Evaluation of Cardiovascular Activity and Emotional Experience in Healthcare Workers (HCWs) Operating in COVID-19 Wards.

The new 2019 coronavirus or SARS-CoV-2 has been the first biological agent to generate, in this millennium, such a global health emergency as to determine the adoption of public health measures. During this sanitary emergency, the emotional experience of healthcare workers (HCWs) has been hugely tested by several factors. In fact, HCWs have been exposed to greatly tiring physical, psychological and social conditions. The authors investigated the cardiocirculatory activity of a group of HCWs as well as how they perceived stress while working in COVID-19 wards. In particular, every HCW underwent a medical check, an electrocardiographic base exam, systolic and diastolic pressure measurement, and cardio frequency measurement. Furthermore, each HCW was provided with a cardiac Holter device (HoC) and a pressure Holter (Hop). Some psychological factors were considered in order to quantify the stress perceived by each HCW while at work through the administration of two questionnaires: the "Social Stigma towards Patients due to COVID Scale (SSPCS)" and the "Professional Quality of Life Scale (ProQOL)". The HoC and HoP analysis results for HCWs working in COVID-19 OU wards showed significant variations in cardiocirculatory activity. From the analysis of the SSPCS questionnaire answers, it is clear that all of them showed a sense of duty towards their patients. The analysis of the ProQOL questionnaire answers showed that the prevailing attitude is fear; however, HCWs did not absolutely discriminate against those who had COVID-19 nor did they refuse to help those in need. Continuous monitoring of these employees, also carried out through occupational medicine surveillance, allows for the detection of critical conditions and the implementation of actions aimed at preventing chronic processes.

SARS-CoV-2 Transmission Prevention Model Application in a Large Retail Company Before the Vaccine Introduction.

On 11 March 2020, following the spread of SARS-CoV-2, WHO declared a pandemic status. The impact on national health and economic systems has been huge. Therefore, many countries took measures to restrict the spread of the virus. Many work activities have been subjected to lockdown measures. However, some production activities, continued to remain open, i.e., large-scale food distribution, food industry, pharmacies, hospitals, etc. In order to contain the spread of the pandemic, public health measures have been implemented by the States to reduce the contagion of the virus in the workplace. Therefore, it was important to implement measures to contrast and contain the spread of SARS-CoV-2/COVID-19 in workplaces. The aim of this study was to adopt and implement a safety protocol useful to restrict the spread of SARS-CoV-2 in a large-scale retail trade company located in the south of Italy, before vaccination, during the first and second pandemic phases also exploiting telemedicine services. Antibody serological test cards were also used during the first pandemic wave and rapid antigenic swabs during the second to detect workers positive for SARS-CoV-2. A population of subjects who worked for another company similar for production activity and distribution on the territory was selected as the control group. During work activities, this group followed the minimum activity protocol provided by the Italian legislation (24 April 2020, Ministry Protocol), which provided the daily monitoring of the body temperature and in the case of SARS- CoV-2 positive subjects the extraordinary sanitation of the workplace. The measures implemented identified the positive subject for SARS-CoV-2 at an early stage. The protocol made it possible to significantly reduce the spread of the virus within large-scale retail distribution, and therefore, to avoid the temporary closure of the stores with a consequent reduction of economic losses compared with the control group.

Survey on COVID-19-related mortality associated with occupational infection during the first phase of the pandemic: A systematic review.

According to the Centre for Disease Control and Prevention in 2020, a cluster of pneumonia cases of unknown etiology caused by the severe acute respiratory syndrome (SARS)-coronavirus 2 was reported in Wuhan, China. The present review examined the literature to reveal the incidence of novel coronavirus-2019 disease (COVID-19) infections, underlying comorbidities, workplace infections and case fatality rates. A review was performed to identify the relevant publications available up to May 15, 2020. Since the early stages of the COVID-19 outbreak, the case fatality rate among healthcare workers (HCWs) has stood at 0.69% worldwide and 0.4% in Italy. Based on the current information, most patients have exhibited good prognoses in terms of after-effects or sequelae and low mortality rate. Patients that became critically ill were primarily in the elderly population or had chronic underlying diseases, including diabetes and hypertension. Among all working sectors, HCWs, since they are front-line caregivers for patients with COVID-19, are considered to be in the high-risk population. Increased age and a number of comorbidity factors have been associated with increased risk of mortality in patients with COVID-19. The most frequent complications of COVID-19 reported that can cause fatality in patients were SARS, cardiac arrest, secondary infections and septic shock, in addition to acute kidney failure and liver failure. Overcoming the COVID-19 pandemic is an ongoing challenge, which poses a threat to global health that requires close surveillance and prompt diagnosis, in coordination with research efforts to understand this pathogen and develop effective countermeasures.

How the Heart Was Involved in COVID-19 during the First Pandemic Phase: A Review.

Coronavirus disease (COVID-19) was first observed in Wuhan, Hubei Province (China) in December 2019, resulting in an acute respiratory syndrome. Only later was COVID-19 considered a public health emergency of international concern and, on 11 March 2020, the WHO classified it as pandemic. Despite being a respiratory virus, the clinical manifestations are also characterized by cardiological involvement, especially in patients suffering from previous comorbidities such as hypertension and diabetes mellitus, its complications being potentially serious or fatal. Despite the efforts made by the scientific community to identify pathophysiological mechanisms, they still remain unclear. A fundamental role is played by the angiotensin 2 converting enzyme, known for its effects at the cardiovascular level and for its involvement in COVID-19 pathogenesis. The goal of this paper was to highlight the mechanisms and knowledge related to cardiovascular involvement during the first pandemic phase, as well as to emphasize the main cardiological complications in infected patients.

Straining at Work and Its Relationship with Personality Profiles and Individual Consequences in Healthcare Workers (HCWs).

Straining is an attenuated form of mobbing, in which the continuity of vexatious actions is not driven by a discriminatory intent. With the objective of testing the possible moderating role of personality in the relationship between perceptions about straining at work and individual consequences, a correlational design research involved 374 healthcare workers (HCWs) from two Italian hospitals. The following questionnaires were administered: (1) Short Negative Acts Questionnaire (S-NAQ), to assess discriminative actions at work); (2) the Italian version of the Big Five Inventory (BFI-10 scale), to assess personality factors; (3) Occupational Stress Indicator (OSI), to measure psychological and physical health. Regression analysis and Structural Equation Models (SEM) were computed in order to test the relationships between variables. Perceived straining showed significant correlations with both psychological and physical health. Conscientiousness was inversely proportional to work-related bullying (WB), as agreeableness was to personal bullying (PB). Emotional stability was negatively correlated with all the three component scales of S-NAQ: WB, PB, and social bullying. The results seem to confirm that straining perceptions especially elicit, through emotional stability, psychological consequences. As regards the role of emotional stability in risk perceptions, it seems management has to pay thorough attention to personal factors in organizational perceptions and to straining actions.

Hepatitis B vaccination coverage among medical residents from Catania University Hospital, Italy.

Medical residents (MRs) are healthcare workers (HCWs) who are likely to be exposed to blood-borne pathogens such as hepatitis B virus (HBV). A total of 220 (100%) MRs from Catania University Hospital (Italy) were enrolled for a seroprevalence study in the framework of occupational surveillance in order to evaluate HBV vaccination coverage. For each MR, Hepatitis B surface antigen (HbsAg), Hepatitis B surface antibody (HBsAb), Hepatitis B core antiboy (HbcAb), Hepatitis C antibody (HCV-Ab) and HIV antibody (HIV-Ab) were assessed. No one was found to be positive for: HbsAg, HbcAb, HCV-Ab or HIV-Ab. HBV vaccination coverage was found in 80% of those tested. A total of 45 MRs showed a nonprotective antibody titer; in eight, complete vaccination had never been carried out; in 37, the vaccination had been carried out, but the antibody titer was not protective. This research showed high adherence to HBV vaccination; however, the vaccine coverage of HCWs is still suboptimal. Vaccinations for HCWs should be made mandatory.

Tuberculosis screening among healthcare workers in Sicily, Italy.

Tuberculosis (TB) is a diffuse communicable disease; and healthcare workers (HCWs) are among the at-risk populations for the disease. This study reports the result of TB surveillance in HCWs operating in three hospitals: one classified as 'low' risk for TB and two as 'medium' risk. A total of 2228 HCWs underwent TB screening using the standard Mantoux technique (also known as the tuberculin sensitivity test [TST]). Interferon-γ release assay (IGRA) was carried out in TST-positive subjects. Results showed an overall positivity of 21% to TST and 2% to IGRA test. TST and IGRA results were statistically associated with HCWs born after 1981. This result is due to university policies that highly recommend TB immunization. Data support the use of IGRA assay in TST-positive HCWs, in order to identify latent TB infection from vaccination.

Biomarkers for Early Diagnosis and Prognosis of Malignant Pleural Mesothelioma: The Quest Goes on.

Malignant pleural mesothelioma (MM) is a highly aggressive tumor characterized by a poor prognosis. Although its carcinogenesis mechanism has not been strictly understood, about 80% of MM can be attributed to occupational and/or environmental exposure to asbestos fibers. The identification of non-invasive molecular markers for an early diagnosis of MM has been the subject of several studies aimed at diagnosing the disease at an early stage. The most studied biomarker is mesothelin, characterized by a good specificity, but it has low sensitivity, especially for non-epithelioid MM. Other protein markers are Fibulin-3 and osteopontin which have not, however, showed a superior diagnostic performance. Recently, interesting results have been reported for the HMGB1 protein in a small but limited series. An increase in channel proteins involved in water transport, aquaporins, have been identified as positive prognostic factors in MM, high levels of expression of aquaporins in tumor cells predict an increase in survival. MicroRNAs and protein panels are among the new indicators of interest. None of the markers available today are sufficiently reliable to be used in the surveillance of subjects exposed to asbestos or in the early detection of MM. Our aim is to give a detailed account of biomarkers available for MM.

Serum lipid, lipoprotein and apolipoprotein profiles in workers exposed to low arsenic levels: Lipid profiles and occupational arsenic exposure.

Epidemiologic studies have reported that exposure to arsenic (As) is associated with higher risk of cardiovascular disease (i.e., coronary heart disease and peripheral arterial heart disease) and mortality. This cross-sectional study aimed to compare serum lipid, lipoprotein, and apolipoprotein profiles in workers exposed to As. The subjects of this study included 57 workers exposed to As and 57 controls. Demographic characteristics and occupational information were collected through questionnaires. Exposure to As was assessed in indoor air of a workplace and determined using the creatinine values in the urine. Blood samples were collected using immunochemistry and nephelometry to measure the levels of total cholesterol (CHOL), triglycerides (TRIG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), lipoprotein(a) (Lp(a)), apolipoprotein-A1 (Apo-A1), and apolipoprotein-B (Apo-B). No significant difference in the demographic data was detected between the two groups. Urinary As concentration was significantly (p<0.001) higher in exposed subjects than in the controls (13.4±6.1 and 4.4±6.1µg/gCreat, respectively). No statistically significant differences were observed in CHOL, TRIG, HDL, and LDL concentrations between the two groups. Lp(a), Apo-B, and Apo-B/Apo-A1 ratio values were significantly higher and the Apo-A1 level was significantly lower in the exposed group than in the control subjects. Regression analysis highlighted a significant (p<0.001) association between urinary As and Lp(a), Apo-A1, and Apo-B concentration, and Apo-B/Apo-A1 ratio. This study revealed the influence of As on apolipoproteins, suggesting a potential risk of cardiovascular diseases in subjects exposed to low levels of As.

Prevalence of anti-nuclear autoantibodies in subjects exposed to natural asbestiform fibers: a cross-sectional study.

Fluoro-edenite (FE) is an asbestiform mineral fiber spotted in the lava rocks excavated from a stone quarry in Biancavilla (Italy). The derived material had been employed locally for building purposes. Previous studies found evidence that exposure to asbestos may induce autoimmunity, with frequency of anti-nuclear autoantibodies (ANA). The aim of this study was to explore the relationship between FE exposure and autoimmune responses in an exposed population. For the study, 60 subjects living in the area of Biancavilla and 60 subjects as control group were randomly invited to participate. A free medical check, including spirometry and a high-resolution computer tomography chest scan, was given to all participants. ANA were determined by indirect immunofluorescence. On medical check, no subject showed any sign and/or symptoms of illness. Prevalence for samples positive to ANA were 70% (n = 42) and 25% (n = 15), respectively, for exposed and non-exposed subjects (p < 0.05). The presence of pleural plaques (PP) was found in 21 (30%) of the exposed subjects and in 2 (3%) of the non-exposed participants. PP subjects were always ANAs positive. In conclusion, as already it was observed with exposure to asbestos fibers, levels of ANA seemed to significantly increase in subjects who had been exposed to FE. Furthermore, all subjects showing PP were also ANA-positive. This first finding in subjects exposed to FE should encourage researchers to further investigate associations between autoimmune unbalance and environmental exposure to asbestiform fibers.

Occupational exposure to Mount Etna's basaltic dust: Assessment of mutagenic and cytotoxic effects.

Basalt and volcanic ash are natural constituents of the ground surrounding volcanic areas such as Mount Etna. The dust may be daily inhaled by the general population as well as by several types of workers, such as construction workers. In this experiment, we analyzed the potential mutagenic and cytotoxic effects of the materials used in construction industry, excavated from Mt. Etna. Ground basalt (A), volcanic ash (B), mixed basalt and cement (C) and cement (D) were studied with Ames test, for mutagenic assessment and with MMT assay for cytotoxic evaluation. The Ames test revealed that cement (sample D), showed a higher and significant mutagenicity than the samples A, B and C. MTT assay showed that samples C and D had a slightly more negative impact on cell viability than A and B. In conclusion, no particular risks seem to exist for construction industry workers, while the exploitation of cement and cement mixed with basalt seems to be a risk for workers, given the high percentage of silica and iron.