Interpersonal sensitivity and persistent attenuated psychotic symptoms in adolescence.

Interpersonal sensitivity defines feelings of inner-fragility in the presence of others due to the expectation of criticism or rejection. Interpersonal sensitivity was found to be related to attenuated positive psychotic symptom during the prodromal phase of psychosis. The aims of this study were to examine if high level of interpersonal sensitivity at baseline are associated with the persistence of attenuated positive psychotic symptoms and general psychopathology at 18-month follow-up. A sample of 85 help-seeking individuals (mean age = 16.6, SD = 5.05) referred an Italian early detection project, completed the interpersonal sensitivity measure and the structured interview for prodromal symptoms (SIPS) at baseline and were assessed at 18-month follow-up using the SIPS. Results showed that individuals with high level of interpersonal sensitivity at baseline reported high level of attenuated positive psychotic symptoms (i.e., unusual thought content) and general symptoms (i.e., depression, irritability and low tolerance to daily stress) at follow-up. This study suggests that being "hypersensitive" to interpersonal interactions is a psychological feature associated with attenuated positive psychotic symptoms and general symptoms, such as depression and irritability, at 18-month follow-up. Assessing and treating inner-self fragilities may be an important step of early detection program to avoid the persistence of subtle but very distressing long-terms symptoms.

Predictors of Hepatitis B Surface Antigen Titers two decades after vaccination in a cohort of students and post-graduates of the Medical School at the University of Palermo, Italy.

Introduction and objective. The introduction of a vaccine against hepatitis B virus (HBV) for newborn babies in Italy in 1991, extended to 12-year-old children for the first 12 years of application, has been a major achievement in terms of the prevention of HBV infection. The objective of this study was to analyse the long-term immunogenicity and effectiveness of HBV vaccination among healthcare students with different working seniorities. Materials and method. A cross-sectional observational study of undergraduate and postgraduate students attending the Medical School of the University of Palermo was conducted from January 2014 - July 2016. HBV serum markers were performed with commercial chemiluminescence assays. Categorical variables were analyzed using the chi-square test (Mantel-Haenszel), whereas means were compared by using the Student's t test. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were also calculated by a multivariable logistic regression, using a model constructed to examine predictors of anti-HBs titer above 10 mIU/mL, assumed as protective. Results. Of the 2,114 subjects evaluated - all vaccinated at infancy or at the age of 12 years and were HBsAg/anti-HBc negative - 806 (38.1%) had an anti-HBs titre <10 IU/L. The latter were younger, more likely to be attending a healthcare profession school (i.e., nursing and midwifery), than a medical postgraduate level school, and more likely to have been vaccinated in infancy (p <0.001, 95% CI 2.63-5.26, adjusted OR 3.70). Conclusion. The results of the study suggest that assessment of HBV serum markers in workers potentially exposed to hospital infections is useful for identifying small numbers of unvaccinated subjects, or vaccinated subjects with low antibody titre, all of whom should be referred to a booster series of vaccinations.

CD8+ T cells expressing IL-10 are associated with a favourable prognosis in lung cancer.

The dual role of tumour-infiltrating macrophages and lymphocytes on nonsmall cell lung cancer (NSCLC) progression and prognosis may be due to the differential activity of their phenotypes. To investigate the impact of inflammatory cells on NSCLC, we first quantified the number of macrophages (CD68+) and lymphocytes (CD8+ and CD4+) and the percentage of CD8+ cells expressing IL-10 (CD8+/IL-10+) in tumour stroma and epithelium. Then, we evaluated the possible relationships between the numbers of these cells and the clinicopathological features and the overall survival of patients. Paraffin-embedded sections of surgical specimens from 64 patients who had undergone surgery for NSCLC were immunostained with antibodies directed against CD68, CD4, CD8 and IL-10. The percentage of CD8+/IL-10+ cells was higher in cancer stroma of patients with stage I NSCLC than in those with stages II, III, and IV. High percentages of stromal CD8+/IL-10+ cells were associated with longer overall patient survival. In contrast, the number of CD68+, CD8+ and CD4+ cells did not differ between stage I NSCLC and stages II, III, and IV. In conclusion, the survival advantage of patients with stage I NSCLC may be related to the anti-tumour activity of the CD8+/IL-10+ cell phenotype.

Macrophage expression of interleukin-10 is a prognostic factor in nonsmall cell lung cancer.

Interleukin (IL)-10 is expressed in many solid tumours and plays an ambiguous role in controlling cancer growth and metastasis. In order to determine whether IL-10 is involved in tumour progression and prognosis in nonsmall cell lung cancer (NSCLC), IL-10 expression in tumour cells and tumour-associated macrophages (TAMs) and its associations, if any, with clinicopathological features were investigated. Paraffin-embedded sections of surgical specimens obtained from 50 patients who had undergone surgery for NSCLC were immunostained with an antibody directed against IL-10. TAMs and tumour cells positive for IL-10 were subsequently quantified. IL-10-positive TAM percentage was higher in patients with stage II, III and IV NSCLC, and in those with lymph node metastases compared with patients with stage I NSCLC. High IL-10 expression by TAMs was a significant independent predictor of advanced tumour stage, and thus was associated with worse overall survival. Conversely, IL-10 expression by tumour cells did not differ between stages II, III and IV and stage I NSCLC. In conclusion, interleukin-10 expression by tumour-associated macrophages, but not by tumour cells, may play a role in the progression and prognosis of nonsmall cell lung cancer. These results may be useful in the development of novel approaches for anticancer treatments.

CC ligand 2 levels are increased in LPS-stimulated peripheral monocytes of patients with non-small cell lung cancer.

Non-small cell lung cancer (NSCLC) shows a particular aggressive behaviour. Tumour associated macrophages (TAMs) play an important role in tumour growth and progression and CC ligand 2 (CCL2)/CCR2 axis is markedly involved in their recruitment in the tumour mass from the circulation. The aim of this study was to determine the plasma levels of CCL2 and the expression of CCR2 in the peripheral blood mononuclear cells (PBMCs) of 18 smokers with NSCLC, eight healthy smokers and nine non-smokers. Then, we investigated CCL2 levels in the supernatants of unstimulated and LPS-stimulated PBMC cultures of the same groups of patients. CCL2 levels in plasma and supernatants of PBMC cultures were determined by ELISA. CCR2 expression in PBMC cytospins was assessed by immunocytochemistry. CCL2 plasma levels and CCR2 expression by PBMCs were similar in patients with NSCLC, healthy smokers and non-smokers. In the supernatants of unstimulated PBMC cultures, CCL2 content was not different between the three groups of subjects. Supernatants of LPS-stimulated PBMCs of NSCLC patients showed a higher content of CCL2 as compared to supernatants of non-smokers (p<0.005). CCL2 content increased 28.5-fold vs baseline production in the group of NSCLC patients, 15-fold in healthy smokers and 13-fold in the group of non-smokers. In conclusion, after LPS stimulation, PBMCs of patients with NSCLC release higher levels of CCL2 as compared to those of non-smokers, supporting the hypothesis of a CCL2 involvement in NSCLC biology.

[The risk management in health personnel tuberculosis]. / La gestione del rischio tbc nel personale sanitario.

Within work environment and even more among health service areas, to deepen the monitoring efforts and awareness of the workers in order to accomplish a more effective and fast response against morbidity indexes and prevalence of tbc, constitute the necessary prerequisite for any subsequent action of prevention and control. On the other hand, one of the employer's obligations toward a health facility is to identify professionally exposed subjects (Legislative Decree 626/94 art.78), and perform risk assessment. Continuous report from various hospitals concerning suspicious contacts between employees and patients affected by tbc further increase the threat. At AOUP in Palermo from 2003 to May 2007, 39 cases of suspected contact between employees and patients affected by tbc were reported to the 'Staff Union for Health Related Issues' by various hospital departments and the 'Office of the Medical Competent', 34 of these reported cases have pulmonary involvement. The above mentioned situation made necessary to launch an effective program capable of addressing the risks of tbc in both circumstances of suspected or certain contact and during normal work activities.

[Occupational exposure and chronic heart failure severity]. / Esposizione professionale e gravità dello scompenso cardiaco cronico.

Chronic heart failure (CHF) is characterized by the inability of the heart to supply the body with sufficient amount of blood for metabolic and circulatory needs. The main risk factors for CHF development are: hypertension, type 2 diabetes, obesity, smoking, chronic kidney diseases. Many occupational exposures, such as extremes of heat or cold temperatures, prolonged exposure to noise, vibrations, pesticides, can contribute to etiology of this disease. The aim of our study was to evaluate if work can affect CHF severity. We analyzed retrospectively the first 76 smokers aged over 65 years who presented to the outpatient Clinic of Chronic Heart Failure. The patients were divided in 4 groups based on their previous job: white-collars, farmers, steelworkers and subjects performing different occupational activities (hairdressers, firemen, masons). Our results showed that farmers had a reduced left ventricular ejection fraction compared with white-collars (p = 0.0045) although NYHA class and the presence/absence of CHF risk factors were not different between the two groups. This data suggests that the farmer job could be associated with the severity of CHF.

[Upper limb mechanical overcharge among health care workers]. / Il rischio da sovraccarico biomeccanico degli arti superiori in ambito sanitario.

In medical circle, the disclosure of recurrent symptomatologies on the upper limbs begins to assume characteristics common to many working classes, raising not few problematic issues regarding the interactions between them and the working environment. In the AOUP of Palermo, some working categories were identified, whose activity implicates the upper limbs for instrument use, as well as repetitious movements (odontologists, ultrasonographers, endoscope technicians). The analysis covered a group of endoscopy technicians, both of the medical area and of the surgical one, the first being middle aged and with working seniority significantly higher than the latter. To these people, a RULA questionnaire was given, partially modified with the addition of some questions finalized at pointing out environmental situations that determine physical stresses on the upper limbs, correlated to the working method, to the number of made tests, to the place where they were made. From the study made, it was found that there is high risk of biomechanical overcharge on the upper limbs in the activity of endoscopy technicians. Thus the necessity of preventive corrective measures geared at avoiding on the one hand insurance claims, and on the other, the pathologies which can limit the working activity.

[Work related diseases: assistance to delivery among obstetricians]. / Patologie lavoro correlate: l'assistenza al parto nel gruppo degli ostetrici.

In the course of Sanitary Surveillance, a high incidence of pathologies of the superior limbs was encountered in a homogeneous group of midwives operating in the AOUP of Palermo. These findings induced the authors' starting a retrospective study aimed at understanding the possibility of correlation between work effected and damage to people, and geared at being able to frame the findings in the ambit of the related to occupational pathologies. It is a fact that the positions taken by midwives in the course of gynecological vaginal delivery, or those necessary to the maneuvers during childbirth, such as the lateral or the simple and/or exaggerated MacRoberts maneuver, require substantial overcharging of the spinal column and a significant engagement of the muscles of the upper limbs. The analysis of the data related to the working load effected in the various years (number of parts/years), highlighted how the group of midwives exposed to a higher risk were those with a longer working life, this in consideration of the great emphasis placed on the upper limbs. It cannot therefore be ruled out that the pathologies encountered in the group of midwives can be framed in the area of occupational related pathologies.

[Organization of work, hardship at work, mobbing: new problem areas that must be considered by the competent doctor in formulating fitness evaluation]. / L'organizzazione del lavoro, il disagio lavorativo, il mobbing: le nuove problematiche all'attenzione del medico competente per la formulazione del giudizio di idoneità.

In recent years, in addition to the more common occupational-health risks (chemical, physical, biological), increasing importance is given to psychological and psychosomatic illness as a result of malfunction in the organization of work: burn-out, mobbing, maladjustment at work. In order to be able to evaluate the influence of such phenomenon whilst judging fitness in some working realities in Sicily, 18 small, medium and large dimension companies with a total of 1413 employees were examined. The typology of the work embraced the industrial, health, information-technology, construction and telephony sectors. The research involved analyzing, with the respective competent physicians, (in a few cases the same physician dealt with more than one company) the Risk Evaluation document, the clinical and risk records and the fitness evaluations. The analysis of the data obtained pointed out that of the 1413 employees observed, 87% was judged fit, 2% fit with limitation and/or prescription, almost 1% not fit. Notwithstanding the type of judgment, it was ascertained how in the above evaluation, only classical "physical" risks were evaluated (noise, MMC, VDT, etc.). The worker is judged as an individual removed from the general context of the company, of it's organization, or, as one who participates only by means of his various organs and apparatus, and who can singularly become ill because of exposure to some occupational risk. As a matter of fact, in none of the DVR's of the 18 companies object of the research, was an element of evaluation of the working organization found. Nor on the communication means, on the transparency of the procedures, on the quality of relations, lack of instruments or physical sites fit to working activity, nor to emotionally extreme working activities. It must therefore be emphasized that the competent physician only possesses the individual pathologies encountered in the various working situations. He lacks elements of evaluation that would supply useful information on the working organization, and on the effects the latter can have on the health of the employees, and, therefore on their fitness to work. The latter; in our opinion, is data that cannot be disregarded in the correct judgment of psycho-physical fitness, as foreseen by the regulations in force.

[Work organization and mobbing: application of cognitive methodology in medical circle]. / L'organizzazione del lavoro e mobbing: applicazione di una procedura conoscitiva in ambito sanitario.

Mobbing is a phenomenon produced for the most part by factors related to work organization. During the medical control of workers in Universitary Policlinico Hospital of Palermo, we used a methodology (in advance applied with effectiveness by ISPESL in other institutions) that is able to evidence factors of work organization causing Mobbing. 338 out 2060 workers (total staff) with different professional figures were recruited. We evidenced the working classes that had more troubles about communications of business information, about interpersonal relationships at work with top manager, with other members of team and with colleagues. Particularly doctors and OTA, in worrying percentage, stated that they suffered psychological molestations. Aim of our study was to assay a procedure that, even if it doesn't identify proclaimed mobbing phenomenon, enables us to acquire information about relationships between business management and workers and organizational aspects perceiving by subordinates. A I level study about a phenomenon in expansion is very useful to recognize preventively intentionally made mobbing actions.

[Occupational exposure to respiratory irritants and chronic obstructive pulmonary disease]. / Esposizione professionale ad agenti irritanti e sviluppo di broncopneumopatia cronica ostruttiva (BPCO).

Cigarette smoking and occupational exposure to respiratory irritants are the major riskfactors for chronic obstructive pulmonary disease (COPD), which is characterized by small-airway obstruction and destruction of pulmonary parenchyma: emphysema. We studied two groups of subjects: one exposed and the other one not-exposed to respiratory irritants, to investigate the relationship, if any, between occupational exposure and COPD. Subjects underwent high-resolution computed tomography-density mask of the chest to quantify pulmonary emphysema, pulmonary function tests, sputum induction and analysis for cell counts and measurements of metalloproteinase (MMP)-9 and its tissue inhibitor TIMP-1. Subjects with occupational exposure to respiratory irritants had higher residual volume and functional residual capacity, higher total inflammatory cells and neutrophils in induced sputum. By contrast, sputum levels of MMP-9, TIMP-1 and MMP-91TIMP-1 ratio did not differ between the 2 groups. We conclude that sputum induction and analysis could be a useful and non-invasive tool to study and follow subjects with occupational exposure to respiratory irritants.

[Primary prevention: environmental modification and changes in chronic respiratory pathology in workers in a metallurgical industry]. / In tema di prevenzione primaria: modifiche ambientali e variazioni della patologia respiratoria cronica in lavoratori di una industria metalmeccanica.

The authors analyse the data connected with chronic pulmonary diseases (mainly bronchitis) of two groups of workers, both belonging to the same metallurgical factory. The data is taken in two different periods, before and after the introduction of measures for primary prevention in the factory. The results confirm that the overall cases of pulmonary diseases are greatly reduced by a correct improvement in the working environment. Moreover, they confirm that a dangerous working environment affects the breathing system more prominently then other factors such as smoking, etc.

[Evaluation of damage in subjects exposed to nephrotoxic substances]. / Valutazione del danno in soggetti esposti a sostanze nefrotossiche.

Nephritic functionality has been studies, making use of same nephritic enzymes dosage (NAG, AAP, alpha-glucosidase, lysozyme) in three groups of workers (varnishers, metallurgists, plastic manufacture employees) professionally exposed to nephritic damage, and in a control group made up of not professionally exposed to the same hazard subjects. The aim was to precociously detect possible nephritic damage, i.e. before classic nephritic functionality indexes were distorted. An increased enzymuria appeared in those subjects that were exposed to nephrotoxic hazard. Increased enzymuria have been found in only one subject of the control group. We deem it should be useful, to customarily measure out nephritic enzymes as trusted index of tabular damage, in hiring and pensionary control examinations.