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A significant reorganization of working activities including those of teaching hospitals occurred after COVID-19 outbreak, leading to the need to re-assess the current status of training after the pandemic. This study aimed to investigate the state of general surgery (GS) residency in Italy. The impact of COVID-19 on GS residents was also assessed.Between October and November 2020, an anonymous online survey was distributed to GS residents across Italy. Email addresses were provided by the Regional Committees of the Italian Polyspecialistic Society of Young Surgeons. The residents completed a set of questions regarding their training schedule and three standardized questionnaires to measure burnout and psychological distress.Overall, 1709 residents were contacted and 648 completed the survey. Almost two-thirds of the residents (68.4%, n = 443) reported to not reach the minimum annual operative case volume. According to ordinal logistic regression analysis, two of the most perceived effects of COVID-19 by trainees on training were reduction of surgical activities (OR = 2.21, p 0.001) and increased concerns about future employment (OR = 1.14, p = 0.025). Loss of training opportunities was also associated with a significant increase of distress (OR = 1.26, p = 0.003) but not with burnout.This study provided a snapshot of the situation of GS residents in Italy after COVID-19 outbreak. Reduction of activities due to pandemic highlighted the need to improve the level of surgical education in our country by implementing all the new available tools for training and ensuring at the same time the well-being of the residents.

Athletes with fear of failure are at risk of developing the symptoms of a wide range of psychological problems, including burnout. Understanding the risks and protective factors of athletes’ psychological health is an essential step in tailoring strategies and interventions to promote athletes’ psychological and mental health. This study examined the mediating roles of resilience and extrinsic motivation in the relationship between fear of failure and burnout among Turkish athletes. The study included 335 young athletes (93.4% males) whose ages ranged from 18 to 55 years (M = 24.95, SD = 8.22). Participants completed the self-reported measures of fear of failure, resilience, extrinsic motivation, and burnout. The analysis revealed that fear of failure had significant predictive effects on resilience, extrinsic motivation, and burnout. Resilience and extrinsic motivation also had significant predictive effects on burnout. The mediation analysis results showed that both resilience and extrinsic motivation partially mediated the effect of fear of failure on athlete burnout. The findings of the study provide a better insight into the underlying mechanisms between fear of failure and athlete burnout by considering resilience and extrinsic motivation as mediators. These results suggest that the adverse impact of fear of failure on athlete burnout can be mitigated by cultivating resilience and hindering extrinsic motivation.

Post-acute COVID-19 syndrome is frequently observed in workers and has a substantial impact on work ability. We conducted a health promotion program to identify cases of post-COVID syndrome, analyze the distribution of symptoms and their association with work ability. Of the 1422 workers who underwent routine medical examination in 2021, 1378 agreed to participate. Among the latter, 164 had contracted SARS-CoV-2 and 115 (70% of those who were infected) had persistent symptoms. A cluster analysis showed that most of the post-COVID syndrome cases were characterized by sensory disturbances (anosmia and dysgeusia) and fatigue (weakness, fatigability, tiredness). In one-fifth of these cases, additional symptoms included dyspnea, tachycardia, headache, sleep disturbances, anxiety, and muscle aches. Workers with post-COVID were found to have poorer quality sleep, increased fatigue, anxiety, depression, and decreased work ability compared with workers whose symptoms had rapidly disappeared. It is important for the occupational physician to diagnose post-COVID syndrome in the workplace since this condition may require a temporary reduction in work tasks and supportive treatment.

Sleep deprivation is a significant risk to the health and judgment of physicians. We wanted to investigate whether anesthesiology residents (ARs) who work only one night shift per week have different physical and mental health from occupational medicine residents (OMRs) who do not work at night. A total of 21 ARs and 16 OMRs attending a university general hospital were asked to wear an actigraph to record sleep duration, heart rate and step count and to complete a questionnaire for the assessment of sleep quality, sleepiness, fatigue, occupational stress, anxiety, depression and happiness. ARs had shorter sleep duration than OMRs; on average, they slept 1 h and 20 min less (p < 0.001). ARs also had greater daytime sleepiness, a higher heart rate and lower happiness than OMRs. These results should be interpreted with caution given the cross-sectional nature of the study and the small sample size, but they are an incentive to promote sleep hygiene among residents.

PurposeThis paper describes how Italy addressed the first Coronavirus disease 2019 (COVID-19) wave and analyzes the possible causes of the current second wave.Design/methodology/approachDescriptive analysis of critical points and differences in the containment strategies between the first and the second waves in Italy.FindingsItaly's strict lockdown has been credited with getting the initial major outbreak under control. Furthermore, the way Italy handled the first wave was considered a lesson for other countries. On the contrary, a decentralized and highly bureaucratic political system with low coordination and political conflicts between government, regions and stakeholders led to a relaxation of individual health behaviors, poor and conflicting communication to the general public, poor management of the public transport and the reopening of schools and companies after the summer, that in turn generated the second wave, which is showing signs of becoming worse than the first.Originality/valueThis is a commentary piece.

The paper presents the information on COVID-19 policy response in Italy inin the second half of 2020, when the second wave of the pandemic occurred. It builds on the authors previous report (1) that addressed the first wave of the COVID-19 pandemic. In Italy, from October till December, the number of SARS-CoV-2 infections increased significantly. However, the Italian government, unlike many other European governments, refrained from introducing a second nationwide lockdown. The pandemic was managed through a system of localized interventions (on a regional and / or provincial basis) which significantly varied across the regions. At the end of December 2020, a national plan for vaccination against COVID-19 was approved. In February 2021, together with the change of government, a new public policy against the COVID-19 pandemic was formulated.

Burnout syndrome (BOS) is a work-related constellation of symptoms characterized by emotional exhaustion, depersonalization, and personal accomplishment. A cross-sectional survey was performed to study the prevalence of BOS among a randomly selected sample of 280 Italian Red Cross volunteers. A socio-demographic questionnaire and the Maslach Burnout Inventory (MBI)-HSS were used to collect data. 241 volunteers participated (response rate: 86.1%). A significant proportion of the workers had BOS subscale scores in the highest tertile: emotional exhaustion 8.0%, depersonalization 35.9% and perceived lack of accomplishment 23.5%, respectively. Volunteers in emergency care reported higher levels of emotional exhaustion (p=0.004) and depersonalization (p=0.001), and lower level of personal accomplishment (p=0.042) than volunteers engaged in non-healthcare social and administrative duties. These findings support the opportunity of a set of administrative, organizational and individual preventive interventions for emergency volunteers' mental health.

The Prospective Study of Intensivists and COVID-19 (PSIC) is a longitudinal study that besides investigating a cohort of intensivists from one of the two COVID-19 hub hospitals in Central Italy since the beginning of the pandemic (first wave, April 2020), has conducted a new survey at each successive wave. In addition to the variables investigated in previous surveys (job changes due to the pandemic, justice of safety procedures, job stress, sleep quality, satisfaction, happiness, anxiety, depression, burnout, and intention to quit), the latest fourth wave (December 2021) study has evaluated discomfort in caring for anti-vax patients. A multivariate logistic regression model confirmed that high levels of occupational stress (distressed 75.8%) were associated with isolation, monotony, lack of time for meditation, and poor relationships with anti-vaccination patients. Compared to the first phase, there was a reduction in levels of insomnia and anxiety, but the percentage of intensivists manifesting symptoms of depression remained high (58.9%). The study underlined the efficacy of organizational interventions and psychological support.

Hopelessness is a particularly critical condition and a risk factor for suicide. Many studies have reported that this condition is common in some occupations and is associated with high stress that is not properly managed. This study examined the prevalence of hopeless status (HS) in a sample of police officers (POs) and the association of hopelessness with depression, burnout, and suicidality. In total, 127 out of 231 POs participated in the survey; they were assessed with the Beck Hopelessness Scale, the Beck Depression Scale, and the Maslach Burnout Inventory. A total of 26.5% of POs reported hopelessness, and a significant association was found with depression and burnout; in individual cases, these conditions were associated with suicidal thoughts. In a multivariate logistic regression model adjusted for confounding variables, depression, emotional exhaustion, and reduction of personal accomplishment were significantly associated with HP status. Depression (OR = 3.02, 95% CI: 1–9.12) and emotional exhaustion (OR = 1.88, 95% CI: 1.06–3.32) significantly increased the risk of hopelessness, while personal accomplishment (OR = 0.57, 95% CI: 0.32–1) was a protective factor. Hopelessness appears to be a very important factor to consider when assessing POs’ mental health.

Background Aging of the workforce challenges European countries. Keeping aged workers healthy and productive, through health promotion, is a key goal of European labour policy. The aim of the present study was to collect experiences of workplace health promotion for older workers (WHPOW) conducted in 10 representative countries of Central Europe, Eastern Europe and the Mediterranean. Methods A literature review of activities of WHPOW was conducted through a comprehensive search of major scientific databases and on the website of the major European Agencies on worker health promotion. The search was restricted to papers published in English from 2000 to 2015. Companies were asked for additional documentation about WHPOW programmes in a survey conducted with SurveyMonkey. Results A total of 756 initiatives regarding WHPOW were identified. 134 of these were guidelines, regulations, or review studies. The remaining 622 activities were intervention studies performed or promoted in the workplace and targeted at older workers or at the aging of the workforce. Most of the programs were carried out in Central Europe (295, 47.4%), less in East Europe (193, 31.0%) and in Mediterranean countries (134, 21.6%). Conclusion Our study shows that there are only a limited number of WHPOW actions throughout the 10 selected European Countries. While in Central Europe widespread interest in issues of aging workforce has resulted in national policies to encourage WHPO, not all the countries of Eastern Europe are equally well equipped. Lastly, in Southern Europe health promotion activities are largely inadequate compared to needs.

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Background Aging of the workforce poses a dramatic challenge for health and safety in all European countries. Method Our study was based on a comprehensive review of the literature on productive aging, work engagement, and human engineering, with particular reference to older worker issues. Results Productive aging, work engagement, and participatory ergonomics appear to be the most promising areas of research in the field of worker aging. An analysis of intervention programs enabled us to identify three main approaches that could be used to tackle the problem. These include encouraging older adults to be involved in work activities, enhancing their work engagement, and sustaining their productive efforts through participatory changes in the working environment and the promotion of healthy lifestyles. Occupational health and safety services in the workplace must extend their activities of prevention to encompass not only traditional environmental risk factors, but also non-occupational risk factors, so that this holistic approach promotes good practices and positive attitudes. Conclusions A set of recommendations and policy briefs for supra-national, national and local authorities was formulated.

The aim of this paper is to highlight the organizational factors that might influence perceived discomfort in police officers. The studies included in the thematic review referred to specific factors, not the general terms “organizational stressors” or “workplace stressors”. It is important to emphasize this distinction because most studies use the general term “organizational stressor” (referring to context) to distinguish from “operational stressor” (referring to content, such as exposure to danger, threat, and trauma). For our purposes, we selected the studies that examined specific organizational factors. The results indicate that organizational social support, organizational culture, leadership, and bureaucracy are the organizational factors associated with police officers’ perceived discomfort. These organizational factors could have negative impacts on individuals, perceptions of stigma when contacting support services, anxiety and depressive symptoms, burnout, PTSD, and suicidal thoughts, among others.

Headache is a very common condition that can have a significant impact on work. This study aimed to assess the prevalence of headaches and their impact on a sample of 1076 workers from 18 small companies operating in different sectors. The workers who volunteered to participate were asked to fill in the Headache Impact Test-6 (HIT-6) and answer questions designed to assess stressful and traumatic factors potentially associated with headaches. The volunteers subsequently underwent a medical examination and tests for diagnosing metabolic syndrome. Out of the 1044 workers who completed the questionnaire (participation rate = 97%), 509 (48.8%) reported suffering from headaches. In a multivariate logistic regression model, female gender, recent bereavement, intrusive leadership, and sleep problems were significantly associated with headaches. In univariate logistic regression models, headache intensity was associated with an increased risk of anxiety (OR 1.10; CI95% 1.09; 1.12) and depression (OR 1.09; CI95% 1.08; 1.11). Headache impact was also associated with the risk of metabolic syndrome (OR 1.02; CI95% 1.00, 1.04), obesity (OR 1.02, CI95% 1.01; 1.03), and reduced HDL cholesterol (OR 1.03; CI95% 1.01; 1.04). The impact of headache calls for intervention in the workplace not only to promote a prompt diagnosis of the different forms of headaches but also to improve work organization, leadership style, and the quality of sleep.

Existing measures of the impact of job characteristics on workers’ well-being do not directly assess the extent to which such characteristics (e.g., opportunity to learn new skills) are perceived as positive or negative. We developed a measure, the Work Annoyance Scale (WAS), of the level of annoyance that workers feel about certain aspects of the job and evaluated its psychometric properties. Using archival data from two cohorts (n = 2226 and 655) of workers that had undergone an annual medical examination for occupational hazard, we show the usefulness of the network psychometric approach to scale validation and its similarities and differences from a traditional factor analytic approach. The results revealed a two-dimensional structure (working conditions and cognitive demands) that was replicable across cohorts and bootstrapped samples. The two dimensions had adequate structural consistency and discriminant validity with respect to other questionnaires commonly used in organizational assessment, and showed a consistent pattern of association with relevant background variables. Despite the need for more extensive tests of its content and construct validity in light of the organizational changes due to the COVID-19 pandemic and of an evaluation of the generalizability of the results to cultural contexts different from the Italian one, the WAS appears as a psychometrically sound tool for assessment and research in organizational contexts.

In complex systems such as hospitals, work organization can influence the level of occupational stress and, consequently, the physical and mental health of workers. Hospital healthcare workers were asked to complete a questionnaire during their regular occupational health examination, in order to assess the perceived level of organizational justice, and to verify whether it was associated with occupational stress, mental health, and absenteeism. The questionnaire included the Colquitt Organizational Justice (OJ) Scale, the Karasek/Theorell demand-control-support (DCS) questionnaire for occupational stress, and the General Health Questionnaire (GHQ12) for mental health. Workers were also required to indicate whether they had been absent because of back pain in the past year. Organizational justice was a significant predictor of occupational stress. Stress was a mediator in the relationship between justice and mental health. Occupational stress was more closely related to perceptions of lack of distributive justice than to perceptions of procedural, informational, and interpersonal justice. Physicians perceived significantly less distributive justice than other workers. In adjusted univariate logistic regression models, the perceptions of organizational justice were associated with a significant reduction in the risk of sick leave for back pain (OR 0.96; CI95% 0.94–0.99; p < 0.001), whereas occupational stress was associated with an increased risk of sick leave (OR 6.73; CI95% 2.02–22.40; p < 0.002). Work organization is a strong predictor of occupational stress and of mental and physical health among hospital employees.

Workplace violence (WV) is a significant occupational hazard for nurses. Previous studies have shown that WV has a reciprocal relationship with occupational stress. Headaches and sleep problems are early neuropsychological signs of distress. This cross-sectional study aims to ascertain the frequency of physical or verbal assaults on nurses and to study the association of WV with headaches and sleep problems. During their regular medical examination in the workplace, 550 nurses and nursing assistants (105 males, 19.1%; mean age 48.02 ± 9.98 years) were asked to fill in a standardized questionnaire containing the Violent Incident Form (VIF) concerning the episodes of violence experienced, the Headache Impact Test (HIT-6) regarding headaches, and the Pittsburgh Sleep Quality Inventory (PSQI) on sleep quality. Occupational stress was measured using the Effort/Reward Imbalance questionnaire (ERI). Physical and non-physical violence experienced in the previous year was reported by 7.5% and 17.5% of workers, respectively. In the univariate logistic regression models, the workers who experienced violence had an increased risk of headaches and sleep problems. After adjusting for sex, age, job type, and ERI, the relationship between physical violence and headaches remained significant (adjusted odds ratio aOR = 2.25; confidence interval CI95% = 1.11; 4.57). All forms of WV were significantly associated with poor sleep in a multivariate logistic regression model adjusted for sex, age, job type, and ERI (aOR = 2.35 CI95% = 1.44; 3.85). WV was also associated with the impact of headaches and with sleep quality. WV prevention may reduce the frequency of lasting psychoneurological symptoms, such as headaches and poor sleep quality, that interfere with the ability to work.

In 2011, NIOSH launched the Total Worker Health (TWH) strategy based on integrating prevention and health promotion in the workplace. For several years now, in Italy, this integration has led to the creation of workplace health promotion embedded in medical surveillance (WHPEMS). WHPEMS projects, which are also implemented in small companies, focus each year on a new topic that emerges from the needs of workers. During their regular medical check-up in the workplace, workers are invited to fill in a questionnaire regarding the project topic, its outcome, and some related factors. Workers receive advice on how to improve their lifestyles and are referred to the National Health Service for any necessary tests or treatments. Results collected over the past 12 years from more than 20,000 participants demonstrate that WHPEMS projects are economical, sustainable, and effective. The creation of a network of occupational physicians who are involved in WHPEMS projects could help to improve the work culture, health, and safety of workers.

Lyme disease (LD) can have significant consequences for the health of workers. The frequency of infection can be estimated by using prevalence and incidence data on antibodies against Borrelia Burgdoferi (BB). A systematic search of studies published in English between 2002 and 2021 and a meta-analysis were conducted in PubMed/Medline, Web of Science, Scopus, and Google Scholar databases. Out of a total of 1125 studies retrieved, 35 articles were included in the systematic review. Overall, in these studies, outdoor workers showed a 20.5% BB seroprevalence rate. Meta-analysis, performed on 15 studies (3932 subjects), revealed a significantly increased risk in outdoor activities (OR 1.93 95%CI 1.15–3.23), with medium-level heterogeneity (I2 = 69.2%), and non-significant publication bias. The estimated OR in forestry and agricultural workers was 2.36 (CI95% 1.28; 4.34) in comparison with the controls, while a non-significant increase in risk (OR = 1.05, CI95% 0.28; 3.88) was found in the remaining categories of workers (veterinarians, animal breeders, soldiers). The estimated pooled risk was significantly higher in the studies published until 2010 (OR 3.03 95%CI 1.39–6.61), while in more recent studies the odds became non-significant (OR 1.08 95% CI 0.63–1.85). The promotion of awareness campaigns targeting outdoor workers in endemic areas, and the implementation of local programs aimed at controlling range expansion of vectors, are key strategies for protecting workers.

Syncope and presyncope episodes that occur during work could affect one’s safety and impair occupational performance. Few data are available regarding the prevalence of these events among workers. The possible role of sleep quality, mental stress, and metabolic disorders in promoting syncope, presyncope, and falls in workers is unknown. In the present study, 741 workers (male 35.4%; mean age 47 ± 11 years), employed at different companies, underwent clinical evaluation and blood tests, and completed questionnaires to assess sleep quality, occupational distress, and mental disorders. The occurrence of syncope, presyncope, and unexplained falls during working life was assessed via an ad hoc interview. The prevalence of syncope, presyncope, and falls of unknown origin was 13.9%, 27.0%, and 10.3%, respectively. The occurrence of syncope was associated with an increased risk of occupational distress (adjusted odds ratio aOR: 1.62, confidence intervals at 95%: 1.05–2.52), low sleep quality (aOR: 1.79 CI 95%: 1.16–2.77), and poor mental health (aOR: 2.43 CI 95%: 1.52–3.87). Presyncope was strongly associated with occupational distress (aOR: 1.77 CI 95%: 1.25–2.49), low sleep quality (aOR: 2.95 CI 95%: 2.08–4.18), and poor mental health (aOR: 2.61 CI 95%: 1.78–3.84), while no significant relationship was found between syncope or presyncope and metabolic syndrome. These results suggest that occupational health promotion interventions aimed at improving sleep quality, reducing stressors, and increasing worker resilience might reduce syncope and presyncope events in the working population.

We aimed to evaluate the impact of the COVID-19 pandemic on anaesthesiology residents in a COVID-19 hub hospital in Latium and ascertain their level of perceived justice and work-related stress. Residents and specialist anaesthesiologists were recruited during April-May 2020. Informational and procedural justice were measured with the Organizational Justice questionnaire; work-related stress was measured with the Effort Reward Imbalance questionnaire. Interns perceived a significantly lower level of informational justice than specialists. Organizational justice protected from occupational stress (OR=0.860, CI95% 0.786-0.940). Our findings suggest that it would be useful to improve knowledge of safety measures in trainees, increasing their confidence in work organization and reducing stress.

Apart from the risk of accidents, war theatres present a hazard related to numerous long-lasting toxic agents. For 10 years, a >60-year-old male journalist worked in war theatres in the Far and Near East where he was exposed to asbestos and other toxic substances (metals, silica, clays, polycyclic aromatic hydrocarbons and other organic substances) contained in dust and smoke of destroyed buildings. More than 15 years later, he developed a mucoepidermoid carcinoma of the soft palate and, subsequently, a pleural malignant mesothelioma. The safety of war journalists should focus not only on preventing the risk of being killed, but also on providing protection from toxic and carcinogenic agents. Exposure to substances released during the destruction of buildings can also pose a carcinogenic risk for survivors.

Hantaviruses are zoonotic pathogens that can cause serious human disorders, including hemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome. As the main risk factor for human infections is the interaction with rodents, occupational groups such as farmers and forestry workers are reportedly at high risk, but no summary evidence has been collected to date. Therefore, we searched two different databases (PubMed and EMBASE), focusing on studies reporting the prevalence of hantaviruses in farmers and forestry workers. Data were extracted using a standardized assessment form, and results of such analyses were systematically reported, summarized and compared. We identified a total of 42 articles, including a total of 28 estimates on farmers, and 22 on forestry workers, with a total workforce of 15,043 cases (821 positive cases, 5.5%). A pooled seroprevalence of 3.7% (95% confidence interval [95% CI] 2.2–6.2) was identified in farmers, compared to 3.8% (95% CI 2.6–5.7) in forestry workers. Compared to the reference population, an increased occurrence was reported for both occupational groups (odds ratio [OR] 1.875, 95% CI 1.438–2.445 and OR 2.892, 95% CI 2.079–4.023 for farmers and forestry workers, respectively). In summary, our analyses stress the actual occurrence of hantaviruses in selected occupational groups. Improved understanding of appropriate preventive measures, as well as further studies on hantavirus infection rates in reservoir host species (rodents, shrews, and bats) and virus transmission to humans, is needed to prevent future outbreaks.

IntroductionSystemic sclerosis is a potentially devastating disease in which the aetiology and pathogenesis has not yet been fully understood. It has been associated with occupational exposure to silica, vinyl chloride, solvents and other chemical agents.Case summaryIn this paper, we present the case of an anaesthetist who developed scleroderma after an occupational exposure to volatile anaesthetic gases (halothane, sevoflurane, isoflurane and enflurane) in operating theatres with poor scavenging systems and we discuss the possible causal link between occupational exposure and the disease.ConclusionsThe case reported is the second that we are aware of in recent years. Reporting scleroderma cases in workers may be the first step in assessing the causal link between occupational exposure to anaesthetic gases and the disease.

Since the beginning of the COVID-19 pandemic, Italy was one of the worst-affected European countries. The rapid surge of cases and the limited capacity of intensive care unit departments have posed a serious threat to the Italian national health system. In this paper we describe the first response and the main measures carried by Italian policy makers, as coordinated by a governmental committee of public health experts, which have succeeded in preventing the pandemic from turning into a disaster. Early closure of the school, quarantine measures and lockdown were put in place and the response of the population has been good overall. Despite the Italian health care system of universal coverage is considered the second-best in the world, during phase 1, the Italian decentralisation and fragmentation of health services probably restricted timely interventions and effectiveness. In northern Italy, Lombardy, Emilia Romagna, Piedmont, and Veneto, which reported most of the Italian cases, carried out different strategies against COVID-19, with great differences in testing, quarantine, and public health procedures. The improvement of the epidemiological situation has allowed an easing of the restrictive measures, with a progressive restarting of work activities. The government and technical-scientific bodies have prepared health strategies to support a possible second epidemic wave in the autumn.

The quality of work organization may be responsible not only for reduced productivity but also for an increased risk of mental and physical disorders. This study was aimed at testing this hypothesis. Workers of a local health unit in Italy were asked to fill out the Work Organization Assessment Questionnaire (WOAQ) during their periodic medical examinations in the second half of 2018. On the same occasion, they also completed the Demand/Control/Support (DCS) measure of job strain, the Effort/Reward Imbalance (ERI) questionnaire, and the General Health Questionnaire (GHQ12) to assess psychological health. A total of 345 workers (85.8%) completed the survey. Linear regression analysis showed that the quality of work organization was inversely proportional to psychological health problems (p < 0.001). Occupational stress, measured both by job strain and ERI, was a moderating factor in this relationship. The relationship between the WOAQ and psychological health, moderated by job strain or ERI, remained highly significant even after adjustment for sex, age, social support, and overcommitment. Regression models explained over 40% of the shared variance of the association between quality of work organization and psychological health. The quality of work organization significantly predicted the risk of sickness absence for musculoskeletal disorders (OR = 0.984, CI95% 0.972–0.996) and for other health problems (OR = 0.977, CI95% 0.967–0.988). A continuous improvement of work organization must consider not only the clients’ or production needs but also the well-being of workers.

The COVID-19 pandemic has severely tested the physical and mental health of health care workers (HCWs). The various stages of the epidemic have posed different problems, consequently, only a prospective study can effectively describe the changes in the workers’ health. This repeated cross-sectional study is based on a one-year investigation (spring 2020 to spring 2021) of intensive care physicians in one of the two COVID-19 hub hospitals in Central Italy and aims to study the evolution of the mental health status of intensivists during the pandemic. Changes in their work activity due to the pandemic were studied anonymously together with their perception of organisational justice, occupational stress, sleep quality, anxiety, depression, burnout, job satisfaction, happiness, and intention to quit. In May–June 2021, one year after the baseline, doctors reported an increased workload, isolation at work and in their social life, a lack of time for physical activity and meditation, and compassion fatigue. Stress was inversely associated with the perception of justice in safety procedures and directly correlated with work isolation. Occupational stress was significantly associated with anxiety, depression, burnout, dissatisfaction, and their intention to quit. Procedural justice was significantly associated with happiness. Doctors believed vaccinations would help control the problem, however, this positive attitude had not yet resulted in improved mental health. Doctors reported high levels of distress (73%), sleep problems (28%), anxiety (25%), and depression (64%). Interventions to correct the situation are urgently needed.

The COVID-19 pandemic has severely tested the physical and mental health of health care workers (HCWs). The various stages of the epidemic have posed different problems; consequently, only a prospective study can effectively describe the changes in the workers’ health. This repeated cross-sectional study is based on a one-year investigation (spring 2020 to spring 2021) of intensive care physicians in one of the two COVID-19 hub hospitals in Central Italy. Changes in their work activity due to the pandemic were studied anonymously together with their perception of organizational justice, occupational stress, sleep quality, anxiety, depression, burnout, job satisfaction, happiness, and intention to quit. In May-June 2021, one year after the baseline, doctors reported an increased workload, isolation at work and in social life, lack of time for physical activity and meditation and compassion fatigue. Stress was inversely associated with the perception of justice in safety procedures and directly correlated with work isolation. Occupational stress was significantly associated with anxiety, depression, burnout, dissatisfaction, and intention to quit. Procedural justice was significantly associated with happiness. Doctors believed vaccinations would help control the problem; however, this positive attitude had not yet resulted in improved mental health. Doctors reported high levels of distress (73%), sleep problems (28%), anxiety (25%), depression (64%). Interventions to correct the situation are urgently needed.

Specific memory B cells and antibodies are reliable read-out of vaccine efficacy. We analyzed these biomarkers after one and two doses of BNT162b2 vaccine. The second dose significantly increases the level of highly-specific memory B cells and antibodies. Two months after the second dose, specific antibody levels decline, but highly specific memory B cells continue to increase thus predicting a sustained protection from COVID-19. Graphical Abstract

Work-related stress is a significant risk for healthcare workers (HCWs). This study aims at evaluating the effectiveness of an individual psychological support programme for hospital workers. In all, 35 workers participated (n). A control group of 245 workers (7n) was set. Occupational distress was measured by the General Health Questionnaire, (GHQ-12), the quality of life by the Short Form-36 health survey, (SF-36), and sickness absence was recorded. Costs and benefits of the service were evaluated and the return on investment (ROI) was calculated. The level of distress was significantly reduced in the treated group at the end of the follow-up (p &lt, 0.001). Quality of life had significantly improved (p &lt, 0.003). A 60% reduction of sickness absence days (SADs) following the intervention was recorded. After the treatment, absenteeism in cases was significantly lower than in controls (p &lt, 0.02). The individual improvement of mental health and quality of life was significantly correlated with the number of meetings with the psychologist (p &lt, 0.01 and p &lt, 0.03, respectively). The recovery of direct costs due to reduced sick leave absence was significantly higher than the costs of the programme, ROI was 2.73. The results must be examined with caution, given the very limited number of workers treated, this first study, however, encouraged us to continue the experience.

The coronavirus-19 (COVID-19) pandemic is putting a severe strain on all healthcare systems. Several occupational risk factors are challenging healthcare workers (HCWs) who are at high risk of mental health outcomes, including Burnout Syndrome (BOS). BOS is a psychological syndrome characterized by emotional exhaustion, depersonalization, and low personal accomplishment. An umbrella review of systematic reviews and meta-analyses concerning BOS and coronavirus (SARS/MERS/SARS-CoV-2) outbreaks was carried out on PubMed Central/Medline, Cochrane Library, PROSPERO, and Epistemonikos databases. Data relating to COVID-19 is insufficient, but in previous SARS and MERS outbreaks about one-third of HCWs manifested BOS. This prevalence rate is similar to the figure recorded in some categories of HCWs exposed to chronic occupational stress and poor work organization during non-epidemic periods. Inadequate organization and worsening working conditions during an epidemic appear to be the most likely causes of BOS. Preventive care and workplace health promotion programs could be useful for protecting healthcare workers during pandemics, as well as during regular health activities.

We read with great interest the paper by Barycka et al. [...]

Background: Breakthrough infections in fully vaccinated HCWs are considered a marker of waning immunity. Serum antibodies represent the most visible and measurable outcome of vaccine-induced B-cell memory. When antibodies decline, memory B cells are expected to persist and perform their function, thus preventing clinical disease. We investigated whether BNT162b2 mRNA vaccine induces durable and in vivo functional B-cell memory against SARS-CoV-2 3, 6 and 9 months after the second dose. Methods: We assessed the duration of SARS-CoV-2 vaccine-induced immunity by measuring specific antibodies and memory B cells 3, 6 and 9 months after vaccination. In fully vaccinated HCWs with breakthrough SARS-CoV-2 infections, we evaluated the humoral and mucosal response of vaccine-induced memory B cells. Findings: Whereas specific serum antibodies decline, anti-Spike memory B cells continue to increase until 9 months after the last vaccine dose. HCWs with breakthrough infections had no signs of waning immunity on the day of the first positive swab. In 3-4 days, memory B cells responded to SARS-CoV-2 infection by producing high levels of specific antibodies in the serum. In the saliva, anti-Spike IgA also rapidly increased in response to the infection. Antibodies to the viral nucleoprotein were produced with the slow kinetics typical of the response to a novel antigen. Interpretation: SARS-CoV-2 specific antibodies physiologically decline months after vaccination. By contrast, memory B cells persist and increase over time. Parenteral administered vaccines do not generate mucosal immunity and serum antibodies reach mucosal sites in small amounts by transudation. In HCWs with SARS-CoV-2 breakthrough infections, memory B cells react by rapidly differentiating into antibody-producing cells and generating IgA for protection of mucosal sites. Funding Information: Italian Ministry of Health COVID-2020-12371817 grant and Ricerca Corrente 2021 “5 per mille”. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: Ethics Committee of Bambino Gesu Children Hospital, Rome, Italy, Ethical approved the study. The study was performed in accordance with the Good Clinical Practice guidelines, the International Conference on Harmonization guidelines, and the most recent version of the Declaration of Helsinki.

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Telecommuting is a flexible form of work that has progressively spread over the last 40 years and which has been strongly encouraged by the measures to limit the COVID-19 pandemic. There is still limited evidence on the effects it has on workers’ health. In this survey we invited 905 workers of companies that made a limited use of telecommuting to fill out a questionnaire to evaluate intrusive leadership of managers (IL), the request for work outside traditional hours (OFF-TAJD), workaholism (Bergen Work Addiction Scale (BWAS)), effort/reward imbalance (ERI), happiness, and common mental issues (CMIs), anxiety and depression, assessed by the Goldberg scale (GADS). The interaction between these variables has been studied by structural equation modeling (SEM). Intrusive leadership and working after hours were significantly associated with occupational stress. Workaholism is a relevant moderator of this interaction: intrusive leadership significantly increased the stress of workaholic workers. Intrusive leadership and overtime work were associated with reduced happiness, anxiety, and depression. These results indicate the need to guarantee the right to disconnect to limit the effect of the OFF-TAJD. In addition to this, companies should implement policies to prevent intrusive leadership and workaholism.

Anesthetist-intensivists who treat patients with coronavirus disease 19 (COVID-19) are exposed to significant biological and psychosocial risks. Our study investigated the occupational and health conditions of anesthesiologists in a COVID-19 hub hospital in Latium, Italy. Ninety out of a total of 155 eligible workers (59%, male 48%) participated in the cross-sectional survey. Occupational stress was assessed with the Effort Reward Imbalance (ERI) questionnaire, organizational justice with the Colquitt Scale, insomnia with the Sleep Condition Indicator (SCI), and mental health with the Goldberg Anxiety and Depression Scale (GADS). A considerable percentage of workers (71.1%) reported high work-related stress, with an imbalance between high effort and low rewards. The level of perceived organizational justice was modest. Physical activity and meditation&mdash, the behaviors most commonly adopted to increase resilience&mdash, decreased. Workers also reported insomnia (36.7%), anxiety (27.8%), and depression (51.1%). The effort made for work was significantly correlated with the presence of depressive symptoms (r = 0.396). Anesthetists need to be in good health in order to ensure optimal care for COVID-19 patients. Their state of health can be improved by providing an increase in individual resources with interventions for better work organization.

Poor sleep and sleepiness in the workplace are associated with accidents. A workplace sleep health promotion program was implemented in an Italian police unit. Of the 242 police officers in the unit, 218 (90%) agreed to take part in the program. A crossover trial was made in which the police officers were divided into two groups that performed sleep health promotion activities in the first and second year, respectively. The first group of officers showed significant sleep improvements at the end of the first year, while the second group had similar or worse parameters than at baseline. At follow-up, a significant improvement in the quantity and quality of sleep was reported in both groups. Sleep improvements at follow-up were associated with a marked reduction in the frequency of accidents at work and near-misses. Before the intervention, sleepiness was the best predictor of injuries (aOR 1.220, CI95% 1.044&ndash, 1.426) and near-misses (aOR 1.382, CI95% 1.182&ndash, 1.615). At follow-up, when sleep conditions had improved, insomnia symptoms were the most significant predictors of work accidents (aOR 13.358, CI95% 2.353&ndash, 75.818). Sleep health promotion can be useful in police officers.

Impaired workers, unable to practice their activities with effective skills and adequate safety protection because of physical or mental illness, alcohol and drug addiction, inappropriate behaviour as a consequence of fatigue, sleepiness, or distress, may be hazardous for colleagues and customers. To properly manage these workers, public health must resolve the ethical dilemma arising from the legitimate interests of all stakeholders. The sick worker's interests include career expectations, role in organization, right to privacy, and right to freedom from discrimination. The customer's interests include protection from harm, right to autonomy, and right to informed choice. The society's interests include maintaining effective and affordable public services, as well as the benefits and burdens of any policies. Traditional ethics, oriented toward the individual relationship, failed to find an uncontroversial solution to these complex issues. Our research pointed to the organisation level. The La.R.A. Study group on Hazardous Workers was set up in 1999 in Italy, to study how to protect the health and safety of impaired workers and that of third parties, without prejudice to the civil rights of workers. The group includes many subject matter experts like: doctors from different specialties, jurists, bioethicists, employees' and employers' representatives. It is independent and not financed. The ethical, legal and operational aspects of each specific problem are discussed from different points of view and at the end a consensus document containing the practical indications for the prevention operators is produced. Over the years, Lara has produced 10 consensus documents on specific problems and has stimulated companies to develop policies for hazardous workers, preferably according to a bottom-up participatory model. The collective definition of methods and solutions allows management of hazardous workers. Key messages Disability management is preferable to exclusion from work. A shared company policy is the basic principle of management of hazardous workers.

Robotic technology represents a new rehabilitation opportunity that, with an approach similar to a video game, increases the motivation to treat children and seems able to activate brain plasticity, at the basis of the functional recovery due to its interactivity and intensity of the training experience. Literature reports few studies that evaluate the ergonomic aspects of devices for neurorehabilitation, from the point of view of both the operator and the patient. Similar studies in the pediatric field are rare. This study aims to evaluate the response of workers, patients and their parents to this new technology. The study considered the response of the workers (perception of the workload, satisfaction), that of the patients and their parents (expectations, benefits) by comparing the answers to subjective questionnaires of those who made use of the new technology with those who used the traditional technique. Twelve workers, 46 patients and 47 parents were enrolled in the study. Significant differences were recorded in the total workload score of operators who use the robotic technology compared to the traditional therapy (p In this pilot study, the robotic neurorehabilitation technique induced an increase in the expectations and satisfaction of patients and their parents. As is frequent in the introduction of new technologies, workers perceived a greater workload. Subsequent studies are needed to verify the results achieved. This study is being developed in an Italian pediatric hospital, with the collaboration and funding of the Italian Ministry of Health, coauthor of this study. Key messages Robotic therapy presents a higher workload compared to traditional one. Robotic technique induced an increase in quality of life of patients and in expectations and satisfaction of their parents.