Near-Real-Time Strong Motion Acquisition at National Scale and Automatic Analysis.

A strong motion monitoring network records data that provide an excellent way to study how source, path, and site effects influence the ground motion, specifically in the near-source area. Such data are essential for updating seismic hazard maps and consequently building codes and earthquake-resistant design. This paper aims to present the Italian Strong Motion Network (RAN), describing its current status, employment, and further developments. It has 648 stations and is the result of a fruitful co-operation between the Italian government, regions, and local authorities. In fact, the network can be divided into three sub-networks: the Friuli Venezia Giulia Accelerometric Network, the Irpinia Seismic Network, and all the other stations. The Antelope software automatically collects, processes, and archives data in the data acquisition centre in Rome (Italy). The efficiency of the network on a daily basis is today more than 97%. The automatic and fast procedures that run in Antelope for the real-time strong motion data analysis are continuously improved at the University of Trieste: a large set of strong motion parameters and correspondent Ground Motion Prediction Equations allow ground shaking intensity maps to be provided for moderate to strong earthquakes occurring within the Italian territory. These maps and strong motion parameters are included in automatic reports generated for civil protection purposes.

The dramatic COVID 19 outbreak in Italy is responsible of a huge drop of urological surgical activity: a multicenter observational study.

OBJECTIVE: To describe the trend in surgical volume in urology in Italy during the coronavirus disease 2019 (COVID-19) outbreak, as a result of the abrupt reorganisation of the Italian national health system to augment care provision to symptomatic patients with COVID-19. METHODS: A total of 33 urological units with physicians affiliated to the AGILE consortium (Italian Group for Advanced Laparo-Endoscopic Surgery; www.agilegroup.it) were surveyed. Urologists were asked to report the amount of surgical elective procedures week-by-week, from the beginning of the emergency to the following month. RESULTS: The 33 hospitals involved in the study account overall for 22 945 beds and are distributed in 13/20 Italian regions. Before the outbreak, the involved urology units performed overall 1213 procedures/week, half of which were oncological. A month later, the number of surgeries had declined by 78%. Lombardy, the first region with positive COVID-19 cases, experienced a 94% reduction. The decrease in oncological and non-oncological surgical activity was 35.9% and 89%, respectively. The trend of the decline showed a delay of roughly 2 weeks for the other regions. CONCLUSION: Italy, a country with a high fatality rate from COVID-19, experienced a sudden decline in surgical activity. This decline was inversely related to the increase in COVID-19 care, with potential harm particularly in the oncological field. The Italian experience may be helpful for future surgical pre-planning in other countries not so drastically affected by the disease to date.

Predictors of turnover intention among Norwegian nurses: A cohort study.

BACKGROUND: Shortage of nurses and instability in the nursing workforce due to turnover have become a global concern. PURPOSE: The aim of this study was to investigate whether symptoms of psychological distress mediated the impact of age, gender, workplace bullying, job satisfaction, and hardiness on turnover intention when controlling for living with children, marital status, percentage of full-time equivalent, and number of night shifts last year and whether the same variables (except full-time equivalent and number of night shifts last year) could predict real turnover. METHODS: In all, 1,246 nurses took part in a survey in 2008/2009 (T1) assessing symptoms of insomnia, sleepiness, anxiety, depression, fatigue, alcohol consumption, age, gender, workplace bullying, job satisfaction, and hardiness. Three years (T2) later they completed a survey assessing turnover intention, living with children, marital status, percentage of full-time equivalent, and number of night shift last year. A total of 99 nurses had left the nursing profession during this period. RESULTS: Workplace bulling was positively related to turnover intention, whereas job satisfaction and hardiness were negatively related to turnover intention. The impact of all three predictors was partly mediated by symptoms of insomnia and anxiety. Age was negatively whereas male gender was positively associated with turnover intention. These effects were partly mediated by harmful alcohol use. Nurses who were living with a partner at T2 and nurses with high scores on fatigue at T1 were more prone to leave the nursing profession during the study period compared to their counterparts. CONCLUSION: Symptoms like insomnia, anxiety, and alcohol consumption may mediate the impact of working conditions and personality traits associated with turnover intention in nurses. PRACTICE IMPLICATIONS: Interventions aiming at counteracting bullying, improving job satisfaction, and alleviating fatigue may reduce turnover intention/turnover.

Novel Amino Acid Assembly in the Silk Tubes of Arid-Adapted Segestriid Spiders.

We investigated in different sites inside or outside the Namib Desert the amino acids composition of the protein material forming the tube silk of Ariadna spiders. These spiders belong to the primitive Segestriidae family and spend their life inside vertical silk burrows dug within the sandy and gravelly soil of arid areas. The silks, previously purified by solubilization in hexafluoroisopropanol, were subjected to partial or total acid hydrolysis. Partial hydrolyzed samples, analyzed by mass spectrometry (matrix assisted laser desorption/ionization and electrospray), led to relevant information on the amino acid sequences in the proteins. The free amino acids formed by complete hydrolysis were derivatized with the Marfey's reagent and characterized by electrospray mass spectrometry. The reconstruction of the amino acids highlights a homogeneous plan in the chemical structure of all the analyzed silks. Eight amino acids constituting the primary structure of the proteins were identified. Alanine and glycine are the most abundant ones, with a prevalence of alanine, constituting together at least 61% of the chemical composition of the protein material, differently from what occurs in known spidroins. High percentages of proline, serine and threonine and low percentages of leucine complete the peculiarity of these proteins. The purified silks were also characterized by Fourier-transform Infrared Spectroscopy and their thermal properties were investigated by differential scanning calorimetry. The comparison of the silk tubes among the various Namibian populations, carried out through a multivariate statistical analysis, shows significant differences in their amino acid assembly possibly due to habitat features.

The ground beetle Parallelomorphus laevigatus is a potential indicator of trace metal contamination on the eastern coast of Sicily.

Carabids are generally considered to be non-specialized predators, and they have been considered useful ecological indicators. They can play a key role in clarifying the route of contaminants in food webs because they are predators of small invertebrates and, in turn, part of the diet of several vertebrates. The Mediterranean species Parallelomorphus laevigatus, which so far has not been studied from an ecotoxicological point of view, is an excellent ecological indicator in sandy coastal environments. We investigated the accumulation of trace elements in Ionian populations of P. laevigatus and evaluated the transfer of metal through the food chain of the coastal ecosystem. We analyzed 15 metals, including 11 essential metals (Co, Cr, Cu, Fe, Mn, Mo, Ni, Se, Sn, V and Zn) and four toxic metals (As, Cd, Hg and Pb). Significant differences were found in metal concentration in animal tissues among sites. Our results support the existence of defense mechanisms for the studied species. High values of As, Cd, Cr, Pb, Ni, and Hg detected in the beetles from the control site can be explained by both the emission sources from the nearby industrial plants and the intense agricultural activity. The present paper shows increasing Hg concentrations in the simplified trophic web of sandy beaches and confirms the capability of this pollutant to biomagnify. Moreover, the high value of biomagnification factor (BMF) points to the severe pollution level in this protected area.

The obstructive sleep apnea syndrome (OSAS): implications for work and Occupational Health. / La syndrome delle apnee ostruttive nel sonno (OSAS): implicazioni per l'attività lavorative e la Medicina del Lavoro.

Commission Directive 2104/85/EU on driving licenses highlighted significant issues related to the Obstructive Sleep Apnea Syndrome (OSAS). Due to the high incidence of this syndrome in the general population, it is important to precisely assess its impact on work and driving performance, in terms of employee and third-party safety, general health and related social costs (errors, accidents, absenteeism, presenteism, treatments). As occupational health physicians regularly check the workers in the age group in which the incidence of OSAS is higher, they are called upon to play a strategic role in the early detection of the disease and the prescription of an appropriate therapy, as well as in monitoring the treatment effectiveness in order to assess fitness to work and/or drive. The soundness and effectiveness of the occupational health physicians' work depend not only on their knowledge of and attention to the problem, but above all on the interaction with specialists from other disciplines, essential to arrive at a correct diagnosis and an effective treatment. Main goals of this activity are to maintain a satisfactory operating performance and to prevent possible deleterious health effects in the medium and long-term period.

Obstructive Sleep Apnea Syndrome (OSAS): Occupational Health and other medical disciplines facing the problem. / La Sindrome delle Apnee Ostruttive nel Sonno (OSAS): la Medicina del Laboro (e non solo)di fronte al problema.

Obstructive Sleep Apnea Syndrome (OSAS) is one of the most common causes of excessive daytime sleepiness, therefore an important determinant of road and work accidents, as well as being associated with multiple chronic-degenerative diseases. The recent transposition of the European Commission Directive 2014/85/EU on driver licensing highlighted the need to tackle the problem appropriately, not only for its high prevalence in the general population, but also for its significant impact on occupational safety and health, and related social costs. The Occupational Health Physician is required to play a strategic role in this regard, not just for early diagnosis, but also for monitoring the therapeutic efficacy in maintaining or reintegrating workers into specific jobs. The effectiveness of his/her work will depend primarily on the level of interaction he/she will be able to establish with the different specialists who are in charge of the diagnostic and therapeutic process, in order to maintain a satisfactory work performance and to prevent possible deleterious effects on health in the medium and long-term period. The logic of this multidisciplinary approach has led nineteen scientific Societies and Associations to establish a Joint Technical Committee and to address the problem in the light of effectiveness and efficiency criteria in the interest of the individual and the community.

Delphi consensus on the monitoring tools of main individual risk factors for chronic diseases by the company doctor. / Ricerca di consenso Delphi sugli strumenti per il monitoraggio da parte del medico competente dei principali fattori di rischio individuali per malattie croniche.

BACKGROUND: Data on individual risk factors for chronic diseases (smoking, physical activity, body mass) are collected by company physicians in heterogeneous ways. This makes comparisons, researches and evaluations difficult. OBJECTIVES: The aim of the study was to find a consensus on evaluation tools for chronic diseases risk factors and for health promotion programs in workplaces that could be performed by company physicians during their clinical activity. METHODS: A first set of tools, proposed by a working group of occupational physicians in Bergamo, was submitted through the Delphi technique to a national expert panel of 22 persons including recognized national experts in specific fields and occupational physicians skilled in health promotion. RESULTS: In three Delphi rounds, the panel selected a set of tools to monitor the main individual risk factors for chronic diseases (smoking, alcohol, physical activity, nutrition, stress and mental health) as well as general data related to the worker and his job. CONCLUSIONS: The use of these specific tools, collected in a homogeneous format, should be recommended to all Italian company physicians, in particular those who work in WHP-programs, in order to allow analysis, comparison and evaluation of health promotion programs effectiveness at a national level.

Person-directed, non-pharmacological interventions for sleepiness at work and sleep disturbances caused by shift work.

BACKGROUND: Shift work is often associated with sleepiness and sleep disorders. Person-directed, non-pharmacological interventions may positively influence the impact of shift work on sleep, thereby improving workers' well-being, safety, and health. OBJECTIVES: To assess the effects of person-directed, non-pharmacological interventions for reducing sleepiness at work and improving the length and quality of sleep between shifts for shift workers. SEARCH METHODS: We searched CENTRAL, MEDLINE Ovid, Embase, Web of Knowledge, ProQuest, PsycINFO, OpenGrey, and OSH-UPDATE from inception to August 2015. We also screened reference lists and conference proceedings and searched the World Health Organization (WHO) Trial register. We contacted experts to obtain unpublished data. SELECTION CRITERIA: Randomised controlled trials (RCTs) (including cross-over designs) that investigated the effect of any person-directed, non-pharmacological intervention on sleepiness on-shift or sleep length and sleep quality off-shift in shift workers who also work nights. DATA COLLECTION AND ANALYSIS: At least two authors screened titles and abstracts for relevant studies, extracted data, and assessed risk of bias. We contacted authors to obtain missing information. We conducted meta-analyses when pooling of studies was possible. MAIN RESULTS: We included 17 relevant trials (with 556 review-relevant participants) which we categorised into three types of interventions: (1) various exposures to bright light (n = 10); (2) various opportunities for napping (n = 4); and (3) other interventions, such as physical exercise or sleep education (n = 3). In most instances, the studies were too heterogeneous to pool. Most of the comparisons yielded low to very low quality evidence. Only one comparison provided moderate quality evidence. Overall, the included studies' results were inconclusive. We present the results regarding sleepiness below. Bright light Combining two comparable studies (with 184 participants altogether) that investigated the effect of bright light during the night on sleepiness during a shift, revealed a mean reduction 0.83 score points of sleepiness (measured via the Stanford Sleepiness Scale (SSS) (95% confidence interval (CI) -1.3 to -0.36, very low quality evidence). Another trial did not find a significant difference in overall sleepiness on another sleepiness scale (16 participants, low quality evidence).Bright light during the night plus sunglasses at dawn did not significantly influence sleepiness compared to normal light (1 study, 17 participants, assessment via reaction time, very low quality evidence).Bright light during the day shift did not significantly reduce sleepiness during the day compared to normal light (1 trial, 61 participants, subjective assessment, low quality evidence) or compared to normal light plus placebo capsule (1 trial, 12 participants, assessment via reaction time, very low quality evidence). Napping during the night shiftA meta-analysis on a single nap opportunity and the effect on the mean reaction time as a surrogate for sleepiness, resulted in a 11.87 ms reduction (95% CI 31.94 to -8.2, very low quality evidence). Two other studies also reported statistically non-significant decreases in reaction time (1 study seven participants; 1 study 49 participants, very low quality evidence).A two-nap opportunity resulted in a statistically non-significant increase of sleepiness (subjective assessment) in one study (mean difference (MD) 2.32, 95% CI -24.74 to 29.38, 1 study, 15 participants, low quality evidence). Other interventionsPhysical exercise and sleep education interventions showed promise, but sufficient data to draw conclusions are lacking. AUTHORS' CONCLUSIONS: Given the methodological diversity of the included studies, in terms of interventions, settings, and assessment tools, their limited reporting and the very low to low quality of the evidence they present, it is not possible to determine whether shift workers' sleepiness can be reduced or if their sleep length or quality can be improved with these interventions.We need better and adequately powered RCTs of the effect of bright light, and naps, either on their own or together and other non-pharmacological interventions that also consider shift workers' chronobiology on the investigated sleep parameters.

Bioaccumulation of trace elements in the sandhopper Talitrus saltator (Montagu) from the Ionian sandy coasts of Sicily.

The Ionian beaches of Sicily are of particular ecological interest because they include the basin of the largest active volcano in Europe and hosts both sites subject to natural protection constraints, as well as important industrial settlements. Consequently, the possibilities for these areas to become polluted are numerous. The sandhopper Talitrus saltator has proven to be a good bioindicator of contamination by numerous trace metals on some European coasts. Nevertheless, no data are available for the populations inhabiting the shores of the southern Mediterranean. Now, as metal accumulation has been shown to vary intraspecifically, the aim of this study was to evaluate trace metal accumulation in adults of T. saltator inhabiting Ionian coastal areas of Sicily and make an assessment of natural and anthropogenic metal pollution of this strip of coast. We also extended our survey to As, Co, Mo, Se, Sn and V never investigated before in this species. Significant differences in metal concentration among sites were found in both sand samples and amphipod tissues. The highest metal content was observed near the mouth of Simeto, the longest river of Sicily which collects waters coming from the volcanic territory of Mount Etna. The bioaccumulation of Cd, Cu, Hg and Zn in T. saltator is fully confirmed; it is also proven for As and Mo and assumed for Cr, Fe, Mn and V. Our outcomes let us to evaluate the prevailing influence of telluric contamination of the Ionian sandy shores of Sicily by trace metals. We also come to the conclusion that in the northern sites, pollution originates from volcanic emission while anthropogenic influence prevails in the southern ones.

ICOH International Code of Ethics for Occupational Health Professionals: Historical fortune and future perspectives in Italy. / I1 Codice Internazionale di Etica ICOH per gli operatori di Medicina del Lvoro: fortuna storica e prospettive future in Italia.

The Working Group responsible for the Italian translation of the third edition of the International Code of Ethics, appointed by the President of the International Commission on Occupational Health (ICOH), Dr. Jukka Takala, completed last April the revision work. The final text, already available on the ICOH website, has been printed and distributed by the Italian National Institute for Insurance against Accidents at Work (INAIL) at the 79th National Congress of the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII), in Rome. The curators of this third Italian edition have accomplished the delicate task of adaptation in Italian, taking into account the specificities of the practice of medicine in the Italian work environment. It involves many professionals with diverse roles and responsibilities in the public and private sectors for safety, hygiene, health and environment in relation to work. More than twenty years after the first Italian edition, we trace the evolution of the ICOH International Code of Ethics, in order to focus its birth, national and international distribution, and continuous improvement as well as its ability to direct the stakeholders towards a participatory prevention model, in a legislative framework that has seen over the past two decades a radical change in the Italian world of work.

Work ability and labor supply after kidney transplantation.

BACKGROUND: The vocational rehabilitation after kidney transplantation (KTX) is suboptimal. We sought to evaluate correlates of occupational outcomes after KTX. METHODS: We included 336 working-age patients with at least one creatinine assessment in the 3-month screening period. We collected clinical information from medical records. All subjects answered a self-administered questionnaire, and a follow-up questionnaire was mailed to each participant after 6 months. Study outcomes were the Work Ability Index (WAI) and labor supply (the number of days each patient worked in the follow-up period). We estimated the glomerular filtration rate (eGFR) with the Modification of Diet in Renal Disease Study equation. RESULTS: The mean eGFR was 52.76 ± 23.68 ml/min/1.73 m(2). The age-standardized employment-to-population ratio was 62%. Comorbidities, self-reported work ability, gender, age, health insurance type, and time since transplant were associated with employment status at baseline. The WAI (38.79 ± 5.88) was associated with the severity of renal impairment, work attachment and comorbidities. After 6 months, labor supply (mean 19.4 ± 9.7 weeks) was associated with WAI item 1 (ρ = 0.22; p = 0.03); eGFR was significantly associated with labor supply, and this association was slightly stronger in patients with physically demanding jobs. CONCLUSIONS: We identified modifiable factors associated with poor occupational outcomes in kidney transplant recipients. Consistent with labor supply theory, our results suggest that health care coverage plays a key role in employment decisions after KTX independent of possible confounders. Additionally, our study provides the rationale to further evaluate the implications of renal function-preserving strategies for indirect cost savings and self-reported ability to work after transplant.

Pharmacological interventions for sleepiness and sleep disturbances caused by shift work.

BACKGROUND: Shift work results in sleep-wake disturbances, which cause sleepiness during night shifts and reduce sleep length and quality in daytime sleep after the night shift. In its serious form it is also called shift work sleep disorder. Various pharmacological products are used to ameliorate symptoms of sleepiness or poor sleep length and quality. OBJECTIVES: To evaluate the effects of pharmacological interventions to reduce sleepiness or to improve alertness at work and decrease sleep disturbances whilst off work, or both, in workers undertaking shift work in their present job and to assess their cost-effectiveness. SEARCH METHODS: We searched CENTRAL, MEDLINE, EMBASE, PubMed and PsycINFO up to 20 September 2013 and ClinicalTrials.gov up to July 2013. We also screened reference lists of included trials and relevant reviews. SELECTION CRITERIA: We included all eligible randomised controlled trials (RCTs), including cross-over RCTs, of pharmacological products among workers who were engaged in shift work (including night shifts) in their present jobs and who may or may not have had sleep problems. Primary outcomes were sleep length and sleep quality while off work, alertness and sleepiness, or fatigue at work. DATA COLLECTION AND ANALYSIS: Two authors independently selected studies, extracted data and assessed risk of bias in included trials. We performed meta-analyses where appropriate. MAIN RESULTS: We included 15 randomised placebo-controlled trials with 718 participants. Nine trials evaluated the effect of melatonin and two the effect of hypnotics for improving sleep problems. One trial assessed the effect of modafinil, two of armodafinil and one examined caffeine plus naps to decrease sleepiness or to increase alertness.Melatonin (1 to 10 mg) after the night shift may increase sleep length during daytime sleep (mean difference (MD) 24 minutes, 95% confidence interval (CI) 9.8 to 38.9; seven trials, 263 participants, low quality evidence) and night-time sleep (MD 17 minutes, 95% CI 3.71 to 30.22; three trials, 234 participants, low quality evidence) compared to placebo. We did not find a dose-response effect. Melatonin may lead to similar sleep latency times as placebo (MD 0.37minutes, 95% CI - 1.55 to 2.29; five trials, 74 participants, low quality evidence).Hypnotic medication, zopiclone, did not result in significantly longer daytime sleep length compared to placebo in one low quality trial and we could not use the data from the study on lormetazepam.Armodafinil taken before the night shift probably reduces sleepiness by one point on the Karolinska Sleepiness Scale (KSS) (MD -0.99, 95% CI -1.32 to -0.67; range 1 to 10; two trials, 572 participants, moderate quality evidence) and increases alertness by 50 ms in a simple reaction time test (MD -50.0, 95% CI -85.5 to -15.5) at three months' follow-up in shift work sleep disorder patients. Modafinil probably has similar effects on sleepiness (KSS) (MD -0.90, 95% CI -1.45 to -0.35; one trial, 183 participants, moderate quality evidence) and alertness in the psychomotor vigilance test in the same patient group. Post-marketing, severe skin reactions have been reported. Adverse effects reported by trial participants were headache, nausea and a rise in blood pressure. There were no trials in non-patient shift workers.Based on one trial, caffeine plus pre-shift naps taken before the night shift decreased sleepiness (KSS) (MD -0.63, 95% CI -1.09 to -0.17).We judged most trials to have a low risk of bias even though the randomisation method and allocation concealment were often not described. AUTHORS' CONCLUSIONS: There is low quality evidence that melatonin improves sleep length after a night shift but not other sleep quality parameters. Both modafinil and armodafinil increase alertness and reduce sleepiness to some extent in employees who suffer from shift work sleep disorder but they are associated with adverse events. Caffeine plus naps reduces sleepiness during the night shift, but the quality of evidence is low. Based on one low quality trial, hypnotics did not improve sleep length and quality after a night shift.We need more and better quality trials on the beneficial and adverse effects and costs of all pharmacological agents that induce sleep or promote alertness in shift workers both with and without a diagnosis of shift work sleep disorder. We also need systematic reviews of their adverse effects.

[Workplace bullying and sickness absenteeism]. / Rischio mobbing e assenze lavorative per malattia.

AIM: To assess the relationship between workplace bullying and sickness absenteeism in a large sample of Italian workers. DESIGN: A cross-sectional study conducted by means of questionnaires. SETTING AND PARTICIPANTS: In all, 8,992 subjects filled in a questionnaire to detect workplace bullying, the presence of work stress factors and days of sickness absence in the last year. EXPOSURES: Workplace bullying and psychosocial stressor were measured by the means of the CDL 2.0 questionnaire. MAIN OUTCOME MEASURE: Days of sickness absence reported by the subjects. RESULTS: On average, days of sickness absence were 7.4, and 7.2% of the respondents were defined as bullied. Results from logistic regression analyses showed that a workplace bullying was associated with more days of sickness absence after controlling for gender, age, professional qualification, company sector and juridical nature and other psychosocial factors (men: OR =1.62; women: OR =2.15). CONCLUSIONS: The present study confirms that workers exposed to a workplace bullying reported higher sickness absenteeism as compared with non-exposed subjects, also when a potentially highly stressful work environment is considered. The results of the present study support that workplace bullying may be viewed as an extreme stressful condition. Interventions to avoid workplace bullying not only favoure workers' health, but also avoid the company costs associated with workers' sickness absenteeism.

[Work stress, common mental disorders and Work Ability Index among call center workers of an Italian company]. / Stress lavorativo, disturbi psichici minori e indice di capacità di lavoro negli addetti al call center di un'azienda italiana.

AIM: To test three hypotheses in an Italian sample of call center workers: higher levels of perceived work stress are associated with more frequent common mental disorders (GHQ-12) and a lower Work Ability Index; combining the Job Strain (JS) and Effort/Reward Imbalance (ERI) models increases explained variance in health over and above either model when applied separately; compared with outbound operators, inbound call handlers are expected to report a lower health status,which is due to a more intense exposure to task-related work stress factors in the latter. DESIGN: A multi-center cross-sectional study, conducted by means of interviews and self-administered questionnaires. SETTING AND PARTICIPANTS: Call handlers working in the Italian branch of a telecommunication multinational company. In all, 1,106 permanent workers were examined (35.9%of the total target population, 98.9% response rate). The majority were women (76.5%);mean age was 33.3 (SD: 3.9) and company seniority 8.0 (SD: 2.1). Nearly 60% worked as inbound call handlers, about one third as outbound operators. EXPOSURES: Work stress was measured with the well-known JS and ERI models. Three exposure levels (based on tertiles) were identified for each scale. OUTCOMES: Common mental disorders were measured with the GHQ-12 questionnaire. Subjects with a GHQ-12 score 4 were classified as "cases". The Work Ability Index (WAI) was used to evaluate work ability. Being in the "poor" or "moderate" categories of the WAI indicated a low work ability status. Cronbach's alphas were 0.70 for all scales. RESULTS: Multivariate Poisson regressions showed that both models were linked to more frequent common mental disorders and a lower WAI. Moreover, combined models demonstrated an advantage in terms of explained variance in health. Finally, performing inbound call handling was associated with a lower WAI in comparison with engaging in outbound activities. Mediation analyses showed that such association is explained by the higher levels of psychological job demands and Job Strain experienced by inbound operators. CONCLUSIONS: Our results highlight the relevance of work stress as a risk factor for lower psychological health, and especially for a poorer WAI among call center workers. The combined use of the two models increases completeness of work stress assessment in this sector.The higher levels of work stress and the lower WAI observed among inbound operators are due to objectively less favourable task-related characteristics.

Conflicts in the workplace, negative acts and health consequences: evidence from a clinical evaluation.

Interpersonal conflicts at workplace are increasing in relation to high competitiveness and pressures at work, mainly connected with labor market globalization. Their manifestation is multifaceted in relation to different working conditions and they not only hinder health, performance, and job satisfaction, but can also harm people's rights and dignity. The study analyses issues related to work conflicts and adverse health consequences in 1,493 workers who approached a hospital service for work-related stress and harassment over a 3-year period. The subjects were examined according to a broad protocol covering working conditions, sources of conflict and negative actions suffered, and resulting impact on health status. Many critical conditions were reported in all occupational sectors with some differentiation in relation to gender (women more at risk) and employment status. Higher qualified levels were more exposed to experiencing severe personal adversities aimed at their progressive expulsion or resignation, with consequent higher risk of chronic adjustment disorders, while lower levels reported more stressful conditions in terms of interpersonal disputes and greater interference in the home-work interface. The study can provide useful indications for a better understanding of workplace conflicts in order to set up the most appropriate actions to manage and prevent them.

Incremental Role of New York Heart Association Class and Cardiopulmonary Exercise Test Indices for Prognostication in Heart Failure: A Cohort Study. / Papel Incremental da Classificação da New York Heart Association e dos Índices do Teste de Exercício Cardiopulmonar para Prognóstico na Insuficiência Cardíaca: um Estudo de Coorte.

BACKGROUND: Central Illustration : Incremental Role of New York Heart Association Class and Cardiopulmonary Exercise Test Indices for Prognostication in Heart Failure: A Cohort Study LVEF: left ventricular ejection fraction; HR: hazard ratio; CI: confidence interval; NYHA: New York Heart Association; VO 2: oxygen consumption. BACKGROUND: The accuracy of the New York Heart Association (NYHA) classification to assess prognosis may be limited compared with objective cardiopulmonary exercise test (CPET) parameters in heart failure (HF). OBJECTIVE: To investigate the prognostic value of the NYHA classification in addition to Weber class. METHODS: Adult outpatients with HF undergoing CPET in a Brazilian tertiary care center were included. The physician-assigned NYHA class and the CPET-derived Weber class were stratified into "favorable" (NYHA I or II; Weber A or B) or "adverse" (NYHA III or IV; Weber C or D). Patients with one favorable class and one adverse class were defined as "discordant." The primary endpoint was time to all-cause mortality. A 2-sided p value < 0.05 was considered statistically significant. RESULTS: A total of 834 patients were included. Median age was 57 years; 42% (351) were female, and median left ventricular ejection fraction was 32%. Among patients with concordant NYHA and Weber classes, those with adverse NYHA and Weber classes had significantly higher all-cause mortality compared to those with favorable classes (hazard ratio [HR]: 5.65; 95% confidence interval [CI]: 3.38 to 9.42). Among patients with discordant classes, there was no significant difference in all-cause mortality (HR: 1.38; 95% CI: 0.82 to 2.34). In the multivariable model, increments in NYHA class (HR: 1.55 per class increase; 95% CI: 1.26 to 1.92) and reductions in peak VO 2 (HR: 1.47 per 3 ml/kg/min decrease; 95% CI: 1.28 to 1.70) significantly predicted mortality. CONCLUSIONS: Physician-assigned NYHA class and objective CPET measures provide complementary prognostic information for patients with HF.

Percutaneous thermal ablation for cT1 renal mass in solitary kidney: A multicenter trifecta comparative analysis versus robot-assisted partial nephrectomy.

INTRODUCTION: Renal cell carcinoma (RCC) in solitary kidney (SK) represents a challenging scenario. We sought to compare outcomes of robot-assisted partial nephrectomy (RAPN) versus percutaneous thermal ablation (PTA) in SK patients with renal tumors cT1. MATERIALS AND METHODS: We performed a multicenter retrospective analysis of SK patients treated for RCC. The PTA group included cryoablation or radiofrequency ablation. We collected baseline characteristics, intraoperative, pathological, and post-operative data. We applied an arbitrary composite "trifecta" to assess surgical, functional, and oncological outcomes, only for malignant histology. RFS analysis was performed using the Kaplan-Meier method. Multivariable regression analysis was performed to determine independent predictors of "trifecta" achievement. RESULTS: We included 198 SK patients (RAPN, n = 50; PTA n = 119). Mean clinical tumor size was not significantly different while R.E.N.A.L. score was higher for RAPN (p < 0.001). No differences in intra and major post-procedural complications. Recurrence rate was higher in PTA group but not statistically significant (p < 0.328). No difference in metastasis rate was found (p = 0.435). RFS was 96.1% in RAPN and 86.8% in PTA cohort (p = 0.003) while no difference in PFS was detected (p = 0.1). Trifecta was achieved in 72.5% of RAPN vs 77.3% of PTA (p = 0.481). Multivariable analysis has not detected predictors for Trifecta achievement. CONCLUSION: PTA offers good outcomes in the management of SK patients with RCC. Compared with RAPN, it might carry a higher risk of recurrence; on the other hand, re-treatment is possible. Overall, PTA can be safely offered to treat SK patients presenting RCC. In general, it should be preferred in more frail patients to minimize the risk of complications.

Percutaneous Ablation vs Robot-Assisted Partial Nephrectomy for Completely Endophytic Renal Masses: A Multicenter Trifecta Analysis with a Minimum 3-Year Follow-Up.

Purpose: To compare outcomes of robot-assisted partial nephrectomy (RAPN) and percutaneous tumor ablation (PTA) for completely endophytic renal masses. Methods: Data of patients who underwent RAPN or PTA for treatment of completely endophytic (three points for "E" domain of R.E.N.A.L. score) were collected from seven high-volume U.S. and European centers. PTA included cryoablation, radiofrequency, or microwave ablation. Baseline characteristics, clinical, surgical, and postoperative outcomes were compared. Recurrence-free survival (RFS) was calculated with Kaplan-Meier analysis. Trifecta was used as arbitrary combined outcome parameter as proxy for treatment "quality." Multivariable logistic regression model assessed predictors of trifecta failure. Results: One hundred fifty-two patients (RAPN, n = 60; PTA, n = 92) were included in the analysis. RAPN group was younger (p < 0.001), had lower American Society of Anesthesiologists score (p = 0.002), and higher baseline estimated glomerular filtration rate (p < 0.001). There was no difference in clinical tumor size, clinical T stage, and tumor complexity scores. PTA had significantly lower rate of overall (p < 0.001) and minor (p < 0.001) complications. ΔeGFR at 1 year was statistically higher for RAPN (-15.5 mL/min vs -3.1 mL/min; p = 0.005), no difference in ΔeGFR at last follow-up (p = 0.22) was observed. No difference in recurrences (RAPN, n = 2; PTA, n = 6) and RFS was found (p = 0.154). Trifecta achievement was higher for RAPN but not statistically different (65.3% vs 58.8%; p = 0.477). R.E.N.A.L. Nephrometry Score resulted predictive of trifecta failure (odds ratio = 1.47; confidence interval = 1.13-1.90; p = 0.004). Conclusions: PTA confirms to be an effective treatment for completely endophytic renal masses, offering low complications and good mid-term functional and oncologic outcomes. These outcomes compare favorably with those of RAPN, which seem to be the preferred option for younger and less comorbid patients.

Microwave versus cryoablation and radiofrequency ablation for small renal mass: a multicenter comparative analysis.

BACKGROUND: Ablative techniques emerged as effective alternative to nephron-sparing surgery for treatment of small renal masses. Radiofrequency ablation (RFA) and cryoablation (CRYO) are the two guidelines-recommended techniques. Microwave ablation (MWA) represents a newer technology, less described. The aim of the study was to compare outcomes of MWA to those of CRYO and RFA. METHODS: Retrospective investigation of patients who underwent MWA, CRYO, or RFA from seven high-volume US and European centers was performed. The first group included patients who underwent CRYO or RFA; the second MWA. We collected baseline characteristics, clinical, intraoperative, and postoperative data. Oncological data included technical success, local recurrence, and progression to metastasis. Multivariate analysis was performed to find predictors for postoperative complications. A composite outcome of "trifecta" was used to assess surgical, functional, and oncological outcomes. RESULTS: 739 patients underwent CRYO or RFA and 50 MWA. CRYO/RFA group had significantly longer operative time (P<0.001), but no difference in LOS, postprocedural Hb mean, intraprocedural complications (P=0.180), overall postprocedural complication rates (P=0.126), and in the 30-day re-admission rate (P=0.853) were detected. No predictive parameter of postprocedural complications was found. Concerning functional outcome, no differences were detected in terms of eGFR at 1 year (P=0.182), ΔeGFR at 1 year (P=0.825) and eGFR at latest follow-up (P=0.070). "Technical success" was achieved in 98.6% of the cases (MWA=100%, CRYO/RFA=98.5%; P=0.775), and there was no significant difference in terms of 2-year recurrence rate (P=0.114) and metastatic progression (P=0.203). Trifecta was achieved in 73.0% of CRYO/RFA vs. 69.6% of MWA cases (P=0.719). CONCLUSIONS: MWA is a safe and effective treatment option for small renal masses. Compared with CRYO/RFA, it seems to offer low complication rates, shorter operation time, and equivalent surgical and functional outcomes.