Indoor Radon Concentration Levels in Healthcare Settings: The Results of an Environmental Monitoring in a Large Italian University Hospital.

The aim of the study is to determine the radon concentrations in the University Hospital of Bari, Apulia Region, Southern Italy. The monitoring took place from 2017 to 2018 for a total of 402 days and included 3492 premises. Radon environmental sampling was performed with passive dosimeters of the CR-39 type. The highest mean concentration was found in basement rooms (118.9 Bq/m3), followed by ground-floor rooms (88.2 Bq/m3), first-floor rooms (78.1 Bq/m3), second-floor rooms (66.7 Bq/m3), and third-floor rooms (68.9 Bq/m3). An average radon concentration lower than the WHO recommended level of 100 Bq/m3 was detected in 73.5% of monitored environments, while only 0.9% exceeded the reference level of 300 Bq/m3 set by the national law (Legislative Decree 101/2020). The frequency of environments in which radon concentrations exceed 300 Bq/m3 is significantly higher in the basement (p-value < 0.001). As for a previous preliminary investigation in the same hospital conducted on a much smaller number of premises (n = 401), most of the monitored environments had radon concentrations lower than the reference levels set by the new national law, and the risk to the healthcare workers' health derived from occupational exposure to radon could be considered acceptable.

SARS-CoV-2 Breakthrough Infections in Health Care Workers: An Italian Retrospective Cohort Study on Characteristics, Clinical Course and Outcomes.

BACKGROUND: The aim of this study was to determine the characteristics, clinical course and outcomes of COVID-19 breakthrough infections (BIs) among healthcare workers (HCWs) of an Italian University Hospital. METHODS: A retrospective observational study was conducted on 6111 HCWs, from January 2021 to February 2022. The study population was offered the full vaccination with BNT162b2 mRNA COVID-19 vaccine. To allow return to work after BI, the protocol required one negative nasopharyngeal RT-PCR swab followed by a medical examination to assess the HCW's health status. Laboratory tests, instrumental tests and specialist evaluations were carried out if necessary. RESULTS: The cases of BIs observed numbered 582 (9.7%). The frequency of BIs was significantly higher in females than in males (67% vs. 33%; p = 0.03), and in nurses than in all other professional categories (p = 0.001). A total of 88% of the HCWs affected by BI were still symptomatic after the negative swab. None of the instrumental tests carried out showed any new findings of pathological significance. All cases showed progressive disappearance of symptoms, such that no cases of long COVID and no hospitalization or deaths were recorded. CONCLUSIONS: Our results confirm that SARS-CoV-2 infections occur even after a full vaccination course; however, the clinical course is favorable and severe outcomes are reduced.

Organizational wellbeing: A model of a new Apulian COVID-19 designated hospital.

Background: Work environment characteristics have an important impact on organizational wellbeing in health care facilities. In the Apulia Region, a new COVID-19 hospital was planned, designated and built in a few weeks for the treatment of patients infected with SARS-CoV-2. To our knowledge, this hospital, together with "Fiera Hospital" in Milan, are two of the few buildings worldwide that have been converted into new health care facilities with intensive care center units to treat COVID-19 patients, and this is the first study assessing organizational wellbeing in a newly designated COVID-19 hospital. Aims: To detect and assess the strong points, criticality, and perceptions of wellbeing/discomfort of health care workers engaged in the management of the current health emergency. Method: The study was conducted on 188 health care workers, with the "Multidimensional Organizational Health Questionnaire." Results: We found an overall positive level of organizational wellbeing. The more positive dimensions were "Collaboration between colleagues," "Organizational efficiency" and "Room Comfort." Conflict situations in the workplace were poorly perceived. A very low rate of absenteeism from work was also observed. Conclusions: Our results show the effectiveness of the organizational model adopted in the management of the COVID-19 hospital, especially in view of the work and emotional overload of the personnel called to face the epidemiological emergency on the frontline, which did not adversely affect the psychophysical conditions of the workers. The success of this model is related to the coexistence of all levels of care required during any type of health emergency in a single structure, paying particular attention to the architectural, functional, and procedural aspects of health care and to the so-called "humanization" of care.

Comparison of Three Different Waves in Healthcare Workers during the COVID-19 Pandemic: A Retrospective Observational Study in an Italian University Hospital.

Background: SARS-CoV-2 has infected many healthcare workers and (HCWs) worldwide. The aim of this study was to determine, analyze, and compare the frequency and characteristics of COVID-19 cases among HCWs of the University Hospital of Bari. Methods: A retrospective observational study was conducted after preventive protocol implementation. The SARS-CoV-2 infection frequency was determined by real-time reverse transcription-polymerase chain reaction on nasopharyngeal samples. Results: Overall, 519 HCWs (9%) tested positive among a total of 6030 HCWs during the three waves. The highest frequency of COVID-19 cases (n = 326; 63%) was observed during the 2nd wave, from September 2020 to December 2020, and the lowest (n = 34; 7%) was observed during the 1st wave, from March 2020 to August 2020 (p < 0.001). Working in a designated COVID-19 department was not a risk factor for infection. Conclusions: The correct use of personal protective equipment and the early identification of symptomatic workers are still essential factors to avoid nosocomial clusters, even in this current phase of vaccine availability.

Mixed-dust pneumoconiosis in a dental technician: a multidisciplinary diagnosis case report.

BACKGROUND: In dental laboratories, exposure to crystalline silica can occur during procedures that generate suspended mineral dusts, e.g. dispersion of mixing powders, removal of castings from molds grinding, polishing of castings and porcelain, and use of silica sand for blasting. There is also a large list of toxic agents (acrylic resins, polymeric materials, etc.) used to produce removable and fixed prostheses, but also impression materials and more. Using personal protective equipment and other aids reduces the exposure to these potentially harmful agents. CASE PRESENTATION: We report the case of a 42-year-old male dental technician who began to suffer from a dry cough and exertional dyspnea after approximately 15 years of work. The operations he conducted for his job resulted in the generation of crystalline silica, aluminum, chromium and titanium dust. The worker did not regularly wear personal protective equipment and some of the above operations were not carried out in closed circuit systems. The Chest X-ray showed diffused micronodules in the pulmonary interstitium of the upper-middle lobes, bilaterally, and a modest left basal pleural effusion. Simple spirometry showed small airway obstruction in its initial stage. High Resolution Computerized Tomography of the chest showed bilateral micronodulation of a miliariform type, with greater profusion to the upper lobes, also present in the visceral pleura, bilaterally. Histological examination showed aggregates of pigment-laden macrophages forming perivascular macules or arranged in a radial pattern around a core of sclerohyalinosis. Scanning Electron Microscopy and Energy Dispersive Spectrometry revealed several mineral particles, typically characterized by the presence of crystalline silica and metal aggregates. The environmental concentrations of total dust and its respirable fraction were all lower than the relative TLV-TWA-ACGIH, yet not negligible. CONCLUSIONS: The above findings and a multidisciplinary assessment led to the diagnosis of mixed dust pneumoconiosis s/q with 2/2 profusion of occupational origin. This diagnosis in a dental technician was supported for the first time in literature by environmental exposure analysis.

Predictors of unemployment status in people with relapsing multiple sclerosis: a single center experience.

BACKGROUND: Multiple sclerosis (MS) is the most common cause of nontraumatic chronic neurological disability affecting young adults during their crucial employment years. OBJECTIVES: To evaluate patients and disease related factors associated to unemployment in a cohort of relapsing-remitting (RR) MS patients. METHODS: We included RRMS patients with a follow-up of at least 1 year. We collected data about years of school education and employment status. Patients underwent a neuropsychological evaluation using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Demographic and clinical predictors of unemployment were assessed through a multivariable stepwise logistic regression model. RESULTS: We evaluated 260 consecutive RRMS patients. Employed patients were less frequently female (68.4% vs 83.3%, p = 0.006), less disabled (median Expanded Disability Status Scale (EDSS) score: 2.0 (0-7.0) vs 2.5 (0-7.5), p < 0.001), with more years of school education (mean ± standard deviation (SD), years: 13.74 ± 0.30 vs 10.86 ± 3.47, p < 0.001). Female sex and a higher EDSS score resulted associated with a greater risk of unemployment (OR 3.510, 95% CI 1.654-7.448, p = 0.001; OR 1.366, 95% CI 1.074-1.737, p = 0.011, respectively), whereas a greater number of years of schooling and current disease-modifying therapy exposure resulted protective factors (OR 0.788, 95% CI 0.723-0.858, p < 0,001; OR 0.414, 95% CI 0.217-0.790, p = 0.008, respectively). CONCLUSIONS: Understanding work is pervasively influenced by consequences of MS, we confirmed the impact of demographic, physical, and cognitive factors on employment status in RRMS patients.

Interplay Between Adherence to the Mediterranean Diet and Lipid Profile: A Comparative Survey Between Day-Time Healthcare and Non-healthcare Female Workers.

Introduction: Occupational physicians, as an aspect of the periodic health surveillance of workers prescribed by law, must develop preventive programs against adverse health-related occurrences (Legislative Decree 81/2008, art.25) to reduce major risk factors for non-communicable/chronic diseases. Eating habits play an important role in defining risk trajectories in the workplace. Methods: We randomly and cross-sectionally evaluated 147 females, of which 59 were healthcare workers (HCWs) and 88 were non-HCWs. The assessment included a dietary screening for adherence to the Mediterranean diet (MD) and a clinical baseline collection of major fluid biomarkers and anthropometric indicators for cardiovascular and metabolic risk. Results: The HCW group exhibited greater adherence to the MD than the non-HCW group. Nevertheless, they showed higher serum levels of triglycerides and total cholesterol. Menopause and type of work significantly and unfavorably affected triglyceride serum levels among HCWs. Conclusion: Greater preventive efforts are needed in the context of periodic health surveillance by occupational physicians. Disseminating additional information on a healthier lifestyle, particularly among female workers of perimenopausal age, is a key issue.

Association between Long COVID and Overweight/Obesity.

BACKGROUND: Long COVID is a syndrome characterized by the persistence of SARS-CoV-2 infection symptoms. Among HCWs, prolonged COVID symptoms could lead to the inability to perform work tasks. The aim of this study is to investigate 35-day long-COVID (35-LC) characteristics and risk factors in a one-year period. METHODS: We carried out a retrospective cohort study during the COVID-19 pandemic at University Hospital of Bari. A total of 5750 HCWs were tested for close contact with a confirmed case, in the absence of personal protective equipment, or for symptom development. RESULTS: Each positive HCW was investigated for cardiovascular risk factors or respiratory diseases. An amount of 352 HCWs (6.1%) were infected by SARS-CoV-2, and 168 cases evolved to long COVID. The 35-LC group showed mean BMI values higher than the non-35-LC group (25.9 kg/m2 vs. 24.8 kg/m2, respectively), and this difference was significant (p-value: 0.020). Moreover, HCWs who suffered from pulmonary disease (OR = 3.7, CL 95%: 1.35-10.53; p-value = 0.007) or overweight (OR = 1.6 CL 95%: 1.05-2.56; p-value = 0.029) had an increased risk of developing 35-LC. CONCLUSIONS: Long COVID is an emerging problem for hospital managers as it may reduce the number of HCWs deployed in the fight against COVID-19. High BMI and previous pulmonary disease could be risk factors for 35-LC development in exposed HCWs.

Health, Transport and the Environment: The Impacts of the COVID-19 Lockdown on Air Pollution.

Lockdown measures were initiated in Italy on March 9th after the start of the SARS-CoV-2 epidemic to flatten the epidemic curve. The aim of the present study was to assess the impact of restrictive measures in the Apulia Region, southern Italy, on air quality from March to April 2020. We applied a dual-track approach. We assessed citizen mobility and vehicle traffic with mobility network data and information obtained from satellite tracking, and we evaluated and compared pollutant concentration data as measured by monitoring stations maintained by the Regional Agency for Environmental Protection and Prevention of Apulia (ARPA). The results showed a decrease in the weekly mean NO2 concentration recorded by urban traffic stations during the lockdown period. In particular, in the city of Bari, the average NO2 concentration decreased from 62.2 µg/m3 in March 2019 to 48.2 µg/m3 in March 2020. Regarding PM10 levels, the average concentrations at the individual traffic stations showed no particular variation compared to those in the same months of the previous year, except for Bari-Caldarola Station in March 2019/2020 (p-value < 0.001) and in April 2019/2020 (p-value = 0.04). In particular the average in March 2019 was ~26.9 µg/m3, while that in March 2020 was ~22.9 µg/m3. For April, the average concentration of PM10 in 2019 was 27.9 µg/m3, while in 2020, the average was ~22.4 µg/m3. This can be explained by the fact that PM10 levels are influenced by multiple variables such as weather and climate conditions and desert dust advections.

Nutritional hazard analysis and critical control points at work (NACCPW): interdisciplinary assessment of subjective and metabolic work-related risk of the workers and their prevention.

In recent decades in high industrialised countries the occupational risks and energy costs of labour have decreased while the subjective nutritional and metabolic risk of workers has increased because they often follow an incorrect lifestyle. This article addresses the multidisciplinary assessment and management of these risks in order to define a Nutrient Hazard Analysis and Critical Control Point at Work (NACCPW), specifically dedicated to proper nutrition, which workers must take over before or during the work schedule. It describes the various steps that the professionals concerned will need to develop to define the work-related and subjective metabolic and nutritional critical points and their corrective actions. NACCPW allows to balance work-related metabolic risk with subjective nutritional risk of workers and gives indications to reduce both. The further improvement in working conditions and lifestyle, with a focus on the nutrition of workers, will help to prevent cardio-vascular, metabolic and cancer diseases still very common in Western countries. The effectiveness of NACCPW is ensured by the possibility of including it in periodic health surveillance, which is required by law, for the entire working life.