Workplace violence against healthcare workers: an umbrella review of systematic reviews and meta-analyses.

OBJECTIVES: The aim of this umbrella review of systematic reviews and meta-analyses was to address workplace violence (WPV) against healthcare workers (HCWs). Several systematic reviews exist in the literature, but the diversity of settings, population considered, and type of violence investigated make it difficult to gain insight and use the vast amount of available data to implement policies to tackle WPV. With this in mind, we conducted an umbrella review of systematic reviews and meta-analyses on WPV against HCWs to examine the global prevalence of the phenomena and its features. STUDY DESIGN AND METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Scopus, and ISI Web of Science were searched for relevant systematic reviews and meta-analyses published in English up to November 2022. Data on authors, year, country, violence type, prevalence (pooled and not), setting, population, and specific considerations were extracted. RESULTS: A total of 32 systematic reviews were included, 19 of which performed a meta-analysis, investigating overall, physical, and non-physical violence. Even considering the variability of the data, the COVID-19 pandemic has exacerbated the scale of the problem. From our review, we found that overall violence prevalence among HCWs was reported to be as high as 78.9%, and nurses working in psychiatric wards were the professionals most impacted. CONCLUSION: In conclusion, this umbrella review revealed a high prevalence of WPV among HCWs, which varies between countries, population subgroups, and detection methods. Strengthening recognition of the problem could lead to appropriate local and international strategies to address it.

Occupational exposure to work-related stress, a proposal of a pilot study to detect psychological distress in collar-workers.

Introduction: Work-related psychosocial risks have been identified as significant occupational health and safety risks; the occupational physicians must assess and monitor the health status of workers in order to verify that work is not a source of harm to exposed operators. The aim of the study was to investigate the outcomes related to anxiety and depression traits in workers exposed to stress-related work. Methods: A questionnaire was administered to a large population of Italian public administration workers; the Centre for Epidemiologic Studies - Depression Scale questionnaire was used to measure depression, the Self rating Anxiety Scale was used to measure anxiety, the UK Management Standards Indicator tool questionnaire was used to assess work adjustment. A descriptive analysis, a multivariate analysis, as well as logistic regression models were used to assess the health outcomes related to stress. Results: A total of 292 workers participated in the study; 100% of participants had a Centre for Epidemiologic Studies - Depression Scale score over the cut-off; 41.78% had a Self rating Anxiety Scale score over the cut-off; the results support a correlation between the Centre for Epidemiologic Studies - Depression Scale results and the UK Management Standards Indicator tool results; and a correlation between Self-rating Anxiety Scale results and the UK Management Standards Indicator tool results. Conclusions: The Demand, Management, Support and Relationship results were associated with mental health outcomes, and it could be a useful tool in occupational medicine, to identify workers at risk for negative mental health outcomes, becoming an essential tool in workers' health assessment and for prevention of mental health disorders.

Working conditions and mental health in teachers: a preliminary study.

BACKGROUND: Unfavourable working conditions are associated with poor mental health and many studies show that teachers are at risk of this. AIMS: To investigate if and to what extent specific dimensions of working conditions are associated with symptoms of depression and anxiety in teachers in state schools in Italy. METHODS: A cross-sectional questionnaire survey of Italian state schoolteachers using the Karasek Job Content Questionnaire, the Self-Rating Anxiety Scale (SAS) and the Center for Epidemiologic Studies Depression Scale (CES-D). We tested the hypotheses that high job demand, low decision latitude and low support are associated with anxiety and depression in teachers using a correlation matrix and hierarchical multiple regression models. RESULTS: 113/180 (63%) of schoolteachers invited to participate completed the survey. 49% scored above the cut-off on CES-D and 11% on SAS. CES-D was positively correlated with job demand (r = 0.517, P < 0.01) and negatively with social support (r = -0.226, P < 0.05). SAS was positively correlated with job demand (r = 0.408, P < 0.01). Hierarchical multiple regression analysis showed that job demand was significantly associated with CES-D and SAS scores, explaining 28 and 25% of variance respectively. CONCLUSIONS: About half of the teachers in this study scored above the threshold for depression and ~1 in 10 for anxiety on self-rating questionnaires. Poor mental health in teachers is significantly associated with high job demand and low social support. These results should be confirmed in larger, more representative samples.

Ascertainment bias in dementias: a secondary to tertiary centre analysis in Central Italy and conceptual review.

BACKGROUND AND AIMS: Ascertainment bias (AB) indicates a bias of an evaluation centre in estimating the prevalence/incidence of a disease due to the specific expertise of the centre. The aim of our study was to evaluate classification of different types of dementia in new cases appearing in secondary and tertiary centres, in order to evidence possible occurrence of AB in the various (secondary to tertiary) dementia centres. METHODS: To assess the mechanism of AB, the rates of new cases of the different forms of dementia reported by different centres were compared. The centres involved in the study were 11 hospital-based centres including a tertiary centre, located in the University Department of Clinical Neurology. The tertiary centre is endowed with state-of-the-art diagnostic facilities and its scientific production is prominently focused on dementia with Lewy bodies (DLB) thus suggesting the possible occurrence of a bias. Four main categories of dementia were identified: Alzheimer's disease (AD), DLB, fronto-temporal dementia (FTD), vascular dementia (VaD), with other forms in a category apart. The classification rate of new cases of dementia in the tertiary centre was compared with rates reported by secondary centres and rates of recoding were calculated during a follow-up of 2 years. RESULTS: The study classified 2,042 newly diagnosed cases of dementia in a population of 1,370,000 inhabitants of which 315,000 were older than 65. AD was categorized in 48-52 % of cases, DLB in 25-28 %, FTD in 2-4 % and VaD in 17-28 %. During the 2-year follow-up the diagnosis was re-classified in 40 patients (3 %). The rate of recoding was 5 % in the tertiary centre, 2-8 % in referrals from secondary to tertiary centre, 2-10 % in recodings performed in secondary centres and addressed to tertiary centre. Recoding or percentages of new cases of AD or DLB were not different in the comparison between secondary or between secondary and tertiary centres. FTD and VaD were instead significantly recoded. CONCLUSION: The results of the study suggest that in a homogeneous area, AB is not interfering with diagnosis of AD or DLB.

Cefixime-induced nonconvulsive status epilepticus.

Nonconvulsive status epilepticus (NCSE) is an epileptic condition lasting >30 min, clinically manifested by an altered mental state and associated with continuous epileptiform activity on the electroencephalogram. NCSE is a common yet still under recognized condition and delay in diagnosis and treatment may be associated with increased mortality as well as cognitive/behavioral consequences. We described an epileptic female patient assuming carbamazepine (900 mg/day) and levetiracetam (3,000 mg/day), seizure free for more than 10 years, who developed NCSE during cefixime treatment, a third-generation cephalosporin compound that along with penicillins is classified within the b-lactam class of antibiotics. In our report we outline the importance and the difficulty to choose secure antibiotic treatment in epileptic patients, we discuss the possible mechanisms by which cephalosporins induce neurotoxicity and the need to stress family components questioning about new drugs assumed. Finally we highlight the value of the EEG recording to diagnose NCSE and treat it adequately and promptly.

Benzene metabolites inhibit the release of proinflammatory mediators and cytokines from human basophils.

Benzene and its metabolites have been involved in the pathogenesis of chronic lung inflammation and allergic disorders such as bronchial asthma. However, the effects of these xenobiotics on human basophils, key cells in the development of respiratory allergy, have not been investigated. We examined the effects of hydroquinone (HQ) and benzoquinone (BQ), two important chemicals implicated in benzene toxicity, on the release of preformed (histamine) and de novo synthesized mediators (cysteinyl leukotriene C4, LTC4, and IL-4) from human basophils. Preincubation of basophils purified from normal donors with HQ (3-100 microM) inhibited up to 30% histamine release induced by anti-IgE and up to 55% of that induced by the Ca2+ ionophore A23187. HQ had no effect on histamine release induced by formyl-methionyl-leucyl-phenylalanine (f-Met-Leu-Phe). Preincubation of basophils with BQ (3-100 microM) resulted in the concentration-dependent inhibition of histamine release (up to 70%) induced by anti-IgE, A23187 and f-Met-Leu-Phe. HQ completely suppressed the de novo synthesis of LTC4 from basophils challenged with anti-IgE or f-Met-Leu-Phe and the production of IL-4 in cells stimulated with anti-IgE. These results indicate that two major benzene metabolites, HQ and BQ, inhibit the release of proinflammatory mediators and Th2-promoting cytokines from basophils activated by different stimuli. These results suggest that benzene metabolites interfere with multiple intracellular signals involved in the activation of human basophils.

[Endocrine disruptors: literature review on toxicology and application field in occupational medicine]. / I distruttori endocrini: analisi della letteratura su tossicologia e campi di applicazione in medicina del lavoro.

Endocrine Disruptors (ED) and their possible impact on human health have become a topic of discussion and an area of active research in toxicology. Endocrine disrupting compound are found in plastics, detergents, surfactants, pesticides and industrial chemicals. This review will focus attention on exposure to ED in occupational context. ED are defined as an extrogenous substance or mixture that alters the function of the endocrine system and consequently causes adverse health effects in an intact organism, or its progeny. ED increases the incidence of endocrine diseases and disorders, affects the development, the immune system and influence the course of immunological disorders including autoimmune diseases. ED affects the reproductive system, they may be responsible for oligospermia, sperm characteristics, testicular steroidogenesis, testicular atrophy, uterus weight increases and proliferation of vaginal epithelium. Adverse effects are related to dose and potency of xenobiotics, ED in high doses may cause a developmental, reproductive and tumorigenic effects, however there isn't agreement that in low exposure there are effects. Symptoms from occupational exposure are reversible after exposure has end, however xenoestrogen exposure during critical stages of developmental (during pregnancy) can also result in irreversible damage.

[Safety of professional drivers: literature review about prevention measures linked to sleeping]. / La sicurezza dei conducenti professionali: analisi della letteratura sugli interventi di prevenzione alle problematiche correlate al sonno.

This study assess the need of development of a common protocol to detect occupational driver with high risk of driving accidents. Several studies have indicated that excessive sleepiness and daytime alertness cause an increased risk of driving accidents in occupational drivers. Excessive daytime sleepiness affects 4 to 12% of general population. The 37% of drivers reported that they have nodded off or fallen asleep at least once in their driving career. A substantial percentage of drivers suffer from sleep-disordered breathing, narcolepsy, sleep deprivation, poor sleep hygiene, changes in wakefulness-sleep circadian rhythm. Some important factors in determining driver sleepiness are duration of the drive, driving at night, more experience as driver, arduous schedules. There is a lack of awareness among the public and among physicians and authorities in general of the problem posed by sleepy drivers. There isn't a national surveillance system that identify sleep loss or sleepiness in relation to work. The first target of a screening program protocol should be to detect the presence of obstructive sleep apnea. Overnight polysomnography in a sleep laboratory is normal practice for diagnosing obstructive sleep apnea but it is expensive. The ambulatory approach can be used to expedite management of screening in occupational driver.

[Nanotubes and occupational medicine]. / Nanotubi e Medicina del Lavoro.

Carbon nanotubes (CNTs) are a man-made form of carbon, they exist in many different forms and can be chemically modified and/or functionalized with biomolecules. Pristine single-walled CNTs (SWNT) are extremely hydrophobic tubes of hexagonic carbon (graphene) with diameters as small as 0.4 nm and lengths up to micrometers. Multiwalled CNTs (MWCNT) consist of several concentric grapheme tubes and diameters of up to 100 nm. Due to their unique chemical, physical, optical, and magnetic properties, carbon nanotubes have found many uses in industrial products and in the field of nanotechnology, including in nanomedicine. From the rapidly emerging applications of CNTs arise the urgent need for toxicological studies on CNTs. Exposure to CNTs is associated with effect on DNA, pulmonary toxicity, fibrotic lesions, skin toxicity. Very interesting data are collected in a study in which CNTs were seen to connect multiple cells together. Of greatest interest was the discovery of unique intercellular carbon structures composed of SWCNT that bridged lung macrophages. These "carbon bridges" offer a novel and easily identifiable biomarker of exposure. This review brings together toxicological studies that have been carried out using carbon nanotubes, to offer a summary of the state-of-the-art in the development of carbon nanotubes toxicology.