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Background: University students are known to have higher sleep disorders prevalence than the general population. Among them, nursing students are even more susceptible to sleep disorders. This study evaluates sleep disorders' risk factors among nursing students and their potential association with symptoms and assesses whether night shifts affect sleep quality by increasing the prevalence of sleep disorders., Methods: A total of 202 nursing students were included; a self-administered questionnaire was used to collect data on sociodemographic and academic characteristics (i.e., gender, age, height, weight, and year of nursing program) and risk factors for sleep disorders (e.g., smoking, lack of physical activity, and coffee intake late in the evening). The survey included the General Health Questionnaire to assess perceived stress, the Sleep and Daytime Habits Questionnaire, and the Epworth Sleepiness Scale to assess sleep disorders symptoms., Results: A high level of perceived stress is associated with sleep disorders symptoms and with poor sleep quality. Daytime symptoms are also associated with smoking. Students who drink coffee late in the evening report fewer nighttime symptoms. Night shifts and their increasing number are not associated with sleep disorders symptoms. The perception of an unsatisfying academic performance is associated with daytime symptoms and poor sleep quality., Conclusions: Although night shifts seem to not affect sleep quality among nursing students, sleep disorders represent a critical issue in this population since sleep disorders symptoms may result in errors, accidents, or low academic performance.

Background: The Clinica del Lavoro of Milan provided several contributions to industrial hygiene and occupational toxicology during the twentieth century., Objectives: Describe the first years of the laboratory of industrial hygiene of Milan through three figures who played a leading role: Enrico Carlo Vigliani, Nicola Zurlo and Gianmario Cavagna., Methods: Scientific literature of the period 1948-1970 was investigated, also interviewing first-hand witnesses of that period., Results: Enrico Vigliani was the first European scholar to understand the importance of a laboratory of industrial hygiene within his institution. Thanks to the support of private (Montecatini) and public (INAIL) institutions he succeeded in creating a laboratory in 1948. Nicola Zurlo, who directed this structure in the first thirty years, conducted innovative studies on chronic mercury intoxication, lead intoxication and silicosis, designing and creating instruments for capturing and analyzing atmospheric dust and protection devices. He conducted analysis of the health effects of organophosphorus insecticides and started to study the air pollution. Zurlo also provided an epistemological and methodological content to the discipline. Gianmario Cavagna, one of the first Italian toxicologists, contributed to the discovery of the origin of fevers caused by the inhalation of metal fumes and to the studies on the pathogenesis of byssinosis, hypothesizing a role of bacterial endotoxins in the genesis of this disease., Conclusions: The contributions provided by these three protagonists to industrial hygiene and occupational toxicology were relevant and made in those years the Clinica del Lavoro of Milan as a landmark, not only in Italy but also abroad.

Introduction: The Clinica del Lavoro, the first clinic for occupational diseases of the world, was inaugurated in Milan on 20 March 1910; its first director was Luigi Devoto, who was in charge until 1935. The purpose of this work is to review the activities of industrial hygiene and toxicology carried out at the Clinica del Lavoro under the guidance of Devoto., Methods: Documents published by the Istituti Clinici di Perfezionamento, a group of clinics of which the Clinica del Lavoro was part, record the birth and organization of this structure and the presence of a laboratory of chemistry; documents by Devoto and other authors were also retrieved to extrapolate specific information on activities of industrial hygiene and toxicology., Results: The Clinica del Lavoro, at the time of its inauguration, included four laboratories: of chemistry, clinical physics, histopathology and bacteriology. The chemistry lab was located on the first floor and was composed of 6 well-lit rooms, modernly equipped with work benches that could accommodate 12 people. In Devoto's view, the chemistry laboratory, supported by that of clinical physics, had to assess the toxicological properties of chemicals commonly found in the workplace and to reveal the mechanisms of induction of damage to humans. In the first 30 years of activity, the Clinica del Lavoro investigated various diseases deriving from exposure to chemical agents, including saturnism, or lead intoxication, mercurialism, phosphorism, benzolism, sulfocarbonism, dust diseases. Several assays were developed and applied to measure toxicants in different biological and environmental mean as evidenced by scientific publications starting from 1920., Conclusion: In Devoto's view, industrial hygiene and toxicology were essential tools for the research and prevention of occupational diseases since the first years of activity of the Clinica del Lavoro.

Background: Benzene is a highly flammable, highly volatile liquid aromatic hydrocarbon. It has been used in many industrial processes as a solvent or a starting material. At the beginning of the twentieth century, it was very widely used in the workplace, especially in printing and in the shoe manufacturing and rubber industries. Although benzene was first recognized to cause aplastic anemia, its association with leukemia has been investigated only since the 1930s. In 1963, Italy was one of the first countries in the world to adopt a law to ban benzene as a solvent in work activities., Objectives: This study analyzed the contribution of the Clinica del Lavoro in Milan, Italy, to studies of the relationship between exposure to benzene and leukemia., Methods: Scientific literature and historical sources on benzene and leukemia in the twentieth century were reviewed, and interviews with a first-hand witness of that period were conducted., Results: By 1928, several scholars had reported anecdotal cases of leukemia among workers exposed to benzene. Enrico Vigliani was the first to collect all of these cases and to try to conduct statistical analysis on these data, in order to support the association between benzene and leukemia. In the 1960s, Vigliani and Alessandra Forni showed that benzene could cause chromosome aberrations in the bone marrow that could produce leukemic clones., Conclusions: As a result of these studies and the subsequent regulations which banned benzene, exposure conditions changed in the workplace in the last few decades. The resulting low concentrations have prompted researchers to investigate new exposure biomarkers and to study any related health problems.

Background: Risk behaviors are frequent among young adults and they are particularly relevant when considering healthcare students., Objectives: The study is aimed to examine the prevalence of smoking, binge drinking, physical inactivity, and excessive bodyweight in a population of healthcare students attending an Italian university., Methods: Healthcare students filled an anonymous multiple-choice questionnaire on the occasion of the occupational health visit that preceded their hospital internship. The questionnaire covered socio-demographic characteristics (including student's working status and cohabitation) and risk behaviors. We evaluated the prevalence of risk behaviors and their association with socio-demographic characteristics., Results: The sample consisted of 494 students (65% women): 23.2% were smokers, 7.9% had excessive bodyweight, 35% did not practice any physical activity and 50% reported binge drinking at least once in the last 12 months. We found associations of male sex (30.5%) and being nursing students (29.9%) with smoking habit. The frequency of binge drinking was higher in men (38.4%), working students (53.9%), and among those who lived without family (50%). Physical inactivity was associated with female sex (44.2%) and living without family (57.1%). Finally, the co-presence of 2 risk behaviors or more was higher in men (36.8%), in nursing students (39.6%) and in working students (44.7%)., Conclusions: Our findings regarding the prevalence of risk behaviors and their potential association with socio-demographic factors may be a clue to the definition of targeted strategies aimed at reducing of risk behaviors among healthcare students.

Background: In the 1950s, occupational medicine and occupational psychology found a common field of action in the Clinica del Lavoro in Milan. OBJECTIVES This study aims to analyze and document how this encounter took place and, in particular, the contribution of the Clinica del Lavoro to the development of occupational psychology in Italy., Methods: Historical sources of that period were investigated., Results: Before the 1950s, experimental psychology was only taught at the Catholic University of the Sacred Heart in Milan. The first professor of clinical psychology in the School of Medicine at the State University of Milan, was Marcello Cesa-Bianchi (1926-2018). He collaborated with the graphic, textile and pharmaceutical industries for the personnel training and management, and carried out important research in occupational psychology on behalf of the European Coal and Steel Community. The Chair of Clinical Psychology was initially located in the Clinica del Lavoro and the activity of the team of Cesa-Bianchi was oriented towards the elaboration of professional profiles and job analysis. In those years Cesa-Bianchi also conducted pioneering research in the field of psycho-gerontology., Conclusions: The historical experience that integrated psychology and occupational medicine in the scientific context of Milan contains a series of values, useful to today's reflection and practice. Our work also undelines the importance of preserving historical documents: only a better knowledge of history can guarantee a better destiny.

Background: The meaning of the term "medico competente" - usually adopted in Italy to indicate the occupational physician - is little known., Objectives: To describe the origins of the word "medico competente" in Italy., Methods: We conducted a comprehensive analysis of the Italian legislation from the end of the nineteenth century to the present day., Results: In the United Kingdom, occupational physicians were originally named as "certifying surgeon" (1833) and "appointed surgeon" (1860). In Italy, the term "medico delegato" was introduced to indicate the physician who visited child laborers (1886), while the word "medico competente" was first used in some propaganda leaflets of the Clinica del Lavoro of Milan in 1910. This term was officially used in Italian legislation in 1927 and was preferred to "medico di fabbrica" (factory physician) in the post-World War II period. Since 1982, the term "medico competente" has started to be considered as a synonym of occupational physician in Italian laws., Conclusions: The name "medico competente" appears to derive from a legislative imposition rather than from a voluntary choice developed in a medical and scientific context. Nowadays, Italian occupational physicians should be stimulated to find scientific, ethical, and professional meanings in this term, so helping to enhance their figure in modern society.

Background: The year 2017 marks the centenary of the death of the Italian scientist Pier Diego Siccardi (1880-1917), one of Luigi Devoto's assistants at the "Clinica del Lavoro" in Milan., Objectives: To commemorate Siccardi and to describe the activities of the physicians of the "Clinica del Lavoro" during World War I., Methods: A comprehensive analysis was conducted on scientific papers written by Pier Diego Siccardi and by other physicians belonging to the Clinica del Lavoro, in the period 1915-1918., Results: During the Great War, the Clinica del Lavoro became a military hospital, even though it indirectly maintained a role in Occupational Health, assisting women who had started to work to replace the men sent to the front. Devoto and his assistants were drafted as Army doctors, but continued their research activities while at the front; focusing on the diseases that affected the soldiers, mainly infections. Bleeding fevers and jaundice were endemic among Italian troops, but their etiology was unknown. Pier Diego Siccardi identified this syndrome as an infection caused by a spirochete, and was the first one to isolate the infectious agent. Siccardi prematurely died of the same disease as a consequence of a laboratory accident, which provided further confirmation for his research., Conclusions: The heroic life of Siccardi and his tragic death testify the important activities of the scientists of the "Clinica del Lavoro" in the years of the Great War.

Background: Phenylketonuria (PKU) is an inborn error of metabolism characterized by increased blood concentrations of phenylalanine (Phe)., Objectives: The aim of the present study was to assess the association between the metabolic compliance of adult patients affected by classic PKU and the characteristics of their present and past occupations., Methods: The study population consisted of working adults, affected by classic PKU, and following a dietary treatment. Univariate linear-mixed models and multivariate analysis were applied to assess the association between Phe blood levels and individual covariates: age, sex, time at diagnosis, educational level and work characteristics., Results: A linear relationship was found with age (an average annual increase of 30.56 μMol/L (C.I. 95%: 7.53; 53.60) in the mean Phe blood levels). Full-time work appeared to be associated with a worse metabolic compliance when compared to part-time work (mean Phe blood levels >281.11 μMol/L). Shift work was related to a worse metabolic compliance, with mean Phe plasmatic levels >356.73 μMol/L., Conclusions: Our data suggests that work may influence the metabolic compliance in adults with PKU. In particular, a part-time employment could allow for a better metabolic compliance, while daily work should be preferred to shift work.

Background: The World Health Organization has been asking for greater collaboration between occupational medicine and primary care for many years., Objectives: To investigate the knowledge of general practitioners (GPs) working in a province of Lombardy about occupational health issues and their experiences with work-related problems among their patients., Methods: Data were collected by telephone interview to GPs, using a 25-item questionnaire., Results: 111 GPs answered to the questionnaire (66.5% of the sample). Only 34.2% of the doctors knew the current regulation of occupational medicine in Italy. The GPs considered that the main work-related disease among their patients were musculoskeletal disorders and work-related stress. 90% of doctors stated to have sent at least one of their patients to an occupational medicine clinic. Only 9% declared to have notified at least one occupational disease. Among GPs who suggested how to improve the relationship between primary care and occupational medicine, 44% proposed training courses on this topic. Only 16.2% said to have attended an occupational health course during university studies., Conclusions: Italian GPs have poor knowledge about occupational medicine and they also have difficult relationships with occupational health physicians. Initiatives to improve cooperation between these two sectors are desirable.

Background: Even if the contagious nature of tuberculosis was universally accepted during the nineteenth century, its transmission to health care workers (HCWs) was initially denied by the scientific community. Working among TB patients was not considered dangerous for healthy adults, so the potential risks for HCWs were branded as unwarranted "phthisiophobia" (fear of contracting tuberculosis)., Objectives: This study aims at analyzing the problem of tuberculosis transmission among health care workers from an historical perspective, particularly highlighting the contribution made by the Italian Occupational Medicine community., Methods: Scientific literature and historical sources on different theories regarding tuberculosis transmission were investigated, specially focusing on the period at the turn of the 19th and 20th centuries., Results: At the beginning of the twentieth century, Luigi Devoto (1864-1936), an Italian pioneer in the field of Occupational Medicine, was one of the first scientists to conduct research on the transmission of tuberculosis among nurses. Since the 1920s several studies, conducted mainly on medical and nursing students, confirmed the risk for HCWs. However an international consensus on this issue was only achieved during the 1950s, when the institution of mandatory chest radiographs on admission for all patients significantly decreased the cases of tuberculosis among HCWs., Conclusions: Devoto was one of the first scholars who postulated the transmission of tuberculosis to HCWs. He also theorized that hospital personnel with active disease could also be a source of contagion to patients. Nowadays, "third party risk" and latent tuberculosis infection pose a new challenge for occupational physicians in hospitals.

Background: One of the last century's greatest personalities in Occupational Medicine was Enrico Carlo Vigliani (1907-1992), director of the "Clinica del Lavoro" in Milan (1942-1977), editor-in-chief of "La Medicina del Lavoro" (1942-1991), Secretary-Treasurer and then President of the "Permanent Commission and International Association on Occupational Health" (1957-1981), the original nucleus of the ICOH., Objectives: The 20th anniversary of his death provides us with the opportunity to discuss the role of this brilliant scholar in the international development of Occupational Medicine and Industrial Hygiene., Methods: A comprehensive analysis of Vigliani's scientific works was conducted. In addition, his close collaborators and pupils were interviewed., Results: In the 1930s, as a young doctor, Vigliani, first in the world, demonstrated the effect of lead on porphyrin metabolism. Afterwards he conducted pioneering studies on occupational oncology (benzene-induced leukaemia, bladder cancer due to aromatic amines, asbestos-related tumours), pathogenesis of silicosis, encephalopathy in carbon disulfide poisoning, byssinosis and metal fume fever, so influencing international research and the implementation of preventive measures against these conditions. Vigliani's scientific authority was widely recognized internationally, as confirmed by his role in ICOH. During his period of active service, the Commission developed from an academic institution to a more open association, substantially increasing its membership. Furthermore, he contributed to establishing subcommittees devoted to specific topics (now called "scientific committees"), one of the strengths of the present Commission., Conclusions: Vigliani's contribution to the development of Occupational Health may be considered as an expression of his genial eclecticism which ranged from clinical medicine to the environment.

Background: Carlo Moreschi (1876-1921) was founding co-editor of the journal "Il Lavoro" (now known as "La Medicina del Lavoro"), together with Luigi Devoto in 1901. Despite this fact, many of his pioneering contributions to 20th century scientific debate are not well known outside Italy., Objectives: The aim of this paper therefore was to recall Moreschi' achievements and the groundbreaking work of this remarkable Italian physician., Methods: A comprehensive analysis was conducted on scientific papers written by Carlo Moreschi between 1901 and 1920, extending the investigation to his original manuscripts and private correspondence with family and colleagues., Results: Careful examination of Moreschi's work reveals several studies in the field of social medicine, epidemiology of infectious diseases, general pathology and oncology. In particular, his main interest in haematology and immunology enabled Moreschi to be one of the first to understand the mechanisms of complement fixation and the formation pathways ofantiglobulin sera. In this manner, Moreschi significantly contributed to the work of Wassermann regarding the diagnosis of syphilis, as well as contributing to the discovery of the "antiglobulin test", first described by Coombs in 1945. Furthermore, Moreschi co-founded "Il Lavoro" and "Haematologica", the oldest journals in their respective fields., Conclusions: According to Devoto, Moreschi can be remembered as the archetype modern researcher and clinician. His role in the 20th century scientific debate and his pioneering work in the field of immunology and haematology, that are often forgotten due to his premature death, deserve to be reconsidered and re-assessed by the Italian and international scientific community.

Background: One of the first studies that "convincingly" described the relationship between pleural mesothelioma and asbestos was made by Wagner, Sleggs and Marchard in 1960. This article, published fifty years ago, contains much of what we still know to-day about malignant mesothelioma., Objectives: The aims of this article were to analyze the historical and scientific developments that led to the publication of Wagner's paper, to critically examine its contents and to consider the contribution to the initernational debate on the carcinogenesis of asbestos fibres made by occupational medicine in Italy in that period., Methods: A thorough analysis ofscientific and historical literature on the relationship between asbestos exposure and tumours was conducted, with special regard to the articles by Italian authors in the 1960's., Results: The decisive role of Wagner's paper in understanding the aetiopathogenetic mechanisms of asbestos-related tumours is inconfutable. In particular, his article clearly demonstrated the existence of a typical cancer of the mesothelium, expressing three fundamental principles of the epidemiology of occupational cancer: association with the carcinogen, latency and individual susceptibility. Enrico Vigliani, then director of the "Clinica del Lavoro" in Milan, made important contributions to this debate, also through the collection of data regarding mortality among Italian asbestos workers., Conclusions: Wagner's 1960 paper can be considered as a milestone not only in the history of occupational and environmental health, but also in the evolution of other medical disciplines such as epidemiology, pathology and oncology. A re-appraisal of the Italian contributions to the international debate on this subject should be considered.

Over the last few years, studies on the relationship between ageing and work have attracted growing interest due to the increased probability among workers of developing major health problems as a consequence of ageing of the working population. Negative outcomes for health are possible when an age-related imbalance appears between physical workload and physical work capacity. Interventions based on workload reductions should help to keep workers on the job for as long as allowed by law. Reference masses by age and sex are suggested by the technical standards of the ISO 11228 series, which are also quoted by Italian law D.Lgs. 81/2008, and EN 1005 series, which recommend limits valid also for manual material handling, and pushing and pulling. Decreasing low back pain prevalence or recurrence, in an ageing population with high prevalence of back disorders, could be more effective than many other approaches to enhance workers' quality of life and consequently maintain and improve workers' performance.