Assessing Workplace Violence: Methodological Considerations.

The risk of violence is present in all workplaces. It must be accurately assessed to establish prevention and protection measures tailored to the features of each situation. The risk management process requires compliance in a sequential order: 1) risk identification, 2) quantitative risk assessment, and 3) impact assessment. Gathering workers' experiences using lists, focus groups, or participatory ergonomics groups is necessary to identify the phenomenon. For risk assessment, spontaneous reporting of events is often insufficient. It may be complemented with two methods: systematic recording of violent events that occurred in the past year during periodic medical examinations of workers and targeted surveys. The epidemiological analysis of data from individual interviews and surveys provides the phenomenon's prevalence, incidence, and evolution. Moreover, reporting the harm suffered by victims of violence allows constructing impact matrices to allocate resources where they are most needed.

Knowledge of Human Papillomavirus (HPV), Attitudes, and Practices Towards Anti-HPV Vaccination Among Israeli Nurses.

Human papillomavirus (HPV) is a small, non-enveloped, double-stranded DNA virus, belonging to the family of Papillomaviridae. It is a highly common infectious agent, which causes one of the most widespread sexually transmitted infections (STIs), involving approximately 20% of sexually active female adolescents and up to 80% of female adults aged 50 years. There exist two major preventative strategies: namely, anti-HPV vaccination and cervical screening. Healthcare providers, including nurses, can play a crucial role in HPV immunization campaigns, counteracting vaccine hesitancy and doing advocacy and counseling. To explore the overall knowledge of HPV and HPV-related issues, as well as the attitudes and practices of Israeli nurses, a modified and adapted, previously validated knowledge, attitudes, and practices (KAP) questionnaire was administered to a sample of 565 participants, 481 female (85.1%) and 84 male (14.9%). Most of them were married (n = 428, 75.8%), with more than 5 years of experience (n = 405, 71.7%), working in the general/internal medicine ward (n = 432, 76.5%), and Jewish (n = 352, 62.3%). Only 87 nurses (15.4%) got vaccinated against HPV. Forty-four (9.1%) of the female nurses never underwent a Pap smear. Higher percentages of right replies were reported only for the item related to available preventative strategies for cervical cancer (82.1% versus 17.9%). Higher percentages of wrong replies were reported for items related to body regions that can be infected by HPV (60.5% versus 39.5%), percentage of girls aged 15-18 years being sexually active (68.0% versus 32.0%). Similar percentages of right and wrong replies were reported for items related to whom the Pap test is recommended (52.7% versus 47.3%), Israeli Ministry of Health's guidelines for anti-HPV vaccination (50.4% versus 49.6%), and percentage of boys aged 15-18 years being sexually active (44.4% versus 55.6%). Concerning the reliability of the third section of the questionnaire, Cronbach's alpha was deemed to be acceptable (α = 0.64). Statistically significant determinants of reporting lower scores in HPV-related attitudes and practices were religion (OR 1.44 [95%CI 1.02-2.04]), and male offspring (OR 1.22 [1.03-1.44]). This study has important implications for policy- and decision-makers in that they should be aware of the overall poor and unsatisfactory level of HPV-related knowledge among Israeli nurses and implement multipronged HPV vaccine promotion programs, taking into account the challenges of a multicultural and diverse society like Israel.

Fitness to Drive: It is Time for Evidence-Based Consensus and Italian Guidelines for Medical Driving Assessment.

European Union (EU) and non-EU countries have adopted different medical procedures for the issuance and renewal of a driver's license showing relevant matters of concern. In Europe, EU directives have been only partially supplemented with national laws, and there is a paucity of evidence-based criteria and methods for fitness-to-drive assessment. For instance, there is no agreement on standards for establishing which is the competent authority charged with the medical examination. Furthermore, license conditions, restrictions, or vehicle modifications, which appear as "limited use" codes on the driver's license are not regulated. This may generate confusion and deformity when it comes to the medico-legal evaluation, with potential ethical implications due to lack of transparency and equity and legal disputes between citizens and competent authorities. In this article, Italian experts on fitness-to-drive medical assessment highlight some major issues concerning the medical driving assessment activity in the EU. The Italian experience is shown as a case study, which is representative of other EU member states, for launching a call for evidence-based consensus documents and scientific guidelines on this topic, which may be helpful to international regulators and medico-legal stakeholders.

Safety & effectiveness of COVID-19 vaccines: A narrative review.

There are currently eight vaccines against SARS-CoV-2 that have received Emergency Use Authorization by the WHO that can offer some protection to the world's population during the COVID-19 pandemic. Though research is being published all over the world, public health officials, policymakers and governments are collecting evidence-based information to establish the public health policies. Unfortunately, continued international travel, violations of lockdowns and social distancing, the lack of mask use, the emergence of mutant strains of the virus and lower adherence by a sector of the global population that remains sceptical of the protection offered by vaccines, or about any risks associated with vaccines, hamper these efforts. Here we examine the literature on the efficacy, effectiveness and safety of COVID-19 vaccines, with an emphasis on select categories of individuals and against new SARS-CoV-2 strains. The literature shows that these eight vaccines are highly effective in protecting the population from severe disease and death, but there are some issues concerning safety and adverse effects. Further, booster shots and variant-specific vaccines would also be required.

Comparison of Vie Scope® and Macintosh laryngoscopes for intubation during resuscitation by paramedics wearing personal protective equipment.

BACKGROUND: Endotracheal intubation (ETI) is still the gold standard of airway management, but in cases of sudden cardiac arrest in patients with suspected SARS-CoV-2 infection, ETI is associated with risks for both the patient and the medical personnel. We hypothesized that the Vie Scope® is more useful for endotracheal intubation of suspected or confirmed COVID-19 cardiac arrest patients than the conventional laryngoscope with Macintosh blade when operators are wearing personal protective equipment (PPE). METHODS: Study was designed as a prospective, multicenter, randomized clinical trial performed by Emergency Medical Services in Poland. Patients with suspected or confirmed COVID-19 diagnosis who needed cardiopulmonary resuscitation in prehospital setting were included. Patients under 18 years old or with criteria predictive of impossible intubation under direct laryngoscopy, were excluded. Patients were randomly allocated 1:1 to Vie Scope® versus direct laryngoscopy with a Macintosh blade. Study groups were compared on success of intubation attempts, time to intubation, glottis visualization and number of optimization maneuvers. RESULTS: We enrolled 90 out-of-hospital cardiac arrest (OHCA) patients, aged 43-92 years. Compared to the VieScope® laryngoscope, use of the Macintosh laryngoscope required longer times for tracheal intubation with an estimated mean difference of -48 s (95%CI confidence interval [CI], -60.23, -35.77; p < 0.001). Moreover VieScope® improved first attempt success rate, 93.3% vs. 51.1% respectively (odds ratio [OR] = 13.39; 95%CI: 3.62, 49.58; p < 0.001). CONCLUSIONS: The use of the Vie Scope® laryngoscope in OHCA patients improved the first attempt success rate, and reduced intubation time compared to Macintosh laryngoscope in paramedics wearing PPE for against aerosol generating procedures. TRIAL REGISTRATION: ClinicalTrials registration number NCT04365608.

Protecting hospitals from SARS-CoV-2 infection: A review-based comprehensive strategy for COVID-19 prevention and control.

SUMMARY: SARS-CoV-2-related infection can determine hospital-acquired infections among patients and healthcare workers. Aim of this paper was to review the literature for developing a strategy for protecting healthcare workers, patients, and visitors by COVID-19 hospital infection. A critical and rapid revision of the literature and international standards and Regulations on this topic allowed us to propose an evidencebased strategy in the framework of the workplace risk assessment for preventing nosocomial COVID-19 outbreaks. The virus' high transmissibility, the high prevalence of asymptomatic carriers and false-negative Covid-19 rates on naso- and oropharingeal swabs, put hospitals at high-risk of COVID-19 outbreaks. A comprehensive strategy based on standard precautions, administrative, environmental, and engineering controls, a screening protocol for patients on their admission to hospital, and a testing-based strategy for HCWs within health surveillance programs may prevent the onset of hospital outbreaks, which are a threat to community, patients and HCWs, compromising the sustainability of healthcare facilities.

Workplace Violence Is Associated With Impaired Work Functioning in Nurses: An Italian Cross-Sectional Study.

OBJECTIVE: Workplace violence against nurses is a widespread phenomenon that has been associated with many unfavorable individual and organizational outcomes. The aim of this study was to analyze the relationship between violence and work functioning in a sample of Italian nurses. DESIGN: Cross-sectional, with retrospective analysis of exposure. METHODS: All nurses from a local hospital were invited to complete a questionnaire assessing violent experiences that occurred in the previous 12 months. The questionnaire also measured job strain (with the Demand-Control-Support questionnaire), organizational justice (with Colquitt's Questionnaire), and work impairment (with the Nurses Work Functioning Questionnaire). The associations were examined with logistic regression analyses. FINDINGS: Of the 302 nurses who were invited, 275 (91.1%) agreed to participate. The total work impairment score was significantly higher among the nurses exposed to violence compared with the nonexposed nurses (42.2 ± 27.8 vs. 31.9 ± 31.6, respectively; p < .001). Exposed nurses also reported significantly higher levels of job strain (0.96 ± 0.25 vs. 0.8 ± 0.21; p = .003) and lower levels of perceived organizational justice (56.6 ± 12.6 vs. 62.5 ± 14.8; p = .001) than nonexposed nurses. Nurses who had experienced violence had a significantly higher risk for impairment of work functioning than their colleagues (crude odds ratio [OR] = 2.33; 95% confidence interval [CI 95%] = 1.42-3.83). The association between violence and impairment remained significant after adjusting for demographic variables, occupational stress, and perceived organizational justice (OR = 1.83; 95% CI 95% = 1.06-3.17). CONCLUSIONS: Workplace violence is associated with impaired work function in nurses. Job strain and perceived organizational injustice are associated with impairment. CLINICAL RELEVANCE: Violence prevention programs in healthcare activities should include training for violent behavior identification and de-escalation techniques, structural and administrative measures for violence control (such as alarms, surveillance, staff increase), and measures to reduce occupational stress, which can include wellness courses, spirituality, organizational improvements, and staffing methodologies.

An Italian Experience of Spirituality from the Coronavirus Pandemic.

In this letter to the editor, the authors tell their personal experience in the fight against Coronavirus pandemic and call for more spirituality needed to battle in the COVID-19 emergency. They commemorate the story of many Italian priests who have died in this tragedy and claim that spiritual skills for healthcare workers are especially important in a disaster scenario like this COVID 19 pandemic, to relieve stress and psychic sufferance of the same healthcare professionals as well as of patients and their families.

The significant role of health surveillance in the occupational heat stress assessment.

In order to address the heat stress hazard, the worker health surveillance makes a difference by providing information about individual factor, feedback, and evidence about efficacy of preventive measures and activities carried out through the risk assessment process, at individual and group levels. Every technical, procedural, or organizational measures could be ineffective without taking into account the results provided by health surveillance.

[Monoclonal gammopathy of uncertain significance (MGUS) and occupational risk factors: criteria to carry out the health surveillance]. / Gammopatia monoclonale di incerto significato (MGUS) e fattori occupazionali di rischio: criteri di attuazione della sorveglianza sanitaria.

SUMMARY: Monoclonal gammopathy of uncertain significance (MGUS) identifies a clinically asymptomatic and laboratory-based situation characterized by a modest monoclonal component (MC). In a limited percentage of cases, on a probabilistic basis, the asymptomatic genepremalignant stage could lead to multiple myeloma (MM). Materials and Methods. Based on literature data and available Guidelines on the subject, the diagnostic criteria and a methodological path are here suggested to the Occupational Physician to formulate a judgment of suitability for the task with exposure risk to RI or pesticides. Results. Some studies have evaluated the prevalence of MGUS in subjects exposed professionally to pesticides. Numerous other studies conducted on the survivors of the atomic bombing of Hiroshima and Nagasaki have highlighted a possible association with exposure to ionizing radiation (IR). The guidelines relating to the diagnosis and management of MGUS cases (with respect to the potential evolution in MM allow) to draw important operational indications for the competent/authorized physician. Conclusions. The routinely use of laboratory tests for subjects exposed to the studied risk factors is generally indicated starting from the worker's 50 years of age. The finding of a MGUS in the absence of further laboratory alterations represents the situation most frequently and does not require further measures, other than those of foreseeing even blood controls at least every two years. In this situation, there are no justified restrictions on work activities with exposure risks to IR or pesticides. If alterations suggestive for an increased risk of evolution in a neoplastic way could be identified, a close periodicity - every 3-6 months - of haematological checks is recommended. In these cases, it appears justified an abstention from activities involving exposure to ionizing radiation for a period of time that will be evaluated based on the evolution of the framework and by the progress of laboratory tests in the monitored period.

[Proposal of a method for assessing the risk of burnout in teachers: the VA.RI.B.O strategy]. / Proposta di un metodo per la valutazione del rischio di burnout negli insegnanti: il VA.RI.B.O (VAlutazione RIschio Burn-Out).

SUMMARY: Introduction. Burnout syndrome (BOS) can be defined as a chronic work strain characterized by three dimensions: emotional exhaustion, depersonalization (or cynicism), reduced professional effectiveness. BOS typically strikes the helping professions like the teachers. Objective. The aims of this study are: 1) clarify the concept of BOS, as currently configured in the international scientific literature; 2) analyze the psychosocial risk factors in teachers; 3) develop a methodology for the assessment and prevention of the risk of BOS in the teachers. Methods. The literature review followed some of the PRISMA guidelines criteria. Results and discussion. The results of the study highlight BOS as a risk factor specific and distinct from labor-related stress. A strategy called VA.RI.B.O is proposed (Burn-Out Recognition) for teachers.

[The Italian version of the "Claustrophobia Questionnaire": validation study and perspectives of use for the occupational physician.] / La versione italiana del "Claustrophobia Questionnaire": studio di validazione e prospettive di utilizzo per il medico del lavoro.

OBJECTIVES: Aim of our study was to adapt the Claustrophobia Questionnaire (CLQ) to the Italian context. METHODS: In our study, a sample of 50 claustrophobic patients was compared to 50 healthy people (control group). All of them answered the Claustrophobia Questionnaire and the Stait-Trait Anxiety Inventory Form Y1 and Y2, as well as demographic questions. RESULTS: As it was theoretically expected, our results confirmed the two-factor structure and showed that the Italian version of the CLQ has good psychometric properties. Indeed, it was observed that claustrophobic patients scored higher in claustrophobia than those from the control group. CONCLUSIONS: In conclusion, the Italian version of the CLQ is a reliable and valid instrument to assess claustrophobic fear.

[Is burnout a syndrome or an occupational disease? Instructions for occupational physicians]. / Il burnout è una sindrome o una malattia professionale? Istruzioni per i medici del lavoro.

Since Herbert Freudenberger described Burnout Syndrome (BOS) in 1974, thousands of scientific papers have been published on this syndrome and this trend does not seem to diminish. After being internationally known as a syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment in helping professions, its construct has been criticized, questioned, and subjected to profound modifications. To date, however, in Italy and in many other Countries it is not possible to diagnose this syndrome, because World Health Organization, in its last ICD-10, did not indicate any clinical criteria to diagnose it. Unfortunately, not even in the recent DSM- 5 by American Psychiatric Association, contrary to what was expected, BOS found room as a specific psychiatric disorder. As a consequence, framing this syndrome from a medical-legal point of view is still widely debated from scholars.

[Thermal comfort and indoor air quality in some of the italian state police workplaces.] / Comfort termico e qualità dell'aria indoor in alcuni ambienti di lavoro della Polizia di Stato in Italia.

OBJECTIVES: Little can be found in the literature about thermal comfort and indoor air quality (IAQ) in law enforcement workplaces. This study, based on environmental surveys carried out by the Centro Sanitario Polifunzionale of Milan (Italian State Police Health Service Department), aims to assess the thermal comfort and IAQ in some of the Italian State Police workplaces. METHODS: Measurements were performed in some indoor workplaces such as offices, archives, laboratories and guard-houses in various regions (Lombardia, Emilia Romagna, Liguria, Veneto, Trentino Alto-Adige) of Northern Italy. The PMV/PPD model developed by Fangar for the evaluation of the thermal comfort was used. We measured both CO2 concentration and relative humidity indoor levels for the evaluation of IAQ. We used Chi square and t Student tests to study both prevalence of thermal discomfort and low IAQ, and their differences between summer and winter. RESULTS: For the purposes of the present study we carried out 488 measurements in 36 buildings (260 in winter and 228 in summer). Our results showed that thermal comfort was reached in 95% and 68% of environmental measurements (in winter and summer, respectively). In summer, we measured different types of thermal discomfort. As regard to IAQ, CO2 exceeded the threshold limit value (1000 ppm) in 39% (winter) and 9% (summer) of our measurements. Chi-square test showed a statistically significant difference between summer and winter for all outcomes considered. Indeed, thermal comfort was better in winter than summer (X2 = 61.0795), while IAQ was found to be better in the summer than winter considering both the CO2 1000 ppm and 1200 ppm threshold values (X2 = 56.9004 and X2 = 8.8845 respectively). Prevalence of low relative humidity in winter was higher than in summer (X2 = 124.7764). CONCLUSIONS: Even though this study did not report any situation of risk to Italian police officers health and safety, it has highlighted some potential issues in some of the examined workplaces, concerning thermal comfort in summer and IAQ in winter. Regarding the risk assessment process, simple and inexpensive preventive measures are already feasible in the 'observation phase' of the risk assessment, before execution of instrumental environmental survey. According to the technical standards and risk assessment models, this way might increase both comfort levels for workers employed in indoor environments and the effectiveness of the risk assessment process, through the optimization of available resources.

Religious Belief and Mental Health in Lay and Consecrated Italian Teachers.

There is compelling evidence that teachers and clergy are stressful occupations. This study aimed to compare the rate of job strain and burnout among lay and consecrated teachers and to study the effect of religious coping on the mental health of these two groups. A cross-sectional survey study was carried out in Catholic kindergarten, preschool and primary schools of an Italian Congregation of nuns, in South Italy. The Italian versions of the Maslach Burnout Inventory-Educator Survey (MBI-ES) scale, of the General Health Questionnaire (GHQ-12) and a study-specific questionnaire with sociodemographic variables and indicators of subjective (self-reported religiosity) and objective (prayer personal and church attendance) religiousness were used. Data were analyzed according to the guidelines for data processing and an analysis of the scales used. The participation rate of this study was 88 %. There was a significant difference between two groups in religiousness and job strain/burnout scores (lay teachers were the most affected group). Moreover, religiousness scores had a positive correlation with personal accomplishment, job satisfaction and perceived performance and a negative correlation with emotional exhaustion, turnover intention and morbidity psychiatric. Therefore, according to religious coping's research, prayer personal and church attendance can be recommended as two of the ways to prevent job strain and burnout in the teacher work.