Bullying at work and work-related stress in healthcare workers: a cross sectional study.

BACKGROUND: Bullying is a serious and growing problem affecting a significant proportion of healthcare professionals, a professional category exposed to work-related stress. Workplace bullying has been defined as a set of negative behaviours consisting in harassment, offense or negative influence on work that are directed to the members of the organization and that occur regularly and repeatedly over a period, becoming part of the context of work. STUDY DESIGN: We performed a cross-sectional study using the HSE questionnaire and defining the sample size considering the number of healthcare workers of a big hospital and then calculating it with EpiInfo™ software. 191 people have been enrolled. METHODS: The study was divided into three steps. The first one to identify, among the workers, those who were exposed to bullying at work and those who were not. The second one has been aimed at assessing the presence of work-related stress through the administration of the HSE questionnaire. The third step has been aimed at performing the statistical analysis of the data. For each single domain explored by the questionnaire the score obtained was treated as a linear variable and the median and interquartile range (IQR) was calculated. After, a non-parametric analysis (Wilcoxon rank-sum test) was performed in order to define the statistical significance of the observed differences. RESULTS: All the 191 questionnaires were self-administered by the Health Care Workers under study and correctly filled in without any multiple or missing responses. Considering the scores obtained to question n. 21, that investigates "bullying at work", we obtained two groups: High-Exposure Group (total, males and females), and Low-Exposure Group (total, males and females). In the High-Exposure Group, two critical domains were found: Demands and Control (total, male and female samples). The differences with the Low-Exposure Group were statistically significant. In the Low-Exposure Group the critical domain was Manager Support (total and female samples). The differences with the High Exposure Group were not statistically significant. CONCLUSION: This study aimed to show how the exposure to bullying can influence the perception of psychosocial risks. It seems that the workers most exposed to bullying also have worse scores on the HSE questionnaire, particularly for two domains: Demands and Control. That is consistent with the most recent scientific literature.

Potential antimicrobial effects of photocatalytic nanothecnologies in hospital settings.

BACKGROUND: Recently, several advanced technologies have been considered to reduce the microbial load in hospital environments and control Healthcare Associated Infections (HAIs) incidence. New strategies for preventing HAIs have continuously evolved, including enforcement of hygiene procedures by novel liquid biocides or no-touch technologies, self-disinfecting surfaces coated by heavy metals or light-activated photosensitizers such as Titanium Dioxide (TiO2) nanoparticles. STUDY DESIGN: Review publications concerning the use of photocatalytic systems in hospital setting, focusing on products based on TiO2. METHODS: Specific keywords combinations were analitically searched in PubMed and Scopus databases. RESULTS: Starting 80s-90s, over 2000 papers report "in vitro" studies on antimicrobial activity of TiO2 photocatalysis on several microorganisms including bacteria, viruses, fungi, yeasts, and antibiotic resistant strains. Besides, at least 4 selected papers addressed the potentials of this approach by "in field" studies, showing a widespread pool of applications in hospital and healthcare settings. However, the low number of available experiences and their heterogeneity represent major limitations to achieve a comprehensive final overview on effectiveness and feasibility of these technologies. CONCLUSIONS: Photocatalytic systems based on TiO2 represent a promising strategy for hospital hygiene and HAI prevention. Additional "in field" studies are desirable in a next future to further evaluate and exploit this novel and interesting health technology.

Procedures in endoscope reprocessing and monitoring: an Italian survey.

BACKGROUND: The high diffusion of endoscopes worldwide and the need for effective reprocessing methods requested the development of guidelines and implementation of surveillance procedures at local level. STUDY DESIGN: In order to collect data on everyday's practice and adherence to available guidelines, endoscopy units from different public institutions were surveyed using a dedicated questionnaire. METHODS: Between July and November 2015 a survey was carried in 12 main hospitals from 10 different Italian regions, involving 22 endoscopy units. The state of the art of national and international guidelines was investigated to compare the protocols adopted at local level. RESULTS: In all the surveyed hospitals, the reprocessing activity is based on pre-established protocols in adherence with principal guidelines. Enzymatic detergents, which are recommended by the international guidelines, are used in 55.6% of units and peracetic acid is currently the most widely used chemical disinfectant. Discrepancies were observed in the application of periodic quality controls. CONCLUSION: Updated guidelines are generally applied in reprocessing practice. Quality controls may represent a critical issue to improve effectiveness and surveillance. The whole of acquired data can promote a positive trend towards the application of best practices.

Monitoring biodiversity in libraries: a pilot study and perspectives for indoor air quality.

Indoor Air Quality (IAQ) in libraries is influenced by the presence of specific factors which can impact on both paper storage as well as people health. Microclimatic conditions induce and support a biodiversity pattern involving environmental and anthropic microorganisms. We used a multidisciplinary monitoring model to characterize microflora biodiversity by Next Generation Sequencing (NGS). Biodiversity indexes were adapted to evaluate anthropic vs environmental pollution by combining Shannon mean index (H), species representativeness (EH), human/environmental pollution ratio (SA) to better characterize the NGS output and acquire synthetic information on Indoor Air Microbial Biodiversity (IAMB). Results indicate a frequently low microbial load (IGCM/m3 < 1000) characterized by different species (n = 102), including several cellulose metabolizing bacteria. Workers and visitors appeared a relevant source of microbial contamination. Air biodiversity assayed by NGS seems a promising marker for studying IAQ.

Nutritional ecology of a prototypical generalist predator, the red fox (Vulpes vulpes).

Generalist species, which exploit a wide range of food resources, are expected to be able to combine available resources as to attain their specific macronutrient ratio (percentage of caloric intake of protein, lipids and carbohydrates). Among mammalian predators, the red fox Vulpes vulpes is a widespread, opportunistic forager: its diet has been largely studied, outlining wide variation according to geographic and climatic factors. We aimed to check if, throughout the species' European range, diets vary widely in macronutrient composition or foxes can combine complementary foods to gain the same nutrient intake. First, we assessed fox's intake target in the framework of nutritional geometry. Secondly, we aimed to highlight the effects of unbalanced diets on fox density, which was assumed as a proxy for Darwinian fitness, as assessed in five areas of the western Italian Alps. Unexpectedly, the target macronutrient ratio of the fox (52.4% protein-, 38.7% lipid- and 8.9% carbohydrate energy) was consistent with that of hypercarnivores, such as wolves and felids, except for carbohydrate intakes in urban and rural habitats. The inverse relation between density and the deviation of observed macronutrient ratios from the intake target suggests that fox capability of surviving in a wide range of habitats may not be exempt from fitness costs and that nutrient availability should be regarded among the biotic factors affecting animal abundance and distribution.

Extra-auditory effects of noise exposure in school workers and preventive measures: a systematic review.

OBJECTIVE: Noise is still today one of the main causes of occupational diseases; in fact, in Italy in the three-year period 2019-2022, hearing loss represented 15% of all occupational diseases recognized by the National Institute for Insurance against Accidents at Work. The extra-auditory effects related to noise exposure also require particular attention, because they can interfere with mental activities that require concentration, memory and ability to deal with complex problems, causing sleep and learning disorders. For this reason, acoustic comfort is considered a fundamental requirement for obtaining an optimal degree of well-being in closed environments. In schools, a high degree of noise pollution not only makes it difficult for students to listen and learn, but also affects school workers. The aim of this study was to perform a systematic review of international literature and analysis of the preventive measures of extra-auditory effects among school workers. MATERIALS AND METHODS: The presentation of this systematic review is in accordance with the PRISMA statement. The methodological quality of the selected studies was assessed with specific rating tools (INSA, Newcastle Ottawa Scale, JADAD, JBI scale and AMSTAR). Only publications in English were selected. No restrictions were applied for the publication type. We excluded articles not concerned with the extra-auditory effects of noise exposure in school workers and preventive measures, findings of less academic significance, editorial articles, individual contributions, and purely descriptive studies published in scientific conferences. RESULTS: Online research indicated 4,363 references: PubMed (2,319), Scopus (1,615) and Cochrane Library (429) have been consulted; 30 studies were included in this review (5 narrative or systematic reviews and 25 original articles). Regarding the scores of narrative reviews, the INSA score showed an average and a median value of 6.5, thus indicating an intermediate/high quality of the studies. Regarding the scores of systematic reviews, the AMSTAR score showed an average of 6.7 and a median and a modal value of 6, thus indicating a high quality of the studies. The scores assigned to the original articles have an average and median value of 7 and a modal value of 6 and this demonstrates an intermediate/high quality of the studies. CONCLUSIONS: We can assume that, as it is highlighted by this study, to date these consequences are not considered at the legislative level for the protection of exposed workers. The extra-auditory effects impacting health afterward environmental noise exposure are many and widespread. Therefore, there is a need for interventions to be carried out by institutions and that the physician of the schools, during health surveillance, investigates the effects and clinical manifestations, in order to prevent disorders and deficits highlighted by our study.

[Evaluation of the impact of night-work on health in a population of workers in Tuscany]. / Valutazione dell'impatto del lavoro notturno sulla salute in una popolazione di lavoratori della Toscana.

Night-work, loading to subversion of physiological circadian rhythms and habits, may cause a lowering of work performance, an increase in the risk of accidental events and, more generally, a perception of less satisfactory living condition. In our experience we have interviewed 359 workers (night-workers and not). We found, in line with the Literature, that night-workers receive a less satisfactory quality of sleep, often associated with daytime sleepiness. The prevalence of disorders of various organs and systems is higher in these subjects, as well as the consumption of caffeine and nicotine. Regarding road and work-accidents, a similar trend is not so clearly confirmed in our series; in this context we have, nevertheless, to take account of some potential bias. Our experience confirmed that night-work may produce animpact on the individual overall well-being and, consequently, on the companies' productivity. To reduce this impact and the related costs, it is necessary to plan interventions on both workers and work organization.

[Cardiovascular risk factors and metabolic shift workers in a population of railway workers]. / Fattori di rischio cardiovascolari e metabolici in lavoratori a turni del settore ferroviario.

Cardiovascular and metabolic risk factors prevalence is studied with an increasing interest, involving also working-age people, Several studies had evidenced that shift-work is a key factor in the etiology of cardiovascular illnesses. Railway workers--especially those who are involved in the monitoring of rail traffic--are often shift-workers. Their shift-schedule is based on a rotation of--in this order--afternoon, morning and night. Regarding the important role played by this kind of workers for the public safety, the evaluation of their cardiovascular risk is of utmost importance. In this study we evaluated the prevalence of cardiovascular risk factors in railway shift-workers to define prevention strategies.

[Risk assessment of arterial hypertension in a working population]. / Alutazione del rischio di ipertensione arteriosa in una popolazione di lavoratori.

During last years life expectation and working-life are increased and, consequently, the evaluation of workers whit chronic age-related diseases is more frequent than in the previous decades. We analyzed 9616 (2337 females and 7279 males) medical reports collected during health surveillance. Workers with arterial hypertension were 1770 (254 females and 1516 males) with an average age of 49.02 years +/- 9.52, and an average BMI of 27.9 +/- 4.43 Kg/m_. Workers who reported a complete fitness-to-work certification were 88.6%, ones with a fitness-to-work certification whit limitations were 11.2%, and only 0.2% were unfit to work. Our data confirm the importance of company strategies oriented to health promotion on the workplaces considering the progressive ageing of the workforces.

[Promoting the quality of health surveillance of workers exposed to wood dust, with particular care to NPSC, in the territory of the Health Agency of Florence]. / Promozione della qualità della sorveglianza sanitaria dei lavoratori esposti a polvere di legno, con particolare riferimento ai TuNS, nel territorio di competenza della Azienda Sanitoria di Firenze.

Wood dust can cause occupational-related naso-sinusal cancer, characterized by a latency period of about 40 years. The Tuscany Cancer Registry estimates that cases of NPSC are from 20-25 per year into the Region (33% related to wood dust). These neoplasms are surgically treatable at early-stage and, for this reason, a rapid endoscopic diagnosis is considered to be reasonably useful for prognostic issues. We used a questionnaire to investigate nasal symptoms and NOSQ and SOLAR questionnaires to highlight respiratory/skins diseases, and a spirometry for each worker. Subjects with a working-age of more than 15 years, and those that were positive to the questionnaire and/or to the medical history were were referred to a specialist in otolaryngology. The prevalence of endoscopic positive findings--detected especially in subjects with a working age of more than 15 years--confirms the significance of the problem.

A case report: Use of FT-IR analysis to improve Colovesical fistula diagnosis.

Colovesical fistula (CVF) is an abnormal connection between the colon and the urinary bladder. Faecaluria, reported in 40-70% of cases, is virtually pathognomonic for CVF. During the 5th day of recovery in an 84 years old subject, the passage of cloudy, malodorous urine with visible debris was observed. According to the pathognomonic character of faecaluria, the sample was signed to the laboratory for biochemical and microbiological investigation, able to define the type and origin of materials. Following clinical requirements, both biochemical pathways and instrumental procedures able to confirm or exclude the presence of faecal components in urine were considered. No biochemical compound or component addressing faecal compounds in urine results available between laboratory tests. The brown powder component of the pellet was identified as Keratin, with 90% overlapping with the reference spectrum of the compound. FT-IR analysis on urine pellet can be proposed as a simple, non-invasive, and fast method to improve the diagnostic course of CVF.

Telework and its effects on mental health during the COVID-19 lockdown.

OBJECTIVE: During the Covid-19 pandemic, many governments promoted the adoption and development of telework to reduce some of the consequences of the current health crisis on the economy and favor social distancing. The aim of this web-based cross-sectional study was to assess the consequences of the Covid-19 pandemic on job organization, exploring the effects of lockdown measures on the psychological distress and perceived well-being of workers experiencing telework. SUBJECTS AND METHODS: A web-based cross-sectional survey has been used to collect data. The participants answered the questionnaire from April 1 to April 30, 2020. The questionnaire consisted of three sections, which investigated: 1) demographic and occupational variables, 2) lifestyle and habits variables, 3) psychological distress and perceived well-being. The General Health Questionnaire (GHQ-12) has been used to evaluate psychological distress and the 5-item World Health Organization Well-Being Index (WHO-5) to explore subjective well-being. RESULTS: Psychological distress was associated with educational level, with habits, and with reporting poor well-being. Poor well-being was associated with a higher job demand during pandemic, lifestyle and habits variables, and psychological distress. CONCLUSIONS: This is one of the first studies exploring the consequences of the COVID-19 pandemic and lockdown measures on the perceived well-being and psychological distress of workers experiencing telework. It is mandatory to pay more and more attention to the mental health of teleworkers, considering the increasing diffusion and adoption of this type of work organization.

[Occupational cardiovascular diseases]. / Cardiovasculopatie professionali.

Cardiovascular system may be the target of multiple occupational risk-factors which can act as causal and co-causal agents. A clinical background of cardiovascular diseases is made difficult by the non-specific anatomic and clinical characteristics and by the simultaneous presence of non-occupational confounding factors. Similarly, a strong distinction between macro- and microangiopathies is not easy because many noxae play a role on both components of the vascular system. Etiologically speaking, cardiovascular diseases can be classified into three different groups: diseases caused by chemical agents, by physical agents, and the ones related to psychosocial and organizational factors. These last factors represent an emerging risk, with related costs for the individual and the society. The assessment of relationships between occupational exposure and cardiovascular diseases allows both to verify the efficacy and the effectiveness of current prevention strategies and to enable the identification of new risk factors.

[The control of drugs consumption in occupational contexts: management of the test results]. / La gestione dei risultati dei test per il controllo dell'assunzione di sostanze stupefacenti.

From November 2008 to July 2010 we made 8300 drug tests to verify the absence of drug addiction or drugs/psychotropic substances consumption. We found 101 positive subjects (1.2%) at the first screening test; for fifty-five of them (54.5% of positives) we obtain a confirmation at second level test (0.7% of total tests). Sixty percent of these were positive for cannabinoids, 18.1% for opiates, 12.7% for cocaine, 9.0% for methadone, 3.6% for ecstasy and nobody for amphetamines. We noticed a good correlation between screening and confirmation tests for cannabinoids, methadone and cocaine. The analysis of the population of positive subjects shows that it's almost entirely composed by males, Italians, middle aged, heavy smokers and generally overweight, in apparent good health (average blood tests, any reported illnesses, any disability or any contraindications/limitations in employment).

The impact of COVID-19 on doctors' well-being: results of a web survey during the lockdown in Italy.

OBJECTIVE: On March 12, 2020, the World Health Organization (WHO) declared the outbreak of a new Coronavirus disease (COVID-19), to be a pandemic. From the beginning, Italy (in particular the Northern regions) was the first large European country to be hit and one of the most affected countries worldwide. This had a significant impact on the workload and psychological health of health workers. The aim of this web-based cross-sectional study is to assess the consequences of the COVID-19 pandemic on Italian doctors' well-being and psychological distress, in respect of demographic and occupational characteristics, lifestyle and habits during the lockdown period. PATIENTS AND METHODS: We conducted a web-based cross-sectional survey based on Google® Forms to collect data. The participation was available during the lockdown period that started in Italy on March 9, 2020 and it was voluntary and anonymous. The questionnaire explored demographic and occupational variables, lifestyle and habits during the lockdown, perceived well-being and psychological distress. Multivariate logistic regression models were fitted. RESULTS: Our study reported the very alarming psychological conditions of Italian doctors, especially among those who worked in the most affected regions, where a level of psychological distress of 93.8% and poor well-being of 58.9% were registered. These percentages were even higher in the case of female hospital workers with low job seniority, and those caring for COVID-19 patients. CONCLUSIONS: Our findings reported a significant psychosocial impact of the COVID-19 outbreak on Italian doctors, particularly among those working in the most affected regions of the country. Further studies are necessary to better understand the effects of the COVID-19 pandemic on doctors' well-being and mental health over time, in order to implement effective prevention measures.

Work-related stress risk and preventive measures of mental disorders in the medical environment: an umbrella review.

OBJECTIVE: Work-related stress (WRS) is widespread among medical doctors. WRS not only affects the physician's mental and physical well-being, but also patient care quality and the overall efficiency of the healthcare system. The aim of this study is to conduct a systematic review of the current preventive measures against mental disorders, work-related stress, and burnout among physicians. MATERIALS AND METHODS: The presentation of this systematic review is in accordance with the PRISMA statement. The methodological quality of the selected studies was assessed with specific rating tools: INSA, Newcastle Ottawa Scale, JADAD scale, and AMSTAR. English publications only were selected. No restrictions applied for publication type. Reviewers excluded articles not concerning the following topics: WRS prevention, WRS risk factors and mental disorders among physicians. Reviewers also excluded findings of less academic significance, editorial articles, individual contributions, purely descriptive studies published in scientific conferences. RESULTS: Online search returned 4748 references on the following databases: PubMed (1638), Scopus (3108) and Cochrane Library (2). 36 studies were included in this review (thereof, 13 reviews and 23 original articles). Narrative reviews were rated on the INSA scale. The mean, median, and modal rating was 6. This indicates an intermediate-high quality of these studies. Systematic reviews were rated on the AMSTAR scale. The mean and median rating was 9, and the modal rating was 8. This indicates a high quality of these studies. The scores assigned to the original articles have a mean, median, and modal rating of 7. This also indicates an intermediate-high quality of these studies. CONCLUSIONS: Work-related stress and mental disorders seem to be widespread among medical practitioners. It is already a priority to adopt preventive measures against these phenomena. However, there is still no consensus on what the most effective measures are. Additional research is needed to formulate evidence-based recommendations.

Functional ovarian lesions in children and adolescents: when to remove them.

STUDY OBJECTIVE: Functional ovarian lesions represent 45% of all pediatric adnexal abnormalities. Their surgical management, even if frequent, is not clear, especially in pediatric age. MATERIALS AND METHODS: We retrospectively reviewed 22 pediatric patients surgically treated for functional ovarian lesions from 2000 to 2006. The following characteristics were analysed: age, size of the lesion, ultrasound (US) aspect and clinical presentation. RESULTS: The average age was 16.1 years of age (range: 6 months-18 years). Of the 22 functional lesions, 12 (55%) were follicular cysts and 10 (45%) corpus luteum ones. The average size was 6.7 cm (range: 5.1-33 cm). US scan showed simple lesions in 10 cases (45%) and complex ones in 12 cases (55%). In 16 girls (72.8%) the presenting symptom was abdominal pain while 2 patients (9%) presented abdominal distention. In the other 4 patients (16.2%) the lesion was found accidentally during US examination. CONCLUSION: In pediatric subjects, functional ovarian cysts rarely required surgical intervention, though no complications or disorder recurrence were reported. To preserve ovarian function, conservative surgery has to be performed whenever feasible.

[Health problems in the working occupation of young people in handicraft factories]. / Problematiche sanitarie nell'inserimento lavorativo del giovane nelle piccole imprese.

The regulation of the work activity of young people (younger and apprentices) evolved in Italy - as in the others industrialized countries - in the last century. In the 1967 was promulgated the Law 977 (Protection of children and adolescent at work), still in force. To start the work activity, young people must be older than fifteen years and need to have ended the compulsory school. The most recent laws extend to the student the worker's rights. Many studies are conducted on the populations of apprentices - a sort of "virgin" subjects respect to work hazards - with the aim of early identify the subjects susceptible to develop, in future, illness related to work. In particular, many studies show an increased percentage in sensitization to high weight proteins, present in many working process, during the apprenticeship period. The practical stage activity, mainly necessary in the technical schools, can hide various hazards for the health of young students. The student must be followed by two different tutors, tightly collaborating together, one of the school and the other of the company where the work activity is done. The health status of the student could be evaluated before starting an hazardous work.

Multiple ovulation and embryo transfer with fresh, frozen and vitrified red deer (Cervus elaphus) embryos in Argentina.

Two multiple ovulation and embryo transfer (MOET) programs with fresh, frozen and vitrified red deer embryos were carried out during the reproductive season of 2005 and 2006 in a local breeding farm in Argentina. Multiparous (n=10 and 9, respectively) weaned hinds were used as donors for each year. The estrous synchronization treatment of donors and recipients consisted of inserting an ovine intravaginal sponge containing medroxiprogesterone acetate (MAP) for 12 days. Superovulation was conducted with a total dose of 180 mg of NIH-FSH-P1 (Folltropin-V, Bioniche, Belleville, Ontario, Canada), given i.m. in eight decreasing doses every 12h (40, 40; 27, 27; 15, 15; 8, 8 mg), from days 10 to 13. Donor females were mated with one stag of proven fertility. The recovery rate was 84.1% (122/145), obtaining 45.1% (55/122) of transferable embryos, 24.6% (30/122) of degenerated embryos and 30.3% (37/122) of unfertilized oocytes. Pregnancy rates after transfer of fresh, OPS vitrified/warmed and ethylene glycol (EG) frozen/thawed embryos were 64.3% (18/28), 53.3% (8/15) and 70.0% (7/10), respectively. Vitrification and freezing with ethylene glycol procedures constitute an interesting alternative for red deer embryo cryopreservation.

Effect of estrous cow serum during bovine embryo culture on blastocyst development and cryotolerance after slow freezing or vitrification.

UNLABELLED: The present study investigated the effect of estrous cow serum (ECS) during culture of bovine embryos on blastocyst development and survival after cryopreservation by slow freezing or vitrification. Embryos were derived from in vitro maturation (IVM) and in vitro fertilization (IVF) of abbatoir-derived oocytes. At Day 3, embryos were cultured in three different media: Charles Ronsenkrans medium + amino acids (CR1aa; without bovine serum albumin (BSA)) + 5% estrous cow serum (CR1-ECS), CR1aa + 3 mg/mL BSA (CR1-BSA) or CR1aa + 5% ECS + 3 mg/mL BSA (CR1-ECS-BSA). At 7.5 d post-insemination (PI), blastocyst yield and quality were evaluated; blastocysts and expanded blastocysts from each media were cryopreserved by Open Pulled Straw (OPS) vitrification method or slow freezing (1.5 M ethylene glycol, EM). Total blastocyst yield did not differ among CR1-ECS, CR1-BSA and CR1-ECS-BSA (30.9, 33.1 and 32.9%, respectively, P < 0.05). Embryo survival (hatching rate) was higher in vitrified versus slow-frozen embryos (43% versus 12%, respectively, P < 0.01), and in embryos cultured in CR1-BSA (40.3%) compared with those cultured in serum-containing media (CR1-ECS, 21.5% and CR1-ECS-BSA, 19.8%; P < 0.01). IN CONCLUSION: (a) it was possible to produce in vitro bovine embryos in serum-free culture medium without affecting blastocyst yield and quality; (b) serum-free medium produced the best quality embryos (in terms of post-cryopreservation survival); and (c) vitrification yielded the highest post-cryopreservation survival rates, regardless of the presence of serum in the culture medium.