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Background and purpose: The patterns of long-term risk of SARS-CoV-2 infection, hospitalization for COVID-19, and related death are uncertain in people with Parkinson disease (PD) or parkinsonism (PS). The aim of the study was to quantify these risks compared to a control population cohort, during the period March 2020–May 2021, in Bologna, Northern Italy. Methods: ParkLink Bologna cohort (759 PD, 192 PS) and controls (9226) anonymously matched (ratio=1:10) for sex, age, district, and comorbidity were included. Data were analysed in the whole period and in the two different pandemic waves (March–May 2020 and October 2020–May 2021). Results: Adjusted hazard ratio of SARS-CoV-2 infection was 1.3 (95% confidence interval [CI] = 1.04–1.7) in PD and 1.9 (95% CI=1.3–2.8) in PS compared to the controls. The trend was detected in both the pandemic waves. Adjusted hazard ratio of hospitalization for COVID-19 was 1.1 (95% CI=0.8–1.7) in PD and 1.8 (95% CI=0.97–3.1) in PS. A higher risk of hospital admission was detected in PS only in the first wave. The 30-day mortality risk after hospitalization was higher (p= 0.048) in PS (58%) than in PD (19%) and controls (26%). Conclusions: Compared with controls, after adjustment for key covariates, people with PD and PS showed a higher risk of SARS-CoV-2 infection throughout the first 15 months of the pandemic. COVID-19 hospitalization risk was increased only in people with PS and only during the first wave. This group of patients was burdened by a very high risk of death after infection and hospitalization.

Made available in DSpace on 2018-08-23T21:52:23Z (GMT). No. of bitstreams: 1 tese_10946_2015_Lorrayne Belotti.pdf: 1964160 bytes, checksum: b863840032dc697e235665fbebcee048 (MD5) Previous issue date: 2017-03-20 O objetivo deste estudo foi analisar a qualidade da fluoretação da água de abastecimento público nos sete municípios da Região Metropolitana da Grande Vitória, Espírito Santo, (RMGV-ES), Brasil. Foi realizado um estudo descritivo e analítico, dividido em três etapas. Inicialmente, foi feita uma revisão crítica, com levantamento de documentos de gestão, de trabalhos científicos que incluiu textos nas línguas portuguesa e inglesa, publicados entre 1953 (ano da implementação dessa medida no ES) e 2015, e de informações sobre fluoretação nos sites das prefeituras e da empresa de abastecimento responsável pelos municípios da RMGV-ES. Para análise dos documentos e artigos foram identificados: o ano do levantamento dos dados; número de municípios incluídos; tema principal; autores/instituições; método de pesquisa; análise de concentração do íon flúor e qual a concentração encontrada. Para as informações encontradas nos sites identificou-se o ano, a fonte, característica e trecho principal. Na segunda etapa, para análise da concentração de fluoreto na água de abastecimento público, foram realizadas 648 coletas de água tratada em Estações de Tratamento de Água que abastecem mais de 80% da população de cada município da RMGV-ES, durante o período de maio a outubro de 2016. As amostras foram analisadas através do Método do Eletrodo Específico e os resultados foram categorizados de acordo com dois critérios de interpretação, segundo a Portaria do Ministério da Saúde nº635/1975 e o critério proposto pelo Centro Colaborador do Ministério da Saúde em Vigilância em Saúde Bucal (CECOL). Também foram selecionadas variáveis contextuais demográficas, socioeconômicas e relacionadas à atenção à saúde de cada município. Para análise de concordância entre os dois critérios de interpretação, realizou-se o Teste Kappa. O Indicador de Proporção de Amostras Adequadas (IPAA) para concentração de flúor foi calculado para ambos critérios. O indicador segundo o critério do CECOL foi relacionado aos fatores contextuais aplicando-se o Teste de Spearman. Na última etapa, foram buscados dados do controle do fluoreto produzidos pela empresa de abastecimento público e pela vigilância municipal, acessados no Sistema de Informação de Vigilância da Qualidade da Água para Consumo Humano (SISAGUA), ambos referentes aos mesmos meses em que foram realizadas as coletas. Em seguida, foram calculadas as médias e desvios-padrão dos resultados das amostras coletadas pelas três fontes de informação para as informações semanais. Essas médias foram comparadas estatisticamente. Para as amostras mensais, disponibilizadas pela empresa e SISAGUA, foi calculado o IPAA, de acordo com a proposta do CECOL, e testadas estatisticamente as diferenças entre as proporções. Na revisão crítica, foram encontrados cinco textos científicos referentes ao tema nos municípios estudados, além de informações baseadas em relatórios de gestão, disponíveis do Centro Colaborador do Ministério da Saúde em Vigilância da Saúde Bucal da Universidade de São Paulo. As informações presentes nos sites da empresa e prefeituras eram superficiais e não foram encontrados dados de controle/heterocontrole da fluoretação. Em relação às coletas, a proporção de amostras adequadas foi de 68,1% e 81,4%, segundo os diferentes critérios. O percentual de concordância entre os dois critérios foi de 86,69% e apresentou concordância substancial pelo Kappa (0,671). O índice de desenvolvimento humano, a média de escovação supervisionada e o tamanho da população total do município exibiram forte correlação positiva com o indicador de proporção de amostras adequadas. A taxa de mortalidade infantil e a proporção de exodontias apresentaram correlação moderada e negativa. A última etapa desta pesquisa mostrou que os percentuais de adequação variaram segundo as ETA e os meses de análise. A comparação entre os percentuais exibiu poucas diferenças estatisticamente significante (p-valor

Tuberculosis (TB) is still a threat for healthcare workers (HCW), due to the non decreasing incidence, the spread of drug-resistance, the introduction of new tests for the screening, the relevant costs of surveillance of exposed subjects. These issues implicate a revision of activities to prevent TB in health-care settings.A multidisciplinary working group, led by occupational physicians, examined the activities to prevent TB performed in 9 Italian hospitals and reviewed the literature, with the aim to formulate evidence-based procedures.In the considered hospitals, 23.000 HCW are classified as exposed to TB, out of 32.000 HCW exposed to biological risks; yearly, about 6000 subjects are screened for preventive, periodical or post-exposure surveillance and 110-130 chemoprophylaxis are prescribed. A high proportion of HCW (54-75%) refused or interrupt to assume the drugs. In the period 2004-2008, 14 occupational TB were diagnosed (9/100.000 HCW exposed to biological risks).Critical issues are the availability of a specific, written TB control plan, including risk assessment, protocols for identifying, evaluating, managing infectious TB patients, health surveillance, education programs, specifically addressed to increase Standard Precaution adoption and compliance to the screening and to adequate risk perception. Risk assessment identify HCW to be included in TB testing (characterized by low positive predictive value), unrecognized TB and environmental control needed; TB risk classification should include no more than 3 or 4 classes and performed by assessing the issues suggested in the Italian guideline. Tubercolin skin test should be used for HCW screening, adding in vitro test in specific circumstances (for example, skin test positivity in BCG vaccinated HCW); the frequency of the screening should not exceed 2 years. Periodical revision of preventive activities should follow up to date scientific literature and need appropriate data computing.

The biological risk from exposure to bloodborne pathogens in health care environments represents a frequent prevaand widespread risk, involving a large number of exposed workers. On the basis of the available scientific innovations, the recent legislation regarding health and safety of workers and the experiences of SIMLII guidelines on health surveillance (HS) workers exposed to biological risk, a multicenter study was carried out, involving nine relevant hospitals and about 32 000 healthcare workers (HCW). A review of the literature was performed, with particular reference to the last 10 years. For each hospital, protocols of HS have been examined according to tasks and biological risk from bloodborne viruses (HBV, HDV, HCV, HIV) as well as management of HCW infected with this pathogens. Differences of risk management in the hospitals, in relationship also with recommendations of the literature have been evaluated. The literature supplies important indications for HS management of HCW exposed to bloodborne pathogens, with relevant information also for patient safety. Preventive examinations are in line with the recommendations of literature and similar across the hospitals for HCV and HIV, while they are different for HBV. Periodic surveillance was different for the frequency, among the hospitals and also as compared to national SIMLII guidelines. As for management, no differentiation among the hospitals was detected as referred to different risk of exposure, while differences were observed around definitions of restrictions. Finally, good medical practices to support occupational physicians in the prevention and management of HCWs’ exposed to biological risks are suggested

Background. Nosocomial transmission of varicellazoster virus, certain paramixovirus and rubivirus might pose a risk of morbidity for varicella (V), rubella (R), mumps (Mu) and measles (Me) in health care workers (HCW), patients and coworkers. International literature and European legislation recommend preventive interventions to minimize the risk. Methods. A literature review and a seroprevalence study were carried out in 9 hospitals located in north and central Italy, in order to evaluate risk assessment, health surveillance and fitness for work of HCW exposed to V, R, Mu and Me. Antibodies (Ab) against V, R, Mu and Me were determined. For a subgroup of 4 hospitals; sociodemographic, occupational data and sera were collected and analyzed. Results. About 36000 tests on about 9000 HCW were analyzed. Differences in seroprevalence ratios (V 85.7-95.1%, R 47-96.8%, Me 71.4-97.8%, Mu 52.5-87.6%) were detected. In a subgroup, a relevant number of non immune HCW was also found among women in fertile age and areas at higher risk. Statistically significant differences were detected only for selected variables and viruses. Discussion and conclusions. Data of multicenter study confirm literature evidences and allow to define good medical practices for manage and minimize the risk of nosocomial transmission of V, R, Me and Mu. Recommendation are issued about serologic screening on HCW exposed to all 4 viruses thorough the modern analytical techniques, in order to assess risk on individual a group basis and to select priorities for intervention. Vaccination should be prescribed for those HCW non immune, selecting areas and HCW according to priorities.

Introduction. The influenza illness is a concern for health care workers (HCW) due to the potential nosocomial transmission and sickness absenteeism. Immunization and Isolation Precautions might be effective preventive measures. Aims. To formulate recommendations on vaccination in healthcare settings. Methods. A multidisciplinary working group, led by occupational physicians (OP), examined the information on seasonal influenza immunisation campaign in 9 Italian hospitals in the period 2005-2009 and reviewed scientific evidence. Results. Many health organizations recommend vaccination of HCW. The literature shows that seasonal influenza vaccination of healthy adult have a modest effect in reducing work day lost; there is no evidence that it affects transmission or it prevents the disease in elderly residents. These observations might be conditioned by methodological limitations. Further studies are required to avoid the risk of bias and in pediatric settings. The rate of flu vaccination among HCW is widely variable and it depends on individual risk perception and information about efficacy and side effects. In the considered hospitals, in the fiveyears period the vaccination rate ranged between 0 and 29%: the median value was 16-17% in 2005, 2008 and 2009 (only against H1N1 influence), 11% and 13% in 2007 and 2006 respectively. OP participation in the vaccination campaign seems to increase the immunization rate. Discussion. Seasonal influenza immunization of HCW might be effective. We recommend to formalize written procedures in health care settings, to perform data computing and to periodically revise immunization activities and promotion and scientific litterature, with the aim to appropriately address resources. Key words: influenza, health care workers, good medical

The study was conducted to evaluate neuropsychological symptoms, subjective stress and response speed functions in subjects occupationally exposed to low levels of anesthetic gases. A group of 112 operating theatre personnel exposed to anesthetic gases (nitrous oxide and isoflurane), and 135 non exposed hospital workers from 10 hospitals in Northern Italy were examined before and after the shift on the first and the last day of the working week. Three different tasks were administered: a complex reaction time test (the Stroop Color Word); a questionnaire for neuropsychological symptoms (EURO-QUEST); the block design subtest (WAIS). Biological and atmospheric indicators of exposure were measured. In the exposed group, the geometric mean of urinary nitrous oxide at the end of the shift was 7.1 micrograms/l (95th percentile 12.4, range 1.5-43) on the first and 7.8 micrograms/l (95th percentile 21.5, range 1.0-73.3) on the last day of the working week. On the same days, end of shift urinary isoflurane was 0.7 microgram/l (95th percentile 2.6, range 0-4.7) on the first day and 0.8 microgram/l (95th percentile 2.0, range 0-5.6) on the last. The exposed and control subjects were comparable for both basic intellectual abilities and subjective stress levels. No statistical differences were observed between exposed and control subjects for neuropsychological tests and symptoms. No dose-effect relationships were observed between the exposure indicators and the test results. In conclusion, no early behavioral effect on the central nervous system was detectable at the exposure levels measured. The biological exposure limits of 13 micrograms/l for nitrous oxide and 1.8 micrograms/l for isoflurane corresponding respectively to the atmospheric concentrations of 25 ppm and 0.5 ppm seem to be adequately protective for the integrity of workers' neurobehavioral functions, as measured with the tests used.

Unlike other apparatuses, the potential effects on the nervous system of occupational exposure to anaesthetic gases have not been exhaustively reviewed. Because of the relevance of these effects, their significance of the quality of life of the exposed subjects and of the increased risk inherent in their delicate work tasks, these themes deserve the greatest attention. This paper briefly examines the data from the international literature as well as the neurobehavioral methods employed, underlines the existing gaps of knowledge and eventually proposes strategies aimed at filling these gaps of knowledge.