A case-crossover study of sleep, fatigue, and other transient exposures at workplace and the risk of non-fatal occupational injuries among the employees of an Italian academic hospital.

OBJECTIVES: Transient exposure with acute effect has been shown to affect the risk of occupational injuries in various industrial settings and at the healthcare workplace. The objective of this study has been to identify transient exposures related to occupational injury risk in an Italian teaching hospital. MATERIAL AND METHODS: A case-crossover study was conducted among the employees of the University Hospital of Udine who reported an occupational injury, commuting accident, or incident involving biological risk in a 15-month period in the years 2013 and 2014. The matched-pair interval approach was used to assess the role of acute sleep deprivation whereas the usual frequency approach was used for other 13 transient exposures. RESULTS: Sleep hours were not associated with the risk of injuries whereas a significant risk increase was associated with fatigue, rush, distraction, emergency situations, teaching to or being taught by someone, non-compliant patients, bloody operative/work field, excess noise, complex procedures, and anger. CONCLUSIONS: We identified transient exposures that increased the risk of occupational injuries in an Italian teaching hospital, providing indications for interventions to increase workers' safety at the healthcare workplace. Int J Occup Med Environ Health 2016;29(6):1001-1009.

Salivary melatonin and cortisol and occupational injuries among Italian hospital workers.

Stress, circadian patterns, and sleep-related factors may have a role on occupational injuries. We investigated the association between occupational injuries among the workers of an Italian hospital and their secretion of salivary melatonin and cortisol. We used a case-control study design. 27 injured cases and 31 non-injured controls provided 5 salivary samples every 60 min from 9 pm to 1 am. Melatonin and cortisol concentrations were measured, and the Dim Light Melatonin Onset (DLMO) derived using two fixed thresholds (1 and 3 pg/mL). The associations between injury, melatonin, cortisol, and DLMO were assessed through univariate and multivariate analyses. Non-injured controls had higher melatonin (median 2.28 pg/mL) and lower cortisol concentrations (0.71 ng/mL), as well as earlier DLMO times (9:00 pm with the 1 pg/mL melatonin cutoff) than cases (1.01 pg/mL, 1.14 ng/mL and 9:12 pm, respectively), although only few results were statistically significant. Measuring these hormones might be helpful to characterize the risk of injury among hospital workers.

An ecological study on the association between characteristics of hospital units and the risk of occupational injuries and adverse events on the example of an Italian teaching hospital.

OBJECTIVES: We explored the association of workplace characteristics with occupational injuries and adverse events in an Italian teaching hospital. MATERIAL AND METHODS: This ecological study was conducted using data routinely collected in the University Hospital of Udine, Northeastern Italy. Poisson regression models were used to investigate, at the hospital unit level, the association between 5 outcomes, including: occupational injuries, patient falls, medication errors, other adverse events and near-misses, and various characteristics of the units. RESULTS: The proportion of female workers in a unit, the average number of sick-leave days and of overtime hours, the number of medical examinations requested by employees, and being a surgical unit were significantly associated with some of the outcomes. CONCLUSIONS: Despite ecological nature of the study, which does not allow for inferences to be drawn at the individual level, the results of our study provide useful clues to support strategies and interventions directed towards healthier work environments and better patient care in hospitals.

Did the temporary shortage in supply of imiglucerase have clinical consequences? Retrospective observational study on 34 italian Gaucher type I patients.

Background. Enzyme Replacement Therapy (ERT) is the standard of care in Gaucher disease. The effects of withdrawal or reduced doses are debated, thus a retrospective cohort study was conducted to investigate clinical and laboratory differences in 34 Gaucher type 1 patients experiencing an ERT dosage reduction after the forced temporary imiglucerase shortage in 2009. Methods. Haemoglobin concentration, leukocytes and platelets counts, and chitotriosidase activity were assessed at baseline and after 6 and 12 months (t0, t6, t12), while bone pain, energy, work or school performance, concentration, memory and social life every 3 months. Results. The cohort was made up of 18 males and 16 females (medians: age 41.8 years, therapy duration 14.1 years, dosage reduction 35.5%). Haemoglobin, leukocytes and platelets remained substantially stable, while chitotriosidase activity showed an increase, especially after t6. Age, splenectomy or genotype were not associated with laboratory parameters changes, except for a significant median increase of chitotriosidase activity in non-splenectomised patients after 12 months (p = 0.01). At 3, 6, 9 and 12 months, more than 50% patients reported at least one problem in subjective well-being (56%, 65%, 70%, 58%, respectively), while bone pain occurred or worsened in 13/33, 13/32, 7/28 and 5/26 patients, respectively. No bone crises were reported. Conclusions. Drug reduction did not induce substantial modification in the laboratory values but seems to have influenced the well-being perception of some Gaucher patients. Thus, bone pain, general health and quality of life should be carefully monitored during ERT reductions.