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.

Oxidative stress, inflammation and disease activity biomarkers in lupus nephropathy.

Lupus nephropathy is a severe and frequent complication of systemic lupus erythematosus. Here, we assessed the biomarkers of oxidative stress, inflammation and disease activity in patients with lupus nephritis. Thirty-four patients with active lupus nephritis, 31 patients with inactive lupus nephritis and 20 lupus patients without renal damage (non-lupus nephritis) were studied. Oxidative stress biomarkers malonyldialdehyde, oxidized-to-total glutathione, catalase, superoxide dismutase and total antioxidant status were assessed, as well as inflammation biomarkers CRP, interleukin 6 and monocyte chemoattractant protein 1. Renal tubular disease biomarkers neutrophil gelatinase-associated lipocalin and ß2-microglobulin were assessed, together with the classic disease activity biomarkers urinary protein/creatinine ratio, anti-dsDNA, anti-C1q antibody and complement proteins C3 and C4. Significant differences were found between active lupus nephritis and inactive lupus nephritis patients and between active lupus nephritis and non-lupus nephritis patients for all the assessed biomarkers (P < 0.05), except for catalase, superoxide dismutase and interleukin 6. There is an imbalance in the redox status in active lupus nephritis patients that would be involved in lipid peroxidation of the glomerular basal membrane that would alter its integrity and could also affect renal tubular function in these patients.

Association of Kaposi's sarcoma-associated herpesvirus-positive primary effusion lymphoma with expression of the CD138/syndecan-1 antigen.

Primary effusion lymphoma (PEL) represents a novel B-cell non-Hodgkin's lymphoma (NHL) type associated with Kaposi's sarcoma-associated herpesvirus infection and typically growing as lymphomatous effusions in the body cavities. The precise B-cell subset from which PEL originates as well as the biologic mechanisms responsible for its peculiar growth pattern are unclear. In this study, we have analyzed PEL for the expression status of CD138/syndecan-1, a molecule selectively associated with late stages of B-cell differentiation and implicated in cell-to-cell and cell-to-extracellular matrix interactions. PEL patient samples (n = 7) and cell lines (n = 5) were investigated by multiple approaches, including immunocytochemistry, flow cytometry, RNA analysis, and Western blot studies. For comparison, lymphomatous effusions other than PEL (n = 13) and tissue-based NHL (n = 103) were also tested. Expression of CD138/syndecan-1 associates at high frequency with PEL (5 of 7 patient samples and 5 of 5 cell lines), whereas it is consistently absent among other lymphomatous effusions (n = 13). The CD138/syndecan-1 isoform expressed by PEL has an average molecular weight of 420 kD, which is substantially different from that of CD138/syndecan-1 molecules generally expressed by plasma cells. These data, along with previous immunophenotypic evidence, unequivocally define that PEL cells represent a preterminal stage of B-cell differentiation and may bear implications for the peculiar growth pattern of this lymphoma.

Forensic aspects of medical student abuse: a Canadian perspective.

The mistreatment and consequences of mistreatment involving medical students have only recently been recognized and studied. This article reports on the nature, frequency, and sequelae of "abuse" that is prohibited by the Criminal Code of Canada, as experienced by fourth year medical students. A 160-item, multiple choice questionnaire, the Medical Student Abuse Survey (MSAS), was administered on a voluntary and anonymous basis in February 1992 and 1993 at the University of Toronto (Canada) Faculty of Medicine. All students enrolled in their fourth year (n = 500) were eligible. Of those present when the survey was administered (n = 415), 72.5 percent (301 of 415) responded. Of all respondents, 8.3 percent (25 of 301) experienced either threats of bodily harm, assault, or assault with a weapon; 12.6 percent (38 of 301) experienced physical sexual advances; four students experienced both. Perpetrators were most often clinicians in a surgical setting. Only about one-third of these students (21 of 59) complained to someone in a position of authority within the medical school, and no one reported these incidents to the police. There is a need within medical training programs to disseminate a "code of conduct" to all parties, familiarize students with complaint procedures, and improve the identification and rehabilitation of perpetrators. The lack of objective measures for verifying students' experiences of abuse remains a limitation of this study.

Effect of refeeding on the energy metabolism of adolescent girls who have anorexia nervosa.

The effect of refeeding on resting energy expenditure (REE) and substrate utilization was studied in 18 hospitalized adolescent girls (aged 12.9-19.1 years) suffering from anorexia nervosa. Changes in body composition were monitored weekly and included weight, fat body mass (FBM), lean body mass (LBM) and total body potassium (TBK). REE was studied weekly by open-circuit calorimetry. Weight gain was noted in all patients (38.2 +/- 5.6 to 44.5 +/- 5.3 kg), involving increased FBM and LBM. REE increased per kg of weight (91.6 +/- 15.1 to 101.7 +/- 18.0 kJ kg-1 d-1) and LBM over the first weeks of refeeding (P less than 0.025) and then stabilized. Substrate utilization showed an increase in carbohydrate and protein utilization (P less than 0.001) during the first few weeks of refeeding. We also studied the thermic effect of food (TEF) in 14 of the 18 subjects. Upon admission the subjects had a reduced TEF (36.4 +/- 24.3 kJ 2 h-1) (P less than 0.001). With refeeding TEF rose to a peak or plateau, then decreased to normal levels (61.9 +/- 36.0 kJ 2 h-1) before discharge from hospital. We conclude that the energy metabolism of adolescent girls adapts to semi-starvation by a reduction in both REE and TEF; with refeeding there is reversal of this adaptive function.

Energy expenditure and body composition in patients with anorexia nervosa.

Blood biochemistry, body composition, and resting energy expenditure were studied in 25 patients with anorexia nervosa admitted to hospital during a period of 18 months. The patients' ages ranged from 12.9 to 17.2 years, and the abnormal feeding history from 3 to 12 months. Blood chemistry values were in the normal range, but fat body mass and lean body mass were reduced and extracellular water volume was expanded beyond normal values. Resting energy expenditure was reduced to 49% to 91% of values predicted by the Harris-Benedict equations. Substrate use after overnight fast indicated an abnormally high use of carbohydrates. Significant correlations were found between extracellular water volume and triceps skin-fold thickness, mid-arm muscle circumference and lean body mass, and substrate use and weight loss as a percentage of initial weight. We suggest that these simple anthropometric measurements can be used to assess and monitor the refeeding of patients with anorexia nervosa.

Changes in body composition during refeeding of patients with anorexia nervosa.

Changes in body composition were studied in 13 girls with anorexia nervosa before and during 2 months of refeeding. Fat body mass and fat-free body mass were derived from skin-fold measurements. Total body potassium was measured by whole body counter, and intracellular water was calculated from it. Extracellular water was measured as the bromide space after oral bromide administration. A gradual increase was noted in weight, fat body mass, fat-free body mass, and total body potassium during refeeding. Extracellular water was expanded on admission and increased in all patients in the first weeks of treatment; later it fell to normal. Most of the changes in fat-free body mass over the first weeks of refeeding could be accounted for by an expansion in extracellular water. Particular care must therefore be taken with fluid balance during the first few weeks of refeeding.