod-ies and Company Physicians together with a shift from a reactive to a proactive attitude of all the parties involved.

Decapitation of an agricultural worker by a combine harvester: a case report.

Background: Each year, there are billions of agricultural work accidents involving the operation of tractors, grain augers, harvest combines, power take-off devices, or balers and thrashers. Field accidents of this nature seem more common on afternoons, just as road accidents tend to skew toward nighttime. The lesions can vary widely and depends strictly on the operation of the machinery analyzed. Aims: This paper aims to present a peculiar case of decapitation by a combine harvester, showing how, in cases of injury due to agricultural machinery, it is fundamental a correct execution of a scene investigation, autoptic examination, and cooperation with a specialist in engineering. Case Report: A 54-year-old man was found decapitated on the header of a combine harvester; his extremities were also dismembered. At autopsy, a clean oblique cut across the first cervical vertebra had severed the head at the neck. Although the right arm remained intact, both lower extremities were mutilated, showing numerous exposed and open fractures. A bleeding, penetrating wound to the back was additionally noted. In the days that followed, missing parts (head and left leg) were discovered in other machine components (grain tank and straw walker, respectively). All observed injuries were compatible with the mechanics of the cochlea, its rotating movement inflicting the damages above. Collaboration between pathologists and engineers was fundamental to recreating the dynamics of this rare decapitation accident by a combine harvester.

Death by artery injury: two peculiar cases of sharp force fatality.

Background: As sharp force injury accounts for 10-20% of clinical forensic examinations, forensic pathologists are often asked to investigate deceased victims of stab wounds. Moreover, homicide by sharp force (stabbing) is one of the most common in European countries, involving generally domestic or interpersonal conflict. Stabbing as a suicide method constitutes a low percentage of all suicides, 2% to 3%. Accidental death due to sharp force is even rarer (0-3%) and usu-ally caused by an impact or a fall into different type of glass surface. Death due to stabbing is usually caused by exsanguinating incisions to organs or large blood vessels (such as arteries), leading to haemor-rhagic shock. Penetrating artery injuries are well known in clinical settings, and extremities are the most common sites of such injuries. Indeed, 50% to 60% of injuries occur in femoral or popliteal arteries, 30% in brachial artery. Aims: The aim of this paper is to present two rare cases of sharp force fatality, showing how a thorough forensic pathology methodology, including death scene investigation, autopsy examination, and toxicological analyses, are pivotal to detect the manner of death. Case Reports: This paper presents two peculiar cases of sharp force fatalities: the first, a single and accidental stab injury on the right armpit which caused a complete transection of the axillary artery; the second, a single homicidal stab wound on the lower leg causing a full-thickness lesion of the anterior tibial artery.

Position statement of the Latin American Dysphagia Society for the management of oropharyngeal and esophageal dysphagia during the COVID-19 pandemic.

INTRODUCTION: The SARS-CoV-2 virus that causes the COVID-19 disease is transmitted through the inhalation of droplets or aerosols and inoculation via the oronasal or ocular routes, transforming the management of swallowing disorders into a challenge for healthcare teams, given their proximity to the aerodigestive tract and the high probability of aerosol generation during patient evaluation and treatment. AIM: To provide essential guidance for Latin American multidisciplinary teams, regarding the evaluation and treatment of oropharyngeal and esophageal dysphagia, at the different levels of healthcare. The position statement was formulated for the purpose of maintaining medical service continuity, in the context of a pandemic, and minimizing the propagation and infection risks of the virus. METHODS: Thirteen experts in swallowing disorders were summoned by the Latin American Dysphagia Society to formulate a series of clinical suggestions, based on available evidence and clinical experience, for the management of dysphagia, taking the characteristics of Latin American healthcare systems into account. RESULTS: The position statement of the Latin American Dysphagia Society provides a series of clinical suggestions directed at the multidisciplinary teams that manage patients with oropharyngeal and esophageal dysphagia. It presents guidelines for evaluation and treatment in different contexts, from hospitalization to home care. CONCLUSIONS: The present statement should be analyzed by each team or healthcare professional, to reduce the risk for COVID-19 infection and achieve the best therapeutic results, while at the same time, being mindful of the reality of each Latin American country.

Anomalous diffusion governed by a fractional diffusion equation and the electrical response of an electrolytic cell.

The electrical response of an electrolytic cell in which the diffusion of mobile ions in the bulk is governed by a fractional diffusion equation of distributed order is analyzed. The boundary conditions at the electrodes limiting the sample are described by an integro-differential equation governing the kinetic at the interface. The analysis is carried out by supposing that the positive and negative ions have the same mobility and that the electric potential profile across the sample satisfies the Poisson's equation. The results cover a rich variety of scenarios, including the ones connected to anomalous diffusion.

Recent Judgement of the Italian Judiciary about medical assisted procreation (MAP): is informed consent valid after parents separation?

ABSTRACT: Law No 40/2004 regulates in Italy the matter of medically assisted procreation (MAP). Recently, the Tribunal of Capua Vetere expressed its position on the subject of informed consent in a case of MAP. In the specific case, a couple entered the preliminary stages of the PMA procedures, carrying out the fertilization of the ovum and the embryo production. Afterwards, the couple separated and the man denied consent to the continuation of the MAP. The woman, willing to proceed with the implantation, the woman made an urgent judicial appeal, obtaining the judge's permission to transfer the embryo to the uterus. This paper analyses the different bioethical positions on MAP's informed consent. In fact, on the one hand, the paper highlight what is set out in Law 219/2017 which provides for the possibility of the patient to revoke at any time the consent to the treatment given. On the other hand, it should be noted that Law 40/2004, willing to protect the embryo, establishes the irrevocability of the position of parental consent after fertilization. The judgment in question seems to favour this latter position, placing itself in the protection of the cryopreserved embryo and recall-ing the principle of entrustment following the fertilization of the egg. Nevertheless, the matter is controversial a consistent amount of legal developments are expected to arise in the next future.

Crossbow injuries: A case report with experimental reconstruction study and a systematic review of literature.

In modern times crossbow - a ranged weapon diffused during Middle Ages - is increasing its popularity in recreational hunting and sports; crossbow bolts have a great penetration capacity, despite their low initial velocity. Great concerns emerge when considering that notwithstanding crossbow is a potentially lethal distance weapon, it is easy to obtain without having to undertake any tests on the buyer's mental or physical health. Although rare, crossbow injuries can be challenging for the forensic pathologist due to great similarities with other wounds pattern (gunshots wounds or injury due to sharp force). Especially when the arrow is removed from its original position or the body is decomposed, identification of the weapon can be difficult. According to forensic literature, suicides, homicides and non-lethal injuries by crossbow have been reported up to the present day. We followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) indications in the identification and selection of studies and reviewed a series of cases of both fatal and non-fatal crossbow injuries, according to the manner of death (homicide, suicide, accidental). The casuistic part of this paper deals with an attempted murder of a 21-year old man: a case of non-lethal crossbow injury of the thorax in which an interdisciplinary approach, involving forensic inspection, ballistic and radiology tests, led to solve the case.

Forensic pathology: past, present and future.

Forensic pathology is the scientific branch which, more than every other, today draws from new technologies inherent to other medical fields. In the last century history of forensic pathology has been characterized by a necessary conjunction between tradition and innovation, which primary achievement is finding the truth and scientific objectivity. During the past centuries several studies have enriched scientific forensic panorama, until the most recent introductions in radiological fields (3D post-mortal CT and MRI) and in the molecular biological one, with disclosure of miRNA. MiRNAs are small, endogenous, single stranded, non-coding RNA molecules identified in plants, animals and DNA virus transcriptome. Various and growing are the fields of application: to establish time of death, to evaluate vitality of skin lesions, in cases of head trauma, and cases of acute myocardial infarction. The introduction of new molecular biology techniques will certainly be useful in the coming years to find the "truth" in challenging judicial cases.

Venous outflow as a criterion of impairment of cerebral vascular reserve.

AIM: The purpose of this work is to evaluate if the asymmetry of venous outflow between the two hemispheres is a reliable criterion of impairment of the cerebral vascular reserve among symptomatic patients harbouring a spontaneous atherosclerotic occlusion of internal carotid artery. METHODS: From January 1995 to December 2007, 7 symptomatic patients, affected from occlusion of internal carotid artery, were submitted to a low-flow by-pass between the superficial temporal artery and the middle cerebral artery owing to the presence of an impairment of cerebral vascular reserve diagnosed by TC-Doppler, SPECT or perfusion-CT with acetazolamide challenge. Conventional angiography was always performed. Angiographic studies of these patients were reviewed in order to find out the presence of asymmetry of the venous outflow. In the same period 35 patients harbouring an occlusion of the carotid artery in the neck and a normal cerebral reserve underwent cerebral angiography in our departments in Monza. Angiographic studies, of this latter group of patients, were also retrospectively analyzed with the same purpose. RESULTS: All patients, with a poor cerebral reserve, showed an asymmetry of venous outflow >3 s omolateral at the carotid occlusion. Patients, with a normal cerebral reserve, showed an asymmetry of venous outflow <2 s. CONCLUSIONS: Asymmetry of venous outflow were correlated to an impaired cerebral reserve also in chronic conditions as atherosclerotic spontaneous occlusion of internal carotid artery. Our data are a further support to the reliability of this criterion in case of therapeutic sacrifice of internal carotid artery.

Personalized medicine in psychiatric disorders: prevention and bioethical questions.

Personalized medicine is an emerging approach to medicine that applies scientific knowledge to predict individual susceptibility to certain pathologies and to identify their response to pharmacological treatments. The aim of the study is to analyze the ethical implications of the use of personalized medicine in the prevention of psychiatric disorders, through the study of specific genetic variations and epigenetic modifications. However, the use of technologies aimed at studying the human genome, in order to prevent these pathologies, cause many bioethical questions.

[The relationship between mobbing and depression syndrome in the female working population of service industry: the problem statement and the prevention strategies in Sicilian environment]. / Rapporto tra mobbing e sindrome depressiva nella popolazione lavorativa femminile del terziario avanzato: dimensione del problema e strategie di prevenzione nella realtà Siciliana.

The concept of "work" and the social interactions in the workplace contribute to develop the working satisfaction and the social and personal identity of the adult. The aim of the survey is that of checking up on the presence of a statistically significant relation between The Depression Syndrome and The Mobbing Phenomenon. It is necessary to understand and value if and how some of the employer's behaviours could have a heavy influence on the worker's psychophysical condition, up to causing a state of anxiety and depression. It has been used the now famous "LIPT" (Leymann Inventory of Psychological Terror), elaborated by Leymann at the beginning of the 90's. It is a short anonymous questionnaire recognized all over Europe as a standard to confirm the Mobbing existence in organizational contexts. The current version of the questionnaire is called "LIPT EGE", a more suitable tool to check the seven parameters of the Mobbing determination, as well as the quantification of the consequent harm. Some scales for depressive symptoms evaluation have been added to the Mobbing questionnaire: The Self Rating Depression Scale (SDS) and The Depression Status Inventory (DSI) of Zung. The questionnaires are administered to 500 workers women in public and private corporation in Sicily, exactly in Siracusa and Catania provinces. 206 women aged 34-50 have answered the questionnaires. In addition to the age and the sex, the distinction variables of the examined people are the position in the firm, nationality, vocational qualification, and the yearly gross income. The research has begun in july and has continued on august 2006. Attention has been focused only on the administrative sectors. Through the chi2 test and the exact Fisher test, the dependence between the changeable presence of depression in the two questionnaires (Zung 1 and Zung 2) and every single variable of the questionnaire on the Mobbing has been pointed out. In particular, the results establish a connection between the presence of depression and systematic isolation, and depression and the changes in the working tasks. The survey has pointed out the working conditions that may lead to Mobbing situations and to psychological frustration; it follows that the Mobbing prevention is a key element if you want to better working life and avoid social emargination.

[Evaluation of the psychological well-being and coping strategies in a population of ex asbestos exposed on its work place]. / Valutazione del benessere psicologico e delle tecniche di coping in una popolazione di ex esposti all'amianto in ambiente lavorativo.

The aim of the current study was mainly to asses the coping strategies used by a sample of subjects (n = 100) and its psychological well-being. The INAIL had recognized these subjects in the past time had been massively exposed to asbestos in their work place. An anonymous self-report questionnaire, made up of (a) an explorative section, (b) the Carver's COPE, (c) the Carol Ryff's Psychological Wellbeing Scales (PWBS), has been used. Both tests parametric (Chi Square and t Student analysis) and not parametric (Mann-Whitney Test) were carried out in order to assure strength results. The survey data indicated that there were an acknowledge about the asbestos-related diseases' action and a general use of "avoidance" coping strategies. Contrary to expectation concerning the PWBS, there was a statistically significant higher score in the "exposed group" than the "control group" (n = 50) as regards the "Positive Relations with Others" and the "Personal Growth" scales. Different variables may concur to explain the results of this study.

[Evalutation of neoplasms prevalence as a consequence of stressful events in the occupational and non-occupational field]. / Valutazione della prevalenza di neoplasie in seguito ad eventi stressanti in ambito lavorativo ed extralavorativo.

Starting from the hypothesis that stressful events, badly elaborated by individuals, can bring a decreasing activity of immunitary system and represent a co-factor in development of breast cancer, analyzing which events are more stressful and as a consequence, which are the ones causing a decreasing of immunitary defence. This study considers the breast cancer in large increasing amongst women. 60 women compiled the Events of Life Questionnaire (Qav) and they have been divided into two groups: 30 elements affected by breast cancer (experimental group) and 30 without evident pathologies (control group). Their age was included between the 25 and 75 years old, they came from the same social class, cultural extraction, instruction level. Throughout every single interview, each one lasting about an a hour with hospitalized patients, we potentially find a depressive personality. The statistic analysis gives extremely interesting results regarding negative events of the affective life: underlining a strong dependence among negative events of affective life relating to the development of the breast cancer This interest start from the evident limit in the medical practice, considering organic problems as the only for disease development, excluding emotional and psychological factors which are part of human being's life. Anyway, today is possible to find especially in onchological medicine, the consciousness that the medical or surgical intervention is not the only duty but is also important to underline, in a more complete view, that the patient's care also depends from the ability of questioning about patient's conditions in every day life; as shown in this study which underlines the necessity of psychotherapeutic intervention for patients affected by breast cancer, specially in pre and post operating phases.