Worse pulmonary function in association with cumulative exposure to nanomaterials. Hints of a mediation effect via pulmonary inflammation.

BACKGROUND: Today, nanomaterials are broadly used in a wide range of industrial applications. Such large utilization and the limited knowledge on to the possible health effects have raised concerns about potential consequences on human health and safety, beyond the environmental burden. Given that inhalation is the main exposure route, workers exposed to nanomaterials might be at risk of occurrence of respiratory morbidity and/or reduced pulmonary function. However, epidemiological evidence regarding the association between cumulative exposure to nanomaterials and respiratory health is still scarce. This study focused on the association between cumulative exposure to nanomaterials and pulmonary function among 136 workers enrolled in the framework of the European multicentric NanoExplore project. RESULTS: Our findings suggest that, independently of lifelong tobacco smoking, ethnicity, age, sex, body mass index and physical activity habits, 10-year cumulative exposure to nanomaterials is associated to worse FEV1 and FEF25 - 75%, which might be consistent with the involvement of both large and small airway components and early signs of airflow obstruction. We further explored the hypothesis of a mediating effect via airway inflammation, assessed by interleukin (IL-)10, IL-1ß and Tumor Necrosis Factor alpha (TNF-α), all quantified in the Exhaled Breath Condensate of workers. The mediation analysis results suggest that IL-10, TNF-α and their ratio (i.e., anti-pro inflammatory ratio) may fully mediate the negative association between cumulative exposure to nanomaterials and the FEV1/FVC ratio. This pattern was not observed for other pulmonary function parameters. CONCLUSIONS: Safeguarding the respiratory health of workers exposed to nanomaterials should be of primary importance. The observed association between cumulative exposure to nanomaterials and worse pulmonary function parameters underscores the importance of implementing adequate protective measures in the nanocomposite sector. The mitigation of harmful exposures may ensure that workers can continue to contribute productively to their workplaces while preserving their respiratory health over time.

Biomarkers of oxidative stress, inflammation, and genotoxicity to assess exposure to micro- and nanoplastics. A literature review.

The increased awareness about possible health effects arising from micro- and nanoplastics (MNPs) pollution is driving a huge amount of studies. Many international efforts are in place to better understand and characterize the hazard of MNPs present in the environment. The literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology in two different databases (PubMed and Embase). The selection of articles was carried out blind, screening titles and abstracts according to inclusion and exclusion criteria. In general, these studies rely on the methodology already in use for assessing hazard from nanomaterials and particles of concern. However, only a limited number of studies have so far directly measured human exposure to MNPs and examined the relationship between such exposure and its impact on human health. This review aims to provide an overview of the current state of research on biomarkers of oxidative stress, inflammation, and genotoxicity that have been explored in relation to MNPs exposure, using human, cellular, animal, and plant models. Both in-vitro and in-vivo models suggest an increased level of oxidative stress and inflammation as the main mechanism of action (MOA) leading to adverse effects such as chronic inflammation, immunotoxicity and genotoxicity. With the identification of such biological endpoints, representing critical key initiating events (KIEs) towards adaptive or adverse outcomes, it is possible to identify a panel of surrogate biomarkers to be applied and validated especially in occupational settings, where higher levels of exposure may occur.

Inflammatory Biomarkers in Exhaled Breath Condensate: A Systematic Review.

Inflammation is a comprehensive set of physiological processes that an organism undertakes in response to a wide variety of foreign stimuli, such as viruses, bacteria, and inorganic particles. A key role is played by cytokines, protein-based chemical mediators produced by a broad range of cells, including the immune cells recruited in the inflammation site. The aim of this systematic review is to compare baseline values of pro/anti-inflammatory biomarkers measured in Exhaled Breath Condensate (EBC) in healthy, non-smoking adults to provide a summary of the concentrations reported in the literature. We focused on: interleukin (IL)-1ß, IL-4, IL-6, IL-8, IL-10, tumour necrosis factor-alpha (TNF-α), and C reactive protein (CRP). Eligible articles were identified in PubMed, Embase, and Cochrane CENTRAL. Due to the wide differences in methodologies employed in the included articles concerning EBC sampling, storage, and analyses, research protocols were assessed specifically to test their adherence to the ATS/ERS Task Force guidelines on EBC. The development of reference intervals for these biomarkers can result in their introduction and use in both research and clinical settings, not only for monitoring purposes but also, in the perspective of future longitudinal studies, as predictive parameters for the onset and development of chronic diseases with inflammatory aetiology.

Multi-level analysis of individual and work environment factors associated with nurses' perceived emotional exhaustion.

BACKGROUND: Several factors at the individual- and work environment-level were suggested to correlate with emotional exhaustion development in nurses. AIM: To explore nurses' perceived emotional exhaustion and associated factors by employing hierarchical modelling techniques. METHODS: 1539 nurses completed the cross-sectional survey. Generalized Linear Mixed Model was performed to identify predictors of emotional exhaustion. RESULTS: At the individual level, female gender, high workload and emotional job demands increased the risk of emotional exhaustion; instead, higher education, satisfaction with the role of follower, perceiving nursing profession as meaningful, feeling independent at work, and group closeness were protective factors. At the work environment level, hospital ward type did not affect emotional exhaustion. CONCLUSIONS: Emotional exhaustion is largely influenced by ward culture and organizational policies, and to a lower extent by socio-demographic variables. Moreover, it emerges as an intrinsic risk of the nursing profession rather than being associated with the clinical area profile.

Contribution to validation of the Italian version of work ability personal radar.

BACKGROUND: Work ability (WA) is an important construct in the occupational health field. Over the years, various WA detection tools have been developed, and a new one is: Work Ability Personal Radar (WA-PR), capable of investigating all the dimensions that define the complexity of WA. The WA-PR was born in the Finnish context, however recently it has also been validated elsewhere. In light of literature on WA assessment tools, our goal is to contribute to the validation of the WA-PR in the Italian context. METHODS: Data were collected using a self-reported questionnaire administered to 405 workers in the chemical industrial sector. RESULTS: Results show that the WA-PR correlate with WAI and with other constructs conceptually related to work ability: need for recovery, stress and general health. CONCLUSIONS: Data analysis confirms that the WA-PR is a useful and reliable tool for evaluating work ability in Italian context.

Prevalence of musculoskeletal disorders among perioperative nurses: a systematic review and META-analysis.

BACKGROUND: To evaluate the prevalence of work-related musculoskeletal disorders (WRMSDs) in perioperative nurses and to explore their association with personal characteristics. METHODS: Medline, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Cochrane Library and Joanna Briggs Institute Database were systematically searched. A meta-analysis calculating event rates, and relative 95% Confidence Intervals (CI) was performed for each musculoskeletal body region. The contribution of perioperative nurses' sex, age, and BMI was assessed through a meta-regression. RESULTS: Twenty-two studies, considering 3590 perioperative nurses, were included in the systematic review. The highest prevalence of WRMSDs was found for the lower-back (62%; 95% CI 0.54-0.70), followed by knee (47%; 95% CI 0.36-0.59), shoulder (44%; 95% CI 0.37-0.51), waist (42%; 95% CI 0.31-0.53), neck (39%; 95% CI 0.29-0.51), ankle-feet (35%; 95% CI 0.22-0.51), upper-back (34%; 95% CI 0.25-0.44), hand-wrist (29%; 95% CI 0.20-0.40), and elbow (18%; 95% CI 0.12-0.26). Meta-regression showed that sex, age, and BMI were not significant predictors of low-back disorders (p = 0.69; R2 = 0). CONCLUSIONS: WRMSDs represent a high prevalence issue among perioperative nurses. Perioperative nurses, in general, are steadily exposed to both physical and temporal risk factors. Further studies should be addressed to identify specific interventions aimed at reducing the burden of WRMSDs including ergonomic education and physical rehabilitation. Our data could be used in future studies as a reference to assess the risk of WRMSDs in other health-care professionals' population.

Job demands and perceived distance in leader-follower relationships: A study on emotional exhaustion among nurses.

BACKGROUND: Emotional exhaustion is the most important component of burnout syndrome, which is a threat to nurses' psychological well-being. OBJECTIVES: The study investigated the impact of job demands - workload, cognitive demands, emotional demands, role conflict - and perceived leader-follower interaction frequency on emotional exhaustion among nurses. METHODS: This study was conducted at three hospitals in northern Italy through an anonymous self-report questionnaire administered to 560 nurses. Multiple hierarchical regression was performed. RESULTS: Workload and role conflict were positively related to emotional exhaustion, whereas cognitive demands and perceived leader-follower interaction frequency were negatively related. Emotional demands displayed a non-significant relationship with emotional exhaustion. Further analyses were performed to comment on the unexpected outcome of cognitive demands. A critical role of the perception of "distance" in leader-follower relationships on burnout was found. CONCLUSIONS: This study provides novel insights into the relationship between job demands and burnout, and much needed empirical evidence on leader-follower relationships among nurses, pointing to the important role played by leader distance in nurses' well-being at work. Findings highlight the importance of training head nurses in managing their working relationship distance from their followers in order to help them soothing emotional exhaustion.

Lead poisoning from Ayurvedic treatment: a further case.

PURPOSE: We report a case of a 30 years old Indian sailor with microcytic anemia (Hb 9.9), persistent abdominal pain, emesis, dark stool, hyperchromic urine, latent jaundice and asthenia. Lead intoxication was confirmed (blood lead value of 102 µg/dL). The patient assumed Ayurvedic medicines in the previous months. Ayurveda is an ancient form of Indian traditional popular medicine aiming to re-establish health and body function through herbal preparations, heavy metals are often added. Our purpose was to treat the patient and to establish the source of poisoning. METHODS: After testing blood and urine lead concentration of other 3 crew members and analyzing over than 150 products used on the ship professional exposure was excluded. We analyzed the two Ayurvedic drugs assumed by the patient with an Inductively Coupled Plasma Mass Spectrometry. The patient underwent three chelation cycles with Calcium Disodium Ethylenediaminetetraacetic acid (EDTA) while monitoring blood and urinary lead levels. RESULTS: The final blood lead level at discharge, after three chelation cycles, was 36.27 µg/dL. One of the two drugs contained extremely high concentrations of lead and mercury. The three different mixtures of this preparation showed lead concentrations of 12,638.54 mg/kg (Sample 2A), 23,043.02 mg/kg (Sample 2B), 21,352.97 mg/kg (Sample 2C); these levels are much higher than the highest values reported in literature for the indian soil (32 mg/kg). CONCLUSIONS: This case and similar cases raise the safety alert on complementary and alternative medicines; Ayurvedic medicine users should be carefully informed about potential risks and signs of poisoning.

Effects of glove finger- versus lidocaine-soaked nasal packing after endoscopic nasal surgery: a prospective randomized controlled trial.

PURPOSE: Nasal packing is a common but unpleasant procedure in patients who undergo endoscopic sinus surgery (ESS). The aim of this study was to assess whether a glove-finger pack strategy would reduce pain compared to lidocaine-soaked packs after ESS. METHODS: A prospective randomized controlled trial enrolling 120 consecutive patients affected by chronic rhinosinusitis, who underwent bilateral ESS. At the end of surgery 62 subjects received 10 cm non-absorbable pack soaked with 5 mL of 2%-lidocaine solution and 58 received a 10 cm non-absorbable pack coated with a latex free glove finger soaked with saline solution. Data concerning pain were collected using a 0 to 10 visual analogue scale at post-operative hours 1, 4, 8, and 16 and at pack removal (24 h ± 15 min). All post-operative analgesic rescue doses were registered. Also, bleeding was reported. RESULTS: The mean VAS score during pack-removal was significantly lower in glove-finger group than in the lidocaine group (3.22 ± 2.16 vs 4.89 ± 2.90, p = 0.0012). There was no statistically significant difference between re-soaking lidocaine-soaked-packs with saline solution or lidocaine at pack removal time (p = 0.42). CONCLUSION: Glove-finger nasal pack seems to provide better pain control after ESS, when compared with lidocaine-soaked pack, especially at pack removal time.

[COVID-19 and work environment: legislative developments about the role of the occupational physician in the emergency management and in the SARS-CoV-2-related work accidents notification]. / COVID-19 e Ambienti di lavoro: recenti evoluzioni normative del ruolo del Medico Competente nella gestione dell'emergenza e nella denuncia dei casi di infortunio professionale legati all'infezione da SARS-CoV-2.

SUMMARY: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and its associated disease (COVID-19) represent a global health emergency that requires integrated and multidisciplinary intervention by international medical and scientific communities, in support of the national governments. In Italy many public health measures have been adopted to contain the transmission of the disease, which also involved occupational physicians. The regulatory path has had a rapid evolution due to the trend of infections and progressive scientific evidence: the most recent Circular from the Ministry of Labor and Social Policies and the Ministry of Health provides for the termination of the "exceptional health surveillance" activity, the management and protection of fragile individuals by activating the medical examination on request of the employee and excludes the old age, without comorbidities, as a specific condition of risk of serious complication of SARS-CoV-2 infection. For preventive and insurance purposes, COVID-19 usually represents a generic biological risk, for which the same measures must be adopted for the entire population. In the Inail Circular no. 13 of April 3, 2020, however, it is stated that professional categories that perform front office duties are considered exposed to a higher risk, as well as, health professionals, can be considered exposed to a specific risk. From January 1st to July 31st 2020, 51,363 cases of infection from SARS-CoV-2 were reported to INAIL as an accident. In the same period INAIL noticed a decrease in reports of accidents and occupational disease overall, correlated to the effects of lockdown and smart working.