Recognition of COVID-19 with occupational origin: a comparison between European countries.

OBJECTIVES: This study aims to present an overview of the formal recognition of COVID-19 as occupational disease (OD) or injury (OI) across Europe. METHODS: A COVID-19 questionnaire was designed by a task group within COST-funded OMEGA-NET and sent to occupational health experts of 37 countries in WHO European region, with a last update in April 2022. RESULTS: The questionnaire was filled out by experts from 35 countries. There are large differences between national systems regarding the recognition of OD and OI: 40% of countries have a list system, 57% a mixed system and one country an open system. In most countries, COVID-19 can be recognised as an OD (57%). In four countries, COVID-19 can be recognised as OI (11%) and in seven countries as either OD or OI (20%). In two countries, there is no recognition possible to date. Thirty-two countries (91%) recognise COVID-19 as OD/OI among healthcare workers. Working in certain jobs is considered proof of occupational exposure in 25 countries, contact with a colleague with confirmed infection in 19 countries, and contact with clients with confirmed infection in 21 countries. In most countries (57%), a positive PCR test is considered proof of disease. The three most common compensation benefits for COVID-19 as OI/OD are disability pension, treatment and rehabilitation. Long COVID is included in 26 countries. CONCLUSIONS: COVID-19 can be recognised as OD or OI in 94% of the European countries completing this survey, across different social security and embedded occupational health systems.

Diagnostic yield of conventional transbronchial needle aspiration biopsy (C-TBNA) without an on-site cytopathologist: Experience of 363 procedures in 219 patients.

INTRODUCTION: Conventional transbronchial needle aspiration biopsy (C-TBNA) is a technique in evaluating mediastinal/hilar lymph nodes (LN). We aimed to investigate diagnostic yield (DY) and safety of C-TBNAs performed in a single university clinic. PATIENTS AND METHODS: We retrospectively reviewed 363 consecutive C-TBNA procedures in 219 patients. The DY and its relationship with location, shortest diameter, SUVmax of LN, and number of sampled stations were evaluated. RESULT: Procedures were diagnostic in 257 (71%) LNs. The most common diagnoses were malignancy (n= 109.30%) and granulomatous inflammation (n= 68, 18.7%).The ratio of patients with at least one diagnostic cytology result was 77% (n= 168). DY was significantly increased with the increased number of sampled LNs (p= 0.033) and larger LN diameter (p< 0.001). Sensitivity, specificity, positive, and negative predictive values were 83.3%, 43.2%, 79.6%, and 49.3% respectively for cut-off LN diameter of 11.5 mm. There was nearly a significant relationship between DY and SUVmax (p= 0.05, cut-off= 4.8). The highest DY was in subcarinal LN (77.4%). No major complications were recorded. CONCLUSIONS: The DY of C-TBNA was 71%. The ratio of the patients with at least one diagnostic cytology result was 77%. The most common diagnoses were malignancy and granulomatous inflammation. The DY of C-TBNA was increased with the increased number of sampled LNs, larger LN diameter, and increased SUVmax. C-TBNA is a safe procedure.

Perspective of Workers' Union Representatives on COVID-19 Measures in Turkish Workplaces in the First Year of the Pandemic

Background: Severe acute respiratory syndrome coronavirus-2, the virus causing coronavirus disease-2019, is a biological hazard in workplaces. Thus, protective measures should be applied. Despite their potential role, the perspective of workplace representatives on coronavirus disease-2019 measures is rarely investigated. Aims: To assess the perspective of workplace union representatives on coronavirus disease-2019 measures in their workplaces in the first year of the pandemic in Turkey. Study Design: A descriptive observational study. Methods: This national descriptive study included workplace chief representatives of 33 workers' unions. A 42-item electronic survey was used to collect data to evaluate the practice of job organization, social distancing and personal protective equipment use, sanitization, and occupational safety and health training. Results: The study included 509 workplace chief representatives' responses. Results showed that several administrative measures, including suspending production or work, encouraging workers to take leave, implementing alternate work schedules, isolating any coronavirus disease-2019 case from other workers in a designated room, and avoiding face-to-face meetings, were not available in more than half of the workplaces. The mean number of available measures was significantly high (p < 0.001) in the industrial sector and workplaces with 250 or more workers. Almost all union representatives (98.8%) reported at least one diagnosis of coronavirus disease-2019 among workers, and 12.6% reported a positive history of coronavirus disease-2019-related mortality. The regression model for any history of coronavirus disease-2019 mortality in workers demonstrated a significantly increased association with workplaces with 250 or more workers compared with workplaces with less than 250 workers (odds ratio =2.99, 95% confidence interval =1.65-5.44, p < 0.001). Conclusion: The results indicate failure in administrative measures and the need for improvement in medium- and small-sized workplaces and the non-industrial sector. All local and national stakeholders need to pay special attention to address these issues. Future studies should evaluate on-site coronavirus disease-2019 workplace measures and their effectiveness.

Perceived Need for Mental Health Services Among Healthcare Workers During the Coronavirus Disease-19 Pandemic in Turkey: A Multicenter Cross-sectional Study

Background: The coronavirus disease-2019 pandemic has contributed to work-related psychosocial risks in healthcare workers. Aims: To evaluate the perceived need for mental health services and related factors in Turkish healthcare workers practicing in pandemic hospitals. Study Design: Cross-sectional study. Methods: Data were collected from face-to-face interviews with healthcare workers at 19 pandemic hospitals in 13 provinces between September and November 2021. The study survey included the evaluation of the perceived need for and utilization of mental health services in the previous year, as well as sociodemographic, health-related, and work-related characteristics, the General Health Questionnaire-12, the World Health Organization Quality of Life-BREF (WHOQoL-BREF) questionnaire, and the Fear of coronavirus disease-2019 scale (FCV-19S). Results: Of 1,556 participants, 522 (33.5%) reported a perceived need for mental health services, but only 133 (8.5%) reported receiving these services. Multiple logistic regression analysis of the perceived need for mental health services revealed significant relationships with lower age, female sex, being a current smoker, having a chronic disease, having a mental disorder, coronavirus disease-2019 contact within the last three months in settings other than the home or workplace, a positive coronavirus disease-2019 vaccination history, being a physician, being a non-physician healthcare professional, and coronavirus disease-2019 contact within the last three months at work. After adjustment for these characteristics, higher General Health Questionnaire-12 and FCV-19S scores and lower WHOQoL-BREF domain scores were related to the perceived need for mental health services in logistic regression analyses. Conclusion: The findings indicate a substantial need for mental health services amongst Turkish healthcare workers during the pandemic and outline participants' characteristics regarding high-priority groups for the intervention. Future research may focus on developing actions and evaluating their efficiency.

Rapid diagnosis of malignant pleural mesothelioma and its discrimination from lung cancer and benign exudative effusions using blood serum.

Malignant pleural mesothelioma (MPM), an aggressive cancer associated with exposure to fibrous minerals, can only be diagnosed in the advanced stage because its early symptoms are also connected with other respiratory diseases. Hence, understanding the molecular mechanism and the discrimination of MPM from other lung diseases at an early stage is important to apply effective treatment strategies and for the increase in survival rate. This study aims to develop a new approach for characterization and diagnosis of MPM among lung diseases from serum by Fourier transform infrared spectroscopy (FTIR) coupled with multivariate analysis. The detailed spectral characterization studies indicated the changes in lipid biosynthesis and nucleic acids levels in the malignant serum samples. Furthermore, the results showed that healthy, benign exudative effusion, lung cancer, and MPM groups were successfully separated from each other by applying principal component analysis (PCA), support vector machine (SVM), and especially linear discriminant analysis (LDA) to infrared spectra.

Environmental asbestos exposure and nonmalignant pleural findings: a retrospective evaluation of a five-year chest CT repository.

This registry-based case-control study aimed to assess the association between asbestos deposits in the birthplace and/or residence and nonmalignant pleural findings, namely pleural plaques (PPs) and pleural thickening (PT), on chest CT scans. In total, 39,472 CT scans obtained over five years in a tertiary referral hospital in Ankara, Turkey, were evaluated. Cases involving patients with PP (n = 537), PT (n = 263), PP&PT (n = 69), and controls (n = 543) from the same study base without those conditions were included. Each case group was compared to controls using unconditional logistic regression. The presence of asbestos deposits in the district of birthplace (adjusted OR = 2.13, 95% CI: 1.35-3.37) and both birthplace and residence (aOR = 4.32, 95% CI: 2.26-8.27) was significantly related to the PPs. As the importance of environmental asbestos exposure in Turkey continues, future prospective studies could contribute to developing screening strategies.

Prevalence and Risk Factors of Work-Related Asthma in Hospital Cleaning Workers.

OBJECTIVE: This study aimed to determine the prevalence and evaluate the risk factors of work-related asthma among professional hospital cleaning workers. MATERIAL AND METHODS: In total, 278 cleaning workers were interviewed (response rate: 75.7%), and pulmonary function tests were performed. The presence of asthma and its work-relatedness was evaluated. Serial peak expiratory flow measurements were planned according to symptoms increased at work or spirometric findings. RESULTS: Totally 40 cleaning workers had asthma (14.3%); of these, 17 (6.1%) had work-related asthma, and 23 (8.2%) had non-work- related asthma. Non-work-related asthma and work-related asthma were significantly associated with the females(odds ratio 95% CI: 3.0, 1.1-8.4, and 3.2, 1.0-10.3, respectively). Non-work-related asthma was significantly associated with a family history of asthma (odds ratio 95%CI: 5.1, 2.0-13.2 and 2.8, 0.99-7.9, respectively) and limescale remover use at work (odds ratio, 95% CI: 0.21, 0.04-0.97, and 1.7, 0.5-5.2, respectively). Only 7 (28.0%) of 25 cleaning workers who were suggested serial peak expiratory flow measurements could complete the measurements. Of those, measurements of 2 cleaning workers were consistent with occupational asthma. CONCLUSION: The negative association between limescale remover use at work and non-work-related asthma suggested health selec- tion bias (avoidance behavior) due to the asthmatic effects of these chemicals.

COVID-19 as a Recognized Work-Related Disease: The Current Situation Worldwide.

Coronavirus disease 2019 (COVID-19), which is a newly emerging infectious disease worldwide, can be categorized as an occupational disease, because employees, particularly in the healthcare system, can be infected at the workplace. As of December 15, 2020, we summarized the occupational safety and health practices in selected countries on the recognition of COVID-19 as one of the occupational risks. The situation has differed among countries, including the recognition status and whether a specific regulation existed. International organizations, namely the International Labour Organization, World Health Organization, and European Union, should plan and conduct studies on the work-relatedness of COVID-19, propose criteria for recognition, and add the infection to the occupational disease list to provide a basis for specific country regulations. Stakeholders should also act to adjust country-level legislation.

The Perspective of the Turkish Thoracic Society Members on Institutional Preparedness During the COVID-19 Pandemic in Turkey.

OBJECTIVE: We aimed to evaluate the perspective of the Turkish Thoracic Society (TTS) members regarding institutional preparedness, in terms of administrative measures and availability of personal protective equipment (PPE), in the first and third months of the coronavirus disease 2019 (COVID-19) pandemic in Turkey. MATERIAL AND METHODS: A 22-item online survey was e-mailed between the first and third months to TTS members, and participants' responses were evaluated. RESULTS: The number of participants was 295 in the first survey and 141 in the second. In the second survey, the percentage of answers implying availability increased in all 18 control measures, 16 of which were statistically significant. However, there were still less than half of the respondents who reported the availability of psychological and behavioral support and some PPE, including respirators, facial protectors, goggles, and gowns. Statistical significance was observed for provision of a waiting area (P = .008), rooms for aerosol-generating procedures (P = .042), and special wards for patients with suspected or definite COVID-19 (P < .001); testing healthcare workers (HCWs) with a history of contact with a COVID-19 case (P < .001); and surveillance of symptomatic HCWs (P = .048), between tertiary vs. primary and secondary healthcare facilities in the first survey, but provision of special wards (P = .002) and supply for aprons (P = .027) in the second survey. CONCLUSION: Our results showed an improvement in control measures in the third month of the pandemic. However, the persistent low availability of psychological and behavioral support and several items of PPE pointed out the need for action. Considering the health and safety of HCWs, the control measures should be actively monitored and deficiencies eliminated.

COVID-19 in Turkish health care workers practicing chest medicine.

OBJECTIVE: This study aimed to evaluate the data of Turkish health care workers practicing chest medicine on their coronavirus disease 2019 (COVID-19) status and related parameters. METHODS: This descriptive study included online survey data that the Turkish Thoracic Society conducted with its members in two phases starting in June and December 2020. The 33-item survey included demographic data, smoking status, the presence of any chronic diseases, occupation, working status, and non-work-related and work-related COVID-19 exposure characteristics. RESULTS: Of 742 responses, 299 (40.3%) reported that they had contracted COVID-19. The second survey detected a higher frequency of health care workers who had contracted COVID-19 (12.1% versus 57.4%, p<0.001) than the first survey. The analysis of the association between study parameters and COVID-19 in health care workers using logistic regression revealed statistical significance with working at the onset of the outbreak (OR 3.76, 95%CI 1.09-12.98, p=0.036), not working at the time of survey (OR 5.69, 95%CI 3.35-9.67, p<0.001), COVID-19 history in colleagues (OR 2.27, 95%CI 1.51-3.41, p<0.001), any non-work-related COVID-19 exposure (OR 4.72, 95%CI 2.74-8.14, p<0.001), COVID-19 exposure at home (OR 6.52, 95%CI 3.52-12.08, p<0.001), and COVID-19 history in family members (OR 8.16, 95%CI 5.52-12.08, p<0.001) after adjusting for age and sex. The study also observed an inverse relationship between the use of aprons and goggles and COVID-19 in health care workers. CONCLUSION: Occupational and nonoccupational characteristics are related to COVID-19 in health care workers practicing chest medicine. Therefore, active surveillance to detect health care workers contracting COVID-19 and to document and control occupational and nonoccupational risks should be provided.

Performance of pulmonary embolism severity index in predicting long-term mortality after acute pulmonary embolism.

OBJECTIVE: In this study, we aimed to evaluate the accuracy of the original and simplified pulmonary embolism (PE) severity index (PESI) to predict all-cause mortality after 30 days of acute PE diagnosis up to five years within consecutive sub-periods. METHODS: Adult patients diagnosed with acute PE between January 1, 2003, and June 30, 2013, were retrospectively included. Data on baseline characteristics and mortality during a five-year follow-up were collected. RESULTS: The study included 414 patients (Male/Female=192/222). The median age at diagnosis was 61.5 (minimum-maximum, 18-93) years. Mortality rates were 13.3% at 30 days, 21.8% at 90 days, 32.6% at one year, and 51.0% at five years. Both stratification into risk classes according to the original PESI and low vs. high-risk classification of original and simplified PESI were significantly correlated with the 30-day, 31-90-day, 91-day-one-year, and one-five-year mortality. Significant PESI predictors for mortality were history of cancer [hazard ratio (HR): 3.31, 95% confidence interval (CI): 1.64-6.68; p=0.001] and heart failure (HR: 2.35, 95% CI: 1.04-5.32, p=0.041) at 31-90-day, history of cancer (HR: 5.45, 95% CI: 2.86-10.40, p<0.001) at 91-day-one-year, advancing age (HR: 1.04, 95% CI: 1.02-1.06, p<0.001) and history of cancer (HR: 5.53, 95% CI: 3.41-8.98, p<0.001) at one-five-year after acute PE diagnosis. CONCLUSION: All-cause long-term mortality in high-risk patients with acute PE according to original or simplified PESI significantly increased up to five years of follow-up. This survival disadvantage was mainly related to cancer and comorbidities rather than acute clinical manifestations. Future prospective studies are needed to demonstrate the effect of various comorbidities on long-term mortality in these patients.

Lessons Learned so Far from the Pandemic: A Review on Pregnants and Neonates with COVID-19.

There are concerns regarding the risk and the course of COVID-19 in pregnancy and in the neonates. In this review, we aimed to present the current understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and neonatal periods considering diagnosis, treatment, prognosis, and prevention. Few studies on pregnant women with COVID-19 have been conducted between December 2019 and April 2020. The majority of patients applied in the third trimester and presented with fever and cough. Ground-glass opacities and consolidation on computed tomography were reported to be common. COVID-19 was proposed to have a milder course than SARS and the Middle East respiratory syndrome coronavirus in pregnant women. Hydroxychloroquine and antiproteases (lopinavir/ritonavir) were reported to be safe; however, therapeutic efficacy and safety of remdesivir still lack evidence. As ribavirin and favipiravir have teratogenic effects, there are some debates on the use of ribavirin in severe cases. There is still no clear evidence of vertical transmission of SARS-CoV-2 during delivery. Occupational safety issues of pregnant healthcare workers on the frontline should be considered as their risk to develop severe pneumonia is higher because of altered maternal immune response. Knowledge about neonatal outcomes of COVID-19 was based on studies of the last trimester of pregnancy. There is much to be learnt about COVID-19 in pregnant women and in the neonates, especially concerning prognosis- and treatment-related issues.

COVID-19 Pandemic and the Global Perspective of Turkish Thoracic Society.

It has been more than 3 months now since the first case of COVID-19 was reported in Turkey. Globally, the number of confirmed cases and deaths reached 9,653,048 and 491,128 respectively, as reported by 216 countries by June 27, 2020. Turkey had 1,396 new cases, 194,511 total cases, and 5,065 deaths by the same date. From the first case until today, the Turkish Thoracic Society (TTS) has been very proactive in educating doctors, increasing public awareness, undertaking academic studies, and assisting with public health policies. In the present report, social, academic, and management perspectives of the pandemic are presented under appropriate subtitles. During this critical public health crisis, TTS has once again demonstrated its readiness and constructive stance by supporting public health, healthcare workers, and the environment. This review summarizes the perspective of TTS on each aspect of the COVID-19 pandemic and casts light on its contributions.

COVID-19 Treatment at a Glance.

As coronavirus disease 2019 (COVID-19) spreads across the world, the ongoing clinical trials are leading to a big race worldwide to develop a treatment that will help control the pandemic. Unfortunately, COVID-19 does not have any known effective treatment with reliable study results yet. In this pandemic, there is not a lot of time to develop a new specific agent because of the rapid spread of the disease. The process of developing a vaccine is long and requires hard work. Although the pathophysiology of the disease is not fully understood, some of the proposed treatment alternatives are based on old evidence and some have been used with the idea that they might work owing to their mechanism of action. The efficacy, reliability, and safety of the currently available treatment alternatives are therefore a matter of debate. Currently, the main therapies used in the treatment of COVID-19 are antiviral drugs and chloroquine/hydroxychloroquine. Other proposed options include tocilizumab, convalescent plasma, and steroids, but the mainstay of the treatment in intensive care units remains supportive therapies.

The Mersin Greenhouse Workers Study. Surveillance of Work-related Skin, Respiratory, and Musculoskeletal Diseases.

BACKGROUND: Skin, respiratory, and musculoskeletal diseases in greenhouse workers are frequently observed due to exposure to plant products and pesticides in enclosed conditions and ergonomic risks. Current studies on occupational health risks of greenhouse workers in Turkey are insufficient. OBJECTIVES: The aim of the present study was to assess work-related skin, respiratory, and musculoskeletal diseases in greenhouse workers in the Erdemli province, Mersin, an area with a workforce predominantly active as greenhouse workers. METHODS: The study population consists of adult greenhouse workers, who visited their family physician between June 12-14, 2017 and were diagnosed with dermatological, respiratory, and musculoskeletal diseases. Immediately after this consultation, occupational physicians conducted face-to-face interviews, asking questions about sociodemographic features and occupational factors including current and previous work, current exposures and relation of current symptoms with work. RESULTS: In total, 423 workers with 555 diagnoses were included in the study. Percentages of diagnoses were 30.1%, 21.6% and 48.3%, for skin, respiratory and musculoskeletal diseases respectively. Nearly half of participants had taken an absence from work due to those diseases. Mean age of onset for greenhouse working was 15.5 years. Almost all participants (96.2%) reported contact with chemicals, and usage of respiratory protection was low (17.3%). Pesticides were regarded as a risk factor by nearly two-thirds of workers with skin or respiratory system disorders. Participants' answers to questions regarding the relationship between their diseases and their work was positive for more than half of patients and patients with skin and respiratory diseases. Nearly half of the patients with musculoskeletal diseases attributed their complaints to physical overload at work. CONCLUSIONS: We found evidence of work-relatedness in almost half of the 555 greenhouse workers with dermatological, respiratory and musculoskeletal diseases. These findings are helpful in creating an awareness program. There is a need for a more detailed assessment of the cases and the related working conditions to start a tailored prevention program.

COVID-19 in Turkish health care workers practicing chest medicine

SUMMARY OBJECTIVE: This study aimed to evaluate the data of Turkish health care workers practicing chest medicine on their coronavirus disease 2019 (COVID-19) status and related parameters. METHODS: This descriptive study included online survey data that the Turkish Thoracic Society conducted with its members in two phases starting in June and December 2020. The 33-item survey included demographic data, smoking status, the presence of any chronic diseases, occupation, working status, and non-work-related and work-related COVID-19 exposure characteristics. RESULTS: Of 742 responses, 299 (40.3%) reported that they had contracted COVID-19. The second survey detected a higher frequency of health care workers who had contracted COVID-19 (12.1% versus 57.4%, p<0.001) than the first survey. The analysis of the association between study parameters and COVID-19 in health care workers using logistic regression revealed statistical significance with working at the onset of the outbreak (OR 3.76, 95%CI 1.09-12.98, p=0.036), not working at the time of survey (OR 5.69, 95%CI 3.35-9.67, p<0.001), COVID-19 history in colleagues (OR 2.27, 95%CI 1.51-3.41, p<0.001), any non-work-related COVID-19 exposure (OR 4.72, 95%CI 2.74-8.14, p<0.001), COVID-19 exposure at home (OR 6.52, 95%CI 3.52-12.08, p<0.001), and COVID-19 history in family members (OR 8.16, 95%CI 5.52-12.08, p<0.001) after adjusting for age and sex. The study also observed an inverse relationship between the use of aprons and goggles and COVID-19 in health care workers. CONCLUSION: Occupational and nonoccupational characteristics are related to COVID-19 in health care workers practicing chest medicine. Therefore, active surveillance to detect health care workers contracting COVID-19 and to document and control occupational and nonoccupational risks should be provided.