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BackgroundSymptoms of anxiety and depression are very common among healthcare workers (HCWs) and could impact the quality of care.ObjectiveThis study aimed to evaluate the prevalence of these disorders in a public health company and their association with work ability and work-related stress.MethodsA cross-sectional study involved 80 HCWs being treated for mental disorders (MD), 55 HCWs who said they suffered from MD but were not being treated, and 824 healthy colleagues. All workers completed the Work Ability Index (WAI), the Siegrist's Effort/Reward Imbalance questionnaire (ERI), the Goldberg's scales of anxiety and depression (GADS), and the Warr's scale of job satisfaction.ResultsThree-quarters of workers with MD suffered from anxiety and/or depression. Workers who declared at the periodic medical examination in the workplace that they were being treated for MD had significantly lower levels of work ability than those of their colleagues who declared good mental health. They also reported greater work stress (high effort, low rewards, high overcommitment) and lower job satisfaction than their healthy colleagues. Symptomatic but untreated workers reported significantly lower work ability, lower satisfaction, and greater occupational stress than their healthy colleagues. In the entire sample, there were many workers with symptoms of anxiety or depression who did not declare these disorders during the examination. Overall, there were 328 suspected cases of anxiety (34.2%) and 334 cases of depression (34.8%). Anxious workers [OR = 8.11, 95% confidence interval (CI) = 3.74–17.58] and depressed workers (OR = 4.49, 95% CI = 2.22–9.10) had an increased risk of being classified as having “poor work ability”.ConclusionThe negative association between psychological symptoms and work ability even in undiagnosed/untreated workers demonstrates the usefulness of screening for these symptoms in work environments.

Abstract Background About one-third of workers identify organisational factors as contributors to workplace violence (WPV), but the associations between these factors and WPV have primarily been explored retrospectively and with measures of perceived organisational constraints, hence providing limited information for prevention. Therefore, we assessed whether objectively measured ward-level indicators of turnover, downsizing, overtime, and night shifts are associated with the occurrence of WPV and whether these associations vary by ward type. Methods We conducted an ecological study at a university hospital in northern Italy from 2016 to 2022, using wards as statistical unit (average: 230 wards per year). Active surveillance of WPV was based on an in-hospital incident reporting procedure, updated in November 2021 based on Health Regional Administration guidelines; 2021 was therefore excluded as a transition year. Individual-level administrative data were used to compute ward-level yearly indicators of turnover, downsizing, overtime and night shifts per active worker. Using generalised linear models, we estimated rate ratios (RRs) for yearly WPV counts per 1 SD increase in the indicators, controlling for study period, ward type (emergency department [ED], psychiatric ward, other) and ward sociodemographic composition. Results A total of 337 WPV episodes occurred in the 1381 ward-year observations. The WPV rates per 100 active workers per year increased from 1.40 (95%CI: 1.23–1.60) during 2016–2020 to 3.48 (2.90–4.17) in 2022. Higher turnover (RR, 95%CI: 1.47, 1.23–1.75) and downsizing (1.12, 1.00-1.24) were associated with a greater occurrence of WPV across all wards; these associations were consistent across the study periods. In wards with night shift scheduling, turnover (1.64, 1.40–1.92), downsizing (1.21, 1.04–1.40) and the mean number of night shifts (2.50, 1.37–4.56) were associated with WPV. The association between night shifts and WPV was greater in psychiatric wards (RR = 8.73; interaction p-value = 0.02), whereas the role of downsizing was greater in EDs (RR = 1.42, interaction p-value = 0.09) and the role of turnover was greater in the other wards (RR = 1.34, interaction p-value = 0.16). Conclusion Work organisational factors are associated with the occurrence of WPV episodes against healthcare workers. Ward type-tailored priorities should be given to minimising turnover and downsizing and promoting a fairer allocation of night shifts to decrease WPV occurrence.

OBJECTIVES: This study aimed to evaluate the independent and interactive effects of changes in overtime and night shifts on burnout among nurses during the COVID-19 pandemic. METHODS: Nurses working in an Italian university hospital (N=317) completed the Maslach Burnout Inventory in September 2019 and again in December 2020. Based on hospital administrative data, changes in overtime and night shifts in the same years were categorized into three groups each. Linear regressions were used to estimate 2020 burnout differences between exposure groups, controlling for 2019 burnout levels, demographic and work-related characteristics, and to test the interaction between the two exposures. RESULTS: Nurses in the onset of high overtime group had higher emotional exhaustion [4.33, 95% confidence interval (CI) 1.74−6.92], depersonalization (2.10, 95% CI 0.49−3.71), and poor personal accomplishment (2.64, 95% CI 0.55−4.74) compared to stable low overtime nurses. Nurses in the increase in night shifts group had lower emotional exhaustion (-4.49, 95% CI -7.46− -1.52) compared to no night shift nurses. Interaction analyses revealed that this apparently paradoxical effect was limited to stable low overtime nurses only. Moreover, increases in night shifts were associated with higher depersonalization and poor personal accomplishment in nurses in the stable high overtime group. CONCLUSIONS: Increase in overtime is an independent risk factor for burnout among nurses, highlighting the need for specific regulations and actions to address it. Long-standing guidelines for the assignment of night shifts might have contributed to attenuate the impact of their increase on nurses’ mental health.

Thallium poisoning, which may be accidental or criminal, presents with a non-specific clinical picture but is rapidly progressive. A delay in diagnosis may cause the appearance of serious, often irreversible, and sometimes fatal lesions. Prompt treatment with Prussian Blue before toxicological confirmation results in immediate improvement in cases of intoxication, without appreciable side effects, and is, therefore, recommended as an “ex juvantibus” strategy in cases of suspected thallium poisoning. A successfully treated case of poisoning is presented as an example of this strategy. An analysis of the contaminated well water the patient had unknowingly drunk subsequently showed pollution over 75 times higher than the potable limit, and plasma levels revealed values 267 times higher than the normal range. All the test results were received when the patient undergoing treatment had improved so much that she had been discharged from hospital. To complete the study, we conducted a scoping review to understand the extent and type of evidence in relation to the latency in the diagnosis of intoxication and health effects. The review of 30 articles covering 115 cases of thallotoxicosis confirmed that early treatment with Prussian Blue offers the best chance of achieving complete recovery.

This viewpoint emphasizes the growing significance of Indoor Air Quality (IAQ) in improving health and comfort in indoor environments, a crucial concern given that individuals spend approximately 90% of their time indoors. It conducts a comprehensive review of IAQ, highlighting its profound impact on overall health and quality of life, often exceeding outdoor environmental pollution. Our paper identifies various risks associated with IAQ, particularly for vulnerable groups such as children, the elderly, and those with chronic health conditions. It details the dual nature of indoor pollutants—external sources like traffic, heating and cooling of buildings, industrial emissions, and internal sources including combustion for food preparation and heating, building materials and furnishing, paints, cleaning products materials, and human activities. These pollutants, ranging from very volatile organic-VVOC, volatile-VOC, semi-volatile organic-SVOC compounds, particulate matter-PM10, PM2.5, and biological entities, necessitate extensive interdisciplinary research. The viewpoint discusses the severe implications of IAQ, especially in developing countries, where it contributes significantly to the global disease burden. It introduces the concept of Indoor Environmental Quality (IEQ), expanding the focus from just air quality to encompass lighting, acoustics, thermal comfort, and water quality. This holistic approach to IEQ is vital for ensuring health and well-being in indoor spaces. Furthermore, the paper explores the interconnection between IAQ and global health crises, such as climate change and the COVID-19 pandemic, and emphasizes the importance of maintaining good IAQ and visual and thermal comfort in workplaces. These factors are linked to improved health, productivity, and sustainable practices. The role of occupational stakeholders, employers, and medical professionals in creating a healthy work environment is critically examined. We argue for their collaboration in promoting health initiatives, ergonomic designs, and effective health surveillance. This collective approach aims to address the complexities of modern workplaces, fostering a healthier, more productive, and sustainable workforce.

Aim: The aim of this study was to analyze the well-being and coping strategies of nurses working in an organizational setting perceived as characterized by workplace bullying. The innovative aspect of this study is that we considered only those who perceive to work in an organizational environment characterized by workplace bullying, and not those who see themselves as victims and those who perceive they work in an organizational environment not characterized by workplace bullying. Method: A questionnaire with the NAQ-R, PGWBI, Val.Mob. and Brief COPE scales was administered to nurses. To better understand this phenomenon, a comparison was made between 331 nurses and 166 workers in other professions who also work in an organizational environment perceived to be characterized by workplace bullying. Results: In both groups (nurses and workers), the results were approximately the same in terms of personal bullying and workplace bullying episodes and the number of physical and emotive symptoms. The PGWBI score was lower for nurses than for workers in other fields. Among the individual symptoms, nurses and registered nurses were more likely to report gastritis, insomnia and heartburn than workers in other contexts. Workers in other contexts were more likely than nurses to report symptoms of anxiety, fear, feelings of insecurity, inferiority and guilt. In terms of coping strategies, nurses were more likely than other workers to report distraction, substance use, emotional support, disengagement, venting, positive reframing, humor, and religion. Workers in other professional context were more likely than nurses to report active coping, denial, instrumental support, planning, acceptance, and self-blame. Conclusion: Results suggest that the consequences of working in a perceived organizational environment characterized by workplace bullying are similar for both groups of workers, with nonstatistical differences in perceived workplace bullying episodes and sum of physical and emotive symptoms. Implication: Overall, findings suggest that workplace bullying prevention is a fundamental element in training workers in all types of workplaces and should be an integral part of curriculum activities.

This viewpoint delves into the transformative role of Artificial Intelligence (AI) in occupational medicine, highlighting its profound impact on preventive healthcare. AI's integration into various aspects of occupational health is reshaping diagnostics, risk assessment, and healthcare administration. The paper emphasizes AI's learning, planning, reasoning, and problem-solving capabilities, which are pivotal in enhancing diagnostic accuracy for conditions like occupational tumor detection and long term health effects from exposure to low-level hazards of chemicals. AI may be valuable for monitoring workplace health and safety, employing predictive analytics for early risk detection, and preventing occupational injuries and work-related diseases. In this viewpoint, the authors explore AI's role in managing health data through natural language processing, aiding physicians in clinical documentation and patient communication. It is needed to address ethical challenges related to AI implementation in the healthcare sector and occupational health practice, such as data protection and decision-making accountability. In conclusion, AI may expand worker training and health literacy scope, demonstrating its comprehensive utility in fostering a safer, healthier, and more informed workforce in occupational health settings.

The growing importance of psychosocial risks in workplaces underscores the necessity of prioritizing employees’ mental well-being. These risks, stemming from inadequate work design and organization, result in significant adverse outcomes across various sectors. A comprehensive analysis of this issue is crucial to address emerging challenges and promote workers’ psycho-physical health. This study explores the definition and identification of psychosocial risks, encompassing workplace harassment, violence, critical service events, emotional demands, and contextual factors like work-related stress. Emerging global challenges, such as the COVID-19 pandemic, affect work organizations, impacting employee psycho-physical stress. Novel work paradigms and digital technologies add complexity. Work-related stress and high emotional demands can lead to chronic stress adaptation disorders, anxiety, depression, and Post-Traumatic Stress Disorder (PTSD), mainly affecting healthcare professionals. ISO 45003 advocates a holistic approach to psychosocial risk assessment, ensuring workers’ mental well-being. The Copenhagen Psychosocial Questionnaire (COPSOQ) offers a validated tool adaptable to various contexts, but comprehensive validation is lacking. Assessing critical service events, violence, and early intervention can mitigate distress. Multidisciplinary teams, including physicians, psychologists, and ergonomists, are vital to address complexity. Health surveillance, guided by competent professionals, gains importance. Beyond risk assessment, it aids in early issue detection and psychological support. In conclusion, managing psychosocial risks requires a collective commitment to create a health-supportive work environment. Comprehensive evaluation, supported by robust tools and health surveillance, safeguards mental well-being and nurtures a culture attuned to psycho-physical health.

Healthcare workers (HCWs) are occupationally exposed to varicella zoster virus (VZV), and their inappropriate vaccination status could contribute to an outbreak involving both professionals and the patients they care for, with a potential impact on the general population. Therefore, since 2007, the Advisory Committee on Immunization Practices (ACIP) recommends that all HCWs have evidence of immunity against varicella. The present meta-analysis was therefore designed to collect the available evidence on the seronegative status of VZV among HCWs. PubMed, Scopus, and Embase databases were searched without backward limit for articles reporting on the seroprevalence of VZV among HCWs, and all articles meeting the inclusion criteria were included in a random-effect meta-analysis model. From 1744 initial entries, a total of 58 articles were included in the quantitative analysis (publication range: 1988 to 2024), for a pooled sample of 71,720 HCWs. Moreover, the included studies reported on seroprevalence data on measles (N = 36,043 HCWs) and rubella (N = 22,086 HCWs). Eventually, the pooled seronegative status for VZV was estimated to be 5.72% (95% confidence interval [95% CI] 4.59 to 7.10) compared to 6.91% (95% CI 4.79 to 9.87) for measles and 7.21% (5.36 to 9.64) for rubella, with a greater risk among subjects younger than 30 years at the time of the survey (risk ratio [RR] 1.434, 95% CI 1.172 to 1.756). Interestingly, medical history of either VZV infection/vaccination had low diagnostic performances (sensitivity 76.00%; specificity 60.12%; PPV of 96.12% but PNV of 18.64%). In summary, the available data suggest that newly hired HCWs are increasingly affected by low immunization rates for VZV but also for measles and rubella, stressing the importance of systematically testing test newly hired workers for all components of the measles–pertussis–rubella–varicella vaccine.

Cardiovascular diseases (CVDs) remain a leading cause of illness and death globally, imposing a significant burden on healthcare systems. The COVID-19 pandemic has exacerbated healthcare inequalities, potentially amplifying the burden of CVDs in certain populations. Sedentary occupations and metabolic syndrome (MetS) are associated with an increased risk of type 2 diabetes mellitus (T2DM) and coronary heart disease, contributing to elevated mortality rates from CVDs. Occupational risk assessment and management are crucial for developing tailored plans to control and mitigate workplace hazards that lead to occupational and work-related diseases. Long working hours have been linked to an increased risk of ischemic heart disease and stroke. Chronic diseases such as diabetes and cardiovascular disease diminish individuals' quality of life and have negative employment consequences. Workplace health promotion programs (WHPs) focusing on healthy lifestyle behaviors have shown positive effects in reducing the incidence of T2DM, CVDs, and mental and musculoskeletal health issues. Aging, sedentary lifestyles, prolonged working hours, physical inactivity, poor diets, and high occupational stress contribute to MetS and subsequent CVDs, emphasizing the need for attention from occupational stakeholders. Implementing interventions such as promoting physical activity, stress management techniques, and flexible work arrangements can help reduce occupational stress levels and combat sedentary work environments. Embedding workplace health promotion within medical surveillance (WHPEMS) offers an economical, sustainable, and effective approach to improving health outcomes. Involving workers in health promotion interventions during regular medical check-ups provides an opportunity for targeted interventions. Occupational health programs, mandatory in the European Union, can be utilized to educate workers on healthier lifestyles and develop tailored WHPs. The Total Worker Health approach, involving cooperation between occupational and public health stakeholders, plays a vital role in achieving comprehensive workplace health promotion.

Introduction: Burnout syndrome (BOS) among healthcare workers (HCWs) is a widespread phenomenon that leads to poor staff health and diminished quality of medical care. Spirituality has been proposed as a coping strategy against BOS. The relationship between spirituality and BOS needs to be evaluated. Therefore, a systematic review was conducted to synthesize evidence for understanding association between spirituality and BOS. Methods: The PRISMA guidelines were used to conduct a systematic search of bibliographical databases, including PubMed/Medline, Scopus, and several others in June 2022. Titles. Abstracts, and full-texts of all articles were screened to determine eligibility. The National Heart, Lung, and Blood Institute (NHLBI) quality assessment tool was utilized for the risk of bias (RoB) assessment. Pertinent data were collected using a standardized codebook. Results: Of the original 217 studies, 26 were included in the systematic review, with a total sample of 8,666 participants. Only five studies were interventional or experimental, while the remaining were cross-sectional. Most studies indicated a positive relationship between spiritual well-being or spirituality and personal accomplishment, and a negative association with emotional exhaustion and depersonalization. Interventional studies found that spirituality-based interventions were effective in reducing BOS among HCWs, however, the evidence is fairly scarce. Discussion and Conclusions: There is weak evidence that spirituality is inversely associated with BOS. There are insufficient evidence that spiritual-based health promotion programs in the workplace may be effective in preventing and/or reducing BOS in HCWs.

A case–control study including 446 workers reporting headaches (cases; 136 males and 310 females, mean age 46.71 ± 10.84 years) and 446 age- and sex-matched colleagues without headaches (controls; mean age 45.44 ± 10.13) was conducted in the second half of 2020 in a sample drawn from socio health and commercial services companies to investigate the association of headache with lifestyle, metabolic, and work-related factors. Workers suffering from headache reported higher body weight (OR: 1.92, 95% CI: 1.46–2.53, p < 0.001), higher blood cholesterol (OR: 2.01, 95% CI: 1.46–2.77, p < 0.001), triglyceride (OR: 2.01, 95% CI: 1.20–3.35, p < 0.01), blood glucose (OR: 1.91, 95% CI: 1.16–3.24, p < 0.01), and blood pressure levels (OR: 1.76, 95% CI: 1.23–2.52, p < 0.01). In the year preceding the survey, cases had experienced a higher frequency of workplace violence (OR: 2.29, 95% CI: 1.25–4.20, p < 0.01 for physical aggression, OR: 2.22, 95% CI: 1.45–3.41, p < 0.001 for threat, OR: 2.74, 95% CI: 1.72–4.38, p < 0.001 for harassment) and were more frequently distressed (effort/reward ratio > 1) (OR: 1.82, 95% CI: 1.39–2.40, p < 0.001) than the controls. Compared to the controls, cases also had higher scores on anxiety and depression scales, lower scores on happiness, and lower levels of sleep quality (p < 0.001). The association of headaches with metabolic and mental health problems suggests that monitoring headaches in the workplace could help to identify workers at risk of impairment.

IntroductionThe COVID-19 pandemic had a negative impact on the psychological wellbeing of workers worldwide. Certain coping styles may increase burnout risk. To investigate the relationship between burnout and coping styles, a systematic review was performed.MethodsFollowing the PRISMA statements, three databases were screened up until October 2022, including research articles written in English language and investigating the relationship between burnout and coping strategies in workers. The quality of articles was assessed by the Newcastle-Ottawa Scale.ResultsThe initial search resulted in 3,413 records, 15 of which were included in this review. Most studies were performed on healthcare workers (n = 13, 86.6%) and included a majority of female workers (n = 13, 86.7%). The most used burnout assessment questionnaire was the Maslach Burnout Inventory (n = 8, 53.3%), and the most used coping assessment tool was the Brief-COPE (n = 6, 40.0%). Task-related coping was a protective factor for burnout in all four studies investigating its correlation with burnout dimensions. Two of the four studies investigating emotion-oriented coping found that it was protective while the other two found that it was predictive of burnout. All five studies investigating avoidance-oriented coping and burnout dimensions found that this coping style was predictive of burnout.DiscussionTask-oriented and adaptive coping were protective for burnout, avoidance-oriented, and maladaptive coping were predictive factors of burnout. Mixed results were highlighted concerning emotion-oriented coping, suggesting that different outcomes of this coping style may depend on gender, with women relying more on it than men. In conclusion, further research is needed to investigate the effect of coping styles in individuals, and how these correlates with their unique characteristics. Training workers about appropriate coping styles to adopt may be essential to enact prevention strategies to reduce burnout incidence in workers.

Garbarino et al review recent experimental and epidemiological developments regarding immune responses to sleep deprivation and consider the role for the sleep deprivation induced immune changes in increasing the risk for chronic diseases.

Exposure to major trauma can have significant consequences for workers’ mental health, but common trauma may also result in poor mental health outcomes. This cross-sectional study retrospectively investigated the occurrence of common physical or psychological workplace trauma in 901 health, social service, and trading company workers and studied these experiences in relation to occupational stress, anxiety, and depression. Stress was measured with the effort/reward imbalance (ERI) model while anxiety and depression were evaluated with the Goldberg Anxiety and Depression Scale (GADS). Healthcare workers reported a high frequency of trauma and significantly higher levels of stress, anxiety, and depression than other workers. Even in the entire population of workers of the various professional categories, verbal violence (harassment and threats), traffic accidents, home injuries, and family bereavement were significantly associated with high levels of stress, anxiety, and depression. Major trauma survivors are known to be at increased risk of mental disorders and require support in the workplace, however, even minor repeated emotional trauma and injuries can affect mental health. During mandatory health surveillance, the occupational physician should systematically collect information on minor trauma and mental health outcomes when assessing the occupational fitness of the workers assigned to him.

Background: Over 20% of healthcare workers (HCWs) are active smokers. Smoking is a targeted issue for workplace health promotion (WHP) programs. Objective: Our study aims to evaluate the effectiveness of the Stop Smoking Promotion (SSP) intervention, a 6-hour training course for HCWs, which took place from May 2018 to July 2019. Methods: We compared HCWs who successfully quit smoking (n = 15) to those who did not (n = 25) in terms of Sickness Absence Days (SADs). Moreover, we conducted an econometric analysis by calculating the return on investment and implementing a break-even analysis. Findings: Among the 40 enrolled workers, a success rate of 37.5% was observed after a span of over two years from the SSP intervention (with nurses and physicians showed the best success rate). Overall, participants showed a noticeable absenteeism reduction after the SSP intervention, with a reduction rate of 85.0% in a one-year period. The estimated ROI for the hospital was 1.90, and the break-even point was 7.85. In other words, the organization nearly doubled its profit from the investment, and the success of at least eight participants balanced costs and profits. Conclusion: Our pilot study confirms that WHP programs are simple and cost-saving tools which may help improve control over the smoking pandemic in healthcare settings.

Purpose – This 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/approach – Descriptive analysis of critical points and differences in the containment strategies between the first and the second waves in Italy. Findings – Italy'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/value – This is a commentary piece.

Introduction: Many occupational factors disturb sleep. This can have significant consequences because sle- ep problems mediate the relationship between work stress and health disorders. The objective of this study is to validate the Sleep Disorders Score Questionnaire (SDS-Q), a questionnaire designed to measure sleep disorders and their consequences in workers. Methods: A cross-sectional study was carried out. Validity was analysed by exploratory factor analyses, and reliability by Cronbach’s alpha. Results: The study was conducted with 240 male police officers. Principal component analysis confirmed the existence of 3 subscales, regarding Insomnia symptoms, Excessive daytime sleepiness (EDS) and Ob- structive Sleep Apnoea (OSA). The Cronbach’s alpha values of the subscales Insomnia symptoms (IS), Sleepiness symptoms (SS) and Apnoea symptoms (AS) were acceptable. Discussion and Conclusions: The Insomnia, Sleepiness and Apnoea subscales of SDS-Q have demonstra- ted good psychometric properties in terms of reliability and validity. The SDS-Q is a valid and reliable tool for assessing workers’ sleep problems and disorders.

A case of recurrent coronavirus disease 2019 (COVID-19) with neurovestibular symptoms was reported. In March 2020, a physician working in an Italian pediatric hospital had flu-like symptoms with anosmia and dysgeusia, and following a reverse transcription PCR (RT/PCR) test with a nasopharyngeal swab tested positive for SARS-CoV-2. After home quarantine, 21 days from the beginning of the symptoms, the patient tested negative in two subsequent swabs and was declared healed and readmitted to work. Serological testing showed a low level of immunoglobulin G (IgG) antibody title and absence of immunoglobulin M (IgM). However, 2 weeks later, before resuming work, the patient complained of acute vestibular syndrome, and the RT/PCR test with mucosal swab turned positive. On the basis of the literature examined and reviewed for recurrence cases and vestibular symptoms during COVID-19, to our knowledge this case is the first case of recurrence with vestibular impairment as a neurological symptom, and we defined it as probably a viral reactivation. The PCR retest positivity cannot differentiate re-infectivity, relapse, and dead-viral RNA detection. Serological antibody testing and viral genome sequencing could be always performed in recurrence cases.

High quality medical assistance and preventive strategies, including pursuing a healthy lifestyle, result in a progressively growing percentage of older people. The population and workforce is aging in all countries of the world. It is widely recognized that older individuals show an increased susceptibility to infections and a reduced response to vaccination suggesting that the aged immune system is less able to react and consequently protect the organism. The SARS-CoV-2 pandemic is dramatically showing us that the organism reacts to novel pathogens in an age-dependent manner. The decline of the immune system observed in aging remains unclear. We aimed to understand the role of B cells. We analyzed peripheral blood from children (4-18 years); young people (23-60 years) and elderly people (65-91 years) by flow cytometry. We also measured antibody secretion by ELISA following a T-independent stimulation. Here we show that the elderly have a significant reduction of CD27dull memory B cells, a population that bridges innate and adaptive immune functions. In older people, memory B cells are mostly high specialized antigen-selected CD27bright. Moreover, after in vitro stimulation with CpG, B cells from older individuals produced significantly fewer IgM and IgA antibodies compared to younger individuals. Aging is a complex process characterized by a functional decline in multiple physiological systems. The immune system of older people is well equipped to react to often encountered antigens but has a low ability to respond to new pathogens.

Robberies and other violent acts by strangers and intruders are common in banks, which can lead to post-traumatic stress disorder in employees. However, the literature indicates that more subtle and less measurable forms of violence, such as psychological violence, can also cause discomfort among employees. The aim of the present work is to investigate the prevalence of verbal aggression and its consequences among 311 Italian bank employees. A self-administered questionnaire was completed by 197 employees. The results showed a high prevalence of verbal aggression in the sample. It is important to investigate and find the causes and effects of verbal aggression in order to understand the phenomenon in this workplace. Cases of verbal aggression need to be prevented and responded to appropriately. In addition, it should be noted that the effects of verbal aggression do not only affect the victim, but also the workplace, as productivity decreases, and the feeling of a safe environment is missing.

Objectives The aging of the workforce is an issue that calls for concrete measures to promote the health of older workers. This study reports on the results of the European “ProHealth65+” research project interventions conducted in Poland in relation to workplace health promotion for older workers (WHPOW) and the institutions involved in these programs. Material and Methods A three-stage search of peer-reviewed and grey literature on the WHPOW in Poland. Results A total of 59 WHPOW programs were retrieved in Poland in the observation period (2000–2015). Most of these aimed at improving the Qualification and Training or at the Work Climate and attitudes toward older workers. The promotion, organization, and funding of these activities were carried out mainly by supra-national and governmental bodies, enterprises and employers, and educational and trainee institutions. Conclusions Although there is great commitment to the medical surveillance of workers on the part of the Polish occupational health service, our search detected a relatively low number of the WHPOW initiatives. Greater efforts should be made to introduce strategies for addressing aging of the workforce. Int J Occup Med Environ Health 2018;31(6):753–761

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.

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.

IntroductionTeaching is a stressful profession that exposes workers to the risk of burnout. Techniques involving higher mental functions, such as transcendental meditation and prayer, have been used in stress and burnout prevention programs. In this study, we report the results of an experience conducted in a group of teachers of a religious institute, in which prayer was used as a technique to prevent burnout.MethodsFifty teachers and support staff employed at a Catholic school of a Congregation of nuns volunteered for this study. They were randomized into two groups: prayer treatment (n = 25) or control group (n = 25). The treatment protocol was based on the combination of individual Christian prayer and a focus group of prayer-reflection. The participants received two 30 min training sessions a week over 2 months. Job satisfaction, well-being, and burnout symptoms (emotional exhaustion and depersonalization sub-scales) were measured at baseline and at follow-up (4 months) with the Italian versions of the Maslach Burnout Inventory validated for teaching and education sector, the General Health Questionnaire, and the Warr, Cook, and Wall’s Job Satisfaction Scale.ResultsAt follow-up, a significant improvement of all outcome measures was observed. Emotional exhaustion (16.80–4.92, p < 0.001), depersonalization (3.72–0.60, p < 0.001) levels, and psychological impairment (10.08–2.04, p < 0.001) were significantly decreased, and job satisfaction (45.96–77.00, p < 0.001) was increased. The effect sizes (Glass’ Δ) of the therapeutic interventions ranged from 0.53 (satisfaction level) to 2.87 (psychological health), suggesting moderate to large effects.DiscussionPrayer could be effective, no less than meditation and other spiritual or mind-body techniques, in contrasting the negative effects of occupational stress and preventing burnout among teachers and possibly other human service professionals.

Background: This systematic review with meta-analysis was carried out to study the relationship between workplace violence and sleep problems.Methods: The PRISMA statement was used to conduct a systematic search of the literature on PubMed/MEDLINE, Scopus, Sociological abstract, DOAJ, Web of Science, and Google Scholar databases. Of the original number of 749 studies, 34 were included in the systematic review, and 7 in the meta-analysis.Results: A total of 119,361 participants from 15 different countries took part in these studies which were published between 1999 and 2019. Significant heterogeneity was observed among the studies (I2 = 96%). In a random-effects meta-analysis model, pooled odds ratio (OR) analysis revealed that there was a direct relationship between occupational exposure to violence and sleep problems (OR = 2.55; 95% CI = 1.77–3.66). According to the GRADE guidelines, the quality of evidence of the association was low.Conclusions: The findings of this study demonstrate that occupational exposure to physical, verbal, or sexual violence is associated with sleep problems. Further research on the relationship between violence and sleep is needed so that appropriate measures can be taken to prevent violence and improve sleep hygiene in the workplace.Trial Registration Number: PROSPERO International prospective register of systematic reviews (CRD42019124903) February 9, 2019.

Specific memory B cells and antibodies are a reliable read-out of vaccine efficacy. We analysed 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. We show that although mucosal IgA is not induced by the vaccination, memory B cells migrate in response to inflammation and secrete IgA at mucosal sites. We show that the first vaccine dose may lead to an insufficient number of highly specific memory B cells and low concentration of serum antibodies, thus leaving vaccinees without the immune robustness needed to ensure viral elimination and herd immunity. We also clarify that the reduction of serum antibodies does not diminish the force and duration of the immune protection induced by vaccination. The vaccine does not induce sterilizing immunity. Infection after vaccination may be caused by the lack of local preventive immunity because of the absence of mucosal IgA.

Occupational exposure to solvents is consistently associated with the risk of systemic sclerosis. We pose the question of whether the occupational exposure to anesthetics may favor the occurrence of this disease. This paper describes an incidence of systemic sclerosis in the case of an anesthesiologist who had been occupationally exposed to high doses of anesthetic in the operating room. Anecdotal cases in the literature give limited support to the causal association of the occupational exposure to anesthetics and systemic sclerosis. The extremely limited number of workers exposed makes it necessary to report all cases observed in order to assess the degree of the occupational risk for anesthesiologists. Med Pr 2016;67(4):557–560

Workplace health and safety is constantly evolving both in developed and developing countries. Under the tumultuous development of technology, working environments are changing, leading to the onset of new occupational hazards and unprecedented risk conditions deriving from the new ways of organizing work. At the same time, progress in medical science, with the knowledge in the fields of genetics, metabolomics, big data, and smart technologies, makes it possible to promptly identify and treat risk conditions that would have escaped notice in the past. Personalized occupational medicine represents the frontier of prevention in the workplace, from the perspective of total worker health and the sustainability of resources. The contributions to this Special Issue range from chemical, physical, and biological to psychosocial risks, and from the search for new ways to control long-known risks, such as mercury toxicity, to observations of the most frequent pathologies in the workplace in the last twenty years, such as repetitive trauma diseases, immunodeficiency transmitted as a result of biological injuries, and violence and psychological trauma in the workplace. New insights are needed in occupational health and safety practice to address the new challenges in this field.

Chronic exposure to low levels of mercury is involved in the development of motor neuron diseases (MND). Genetic alterations may have a crucial role in the onset and progression. We presented a case of a TANK-binding kinase 1 (TBK1)-mutated 54-year-old male worker who developed a MND due to chronic mercury exposure at work. He was employed in a chlor-alkali plant in Central Italy. After two years of employment he had acute mercury intoxication with suggestive neurological symptoms and a high urinary level of the metal. Through years, many episodes of intoxication occurred, but he continued to perform the same job and be exposed to mercury. After yet another episode of intoxication in 2013, he showed fasciculations of the upper limbs and trunk, and electromyographic activity patterns were consistent with amyotrophic lateral sclerosis (ALS). In 2016, a genetic test revealed a mutation of TBK1, an ALS-related gene. This case highlights the important role of genetics in personalized occupational medicine. Occupational physicians should use genetic tests to identify conditions of individual susceptibility in workers with documented frequent episodes of mercury intoxication recorded during health surveillance programs to customize prevention measures in the workplace and act before damage appears.

Occupational exposure to elemental mercury still represents a significant risk in the workplace. The sensitivity of the exposed subjects varies considerably. This study aims to summarize the literature on the role of genetic factors in occupationally exposed cohorts. A systematic search of the literature was carried out on PubMed Central (PMC), MEDLINE, and Google Scholar databases in accordance with the “Preferred Reporting Items for Systematic reviews and Meta-Analyses” (PRISMA) guidelines, from 1946 to July 2020. Ten cross-sectional studies were included in the review. All studies referred to the polymorphisms that can favour some neurotoxic effects of the metal in occupational cohorts. Some genetic variants may be associated with an increase in the occupational effects of mercury. Given the limited evidence, genetic screening of all mercury-exposed workers is not recommended. However, a personalized search for polymorphisms could be taken into consideration if exposed workers report early neurotoxic symptoms.

OBJECTIVE:Previous studies have shown that workers chronically exposed to occupational stress have an increased risk of metabolic syndrome (MetS) and sleep problems (SPs). The purpose of this study was to verify whether SPs mediate the relationship between stress and MetS. METHOD:A 5-year prospective cohort study included 242 police officers from a rapid response unit engaged exclusively in maintaining law and order. Perceived stress levels were measured repeatedly with the demand-control-support and the effort-reward-imbalance questionnaires; insomnia symptoms were assessed with the Pittsburgh Sleep Quality Index; excessive daytime sleepiness was measured using the Epworth Sleepiness Scale. MetS and its components were evaluated at baseline and at follow-up. RESULTS:During 5-year follow-up period, 26 new cases of MetS were identified. Both occupational stress and SPs were significantly related to incident cases of MetS. Insomnia symptoms showed a highly significant association with MetS (aOR 11.038; CI95% 2.867-42.493). Mediation analysis confirmed that SPs mediate the relationship between stress and MetS. A reciprocal relationship was found between job stress and SPs. Work-related stress was a significant predictor of insomnia symptoms, short sleep duration, sleep dissatisfaction, and sleepiness. Compared to the reference group, police officers with SPs at baseline had significantly higher odds of reporting high stress at follow-up. CONCLUSION:SPs play a mediating role in the relationship between occupational stress and MetS. Prevention of MetS must include the control of stress factors and an increase in the resilience of workers, but correct sleep hygiene is also an essential factor.

Introduction: Obstructive sleep apnea (OSA) is a serious and prevalent medical condition with major consequences for health and safety. Excessive daytime sleepiness (EDS) is a common—but not universal—accompanying symptom. The purpose of this literature analysis is to understand whether the presence/absence of EDS is associated with different physiopathologic, prognostic, and therapeutic outcomes in OSA patients.Methods: Articles in English published in PubMed, Medline, and EMBASE between January 2000 and June 2017, focusing on no-EDS OSA patients, were critically reviewed.Results: A relevant percentage of OSA patients do not complain of EDS. EDS is a significant and independent predictor of incident cardiovascular disease (CVD) and is associated with all-cause mortality and an increased risk of metabolic syndrome and diabetes. Male gender, younger age, high body mass index, are predictors of EDS. The positive effects of nasal continuous positive airway pressure (CPAP) therapy on blood pressure, insulin resistance, fatal and non-fatal CVD, and endothelial dysfunction risk factors have been demonstrated in EDS-OSA patients, but results are inconsistent in no-EDS patients. The most sustainable cause of EDS is nocturnal hypoxemia and alterations of sleep architecture, including sleep fragmentation. These changes are less evident in no-EDS patients that seem less susceptible to the cortical effects of apneas.Conclusions: There is no consensus if we should consider OSA as a single disease with different phenotypes with or without EDS, or if there are different diseases with different genetic/epigenetic determinants, pathogenic mechanisms, prognosis, and treatment.The small number of studies focused on this issue indicates the need for further research in this area. Clinicians must carefully assess the presence or absence of EDS and decide accordingly the treatment. This approach could improve combination therapy targeted to a patient's specific pathology to enhance both efficacy and long-term adherence to OSA treatment and significantly reduce the social, economic, and health negative impact of OSA.

Sleep-related problems are known risk factors for road accidents. However, very few studies have investigated the role played by insomnia and its components, and no data are available for a population of occupational drivers at risk, such as the truck driver category.To measure the prevalence and impact of insomnia on motor vehicle accidents (MVAs) and near-miss accidents (NMAs) in 949 truck drivers.Cross-sectional survey.Insomnia affected 27.5% of the sample. Compared to other drivers, in the 3 years prior to the study, truck drivers with insomnia had reported a significantly higher number of MVAs; they had also reported a greater number of NMAs in the previous 6 months. After correction for the presence of obstructive sleep apnea, excessive daytime sleepiness, short sleep duration, and other concurrent diseases, insomniac truck drivers had an almost two-fold risk of driving accidents (OR: 1.82, CI 95%:1.33-2.49) and a more than three-fold increased risk of near-miss accidents (OR: 3.35, CI95%:2.06-5.45) compared to non-insomniac drivers.Insomnia emerged as an independent risk factor for MVAs and NMAs. We strongly advise screening commercial drivers for signs and symptoms of insomnia in order to improve health and safety on the road.

Recent research has found evidence of an association between motor vehicle accidents (MVAs) or near miss accidents (NMAs), and excessive daytime sleepiness (EDS) or its main medical cause, Obstructive Sleep Apnea (OSA). However, EDS can also be due to non-medical factors, such as sleep debt (SD), which is common among professional truck drivers. On the opposite side, rest breaks and naps are known to protect against accidents.To investigate the association of OSA, SD, EDS, rest breaks and naps, with the occurrence of MVAs and NMAs in a large sample of truck drivers.949 male truck drivers took part in a cross-sectional medical examination and were asked to complete a questionnaire about sleep and waking habits, risk factors for OSA and EDS.MVAs and NMAs were reported by 34.8% and 9.2% of participants, respectively. MVAs were significantly predicted by OSA (OR = 2.32 CI95% = 1.68-3.20), SD (OR = 1.45 CI95% = 1.29-1.63), EDS (OR = 1.73 CI95% = 1.15-2.61) and prevented by naps (OR = 0.59 CI95% = 0.44-0.79) or rest breaks (OR = 0.63 CI95% = 0.45-0.89). NMAs were significantly predicted by OSA (OR = 2.39 CI95% = 1.47-3.87) and SD (OR = 1.49 CI95% = 1.27-1.76) and prevented by naps (OR = 0.52 CI95% = 0.32-0.85) or rest breaks (OR = 0.49 CI95% = 0.29-0.82).When OSA, SD or EDS are present, the risk of MVAs or NMAs in truck drivers is severely increased. Taking a rest break or a nap appear to be protective against accidents.

The aim of this study was to evaluate the association between psychological damage caused by common occupational trauma and metabolic syndrome (MES).571 workers from 20 small Italian companies were invited to fill in the Psychological Injury Risk Indicator (PIRI) during their routine medical examination at the workplace.Compared to workers with no psychological injury, workers with a high PIRI score had a significantly increased risk of having at least one metabolic syndrome component (adjusted hazards ratio, 1.8; 95% confidence interval, 1.2 to 2.6). There was a significant increase in the risk of hypertriglyceridemia in male workers (OR 2.53 CI95% 1.03-6.22), and of hypertension in female workers (OR 2.45 CI95% 1.29-4.66).Psychological injury related to common occupational trauma may be a modifiable risk factor for metabolic syndrome.

ObjectiveThe aim of this longitudinal study was to evaluate the association between occupational stress and metabolic syndrome (MetS) in a rapid response police unit.MethodWork-related stress was continuously monitored during the 5-year period with both the Demand-Control-Support (DCS) and the Effort-Reward Imbalance (ERI) models. Blood pressure, body mass index (BMI), waist circumference, triglycerides, HDL-cholesterol, and fasting blood glucose were measured at baseline in January 2009, and in January 2014. 234 out of 290 police officers (81%) completed the follow-up.ResultsThe majority of police officers had high stress levels. At follow-up, police officers in the highest quartile of stress had significantly higher mean levels of triglycerides, and lower levels of HDL-cholesterol than their colleagues in the lowest quartile. Police officers with high stress had an increased adjusted risk of developing MetS (aOR = 2.68; CI95% = 1.08-6.70), and hypertriglyceridemia (aOR = 7.86; CI95 = 1.29-48.04). Demand and Effort were significant predictors of MetS.ConclusionOur study supports the hypothesis that work-related stress induces MetS, particularly through its effects on blood lipids. Future longitudinal studies with continuous monitoring of stress levels will definitively confirm this hypothesis.

Background. The aim of this study was to cross-culturally adapt the Psychological Injury Risk Indicator (PIRI) and to validate its psychometric properties. Methods. Workers from 24 small companies were invited to self-complete the PIRI before undergoing their routine medical examination at the workplace. All participants (841 out of 845, 99.6%) were also asked to report occupational injuries and episodes of violence that had occurred at the workplace in the previous 12 months and were given the General Health Questionnaire (GHQ12) to complete. Results. Exploratory factor analysis revealed a 4-factor structure, “sleep problems,” “recovery failure,” “posttraumatic stress symptoms,” and “chronic fatigue,” which were the same subscales observed in the original version. The internal consistency was excellent (alpha = 0.932). ROC curve analysis revealed that the PIRI was much more efficient than GHQ12 in diagnosing workers who had suffered trauma (workplace violence or injury) in the previous year, as it revealed an area under the curve (AUC) of 0.679 (95% CI: 0.625–0.734) for the PIRI, while for the GHQ12 the AUC was 0.551 (not significant). Conclusions. This study, performed on a large population of workers, provides evidence of the validity of the Italian version of the PIRI.

OBJECTIVE:To determine the frequency of obstructive sleep apnea syndrome (OSAS), metabolic syndrome and common mental disorders in the working population of 11 small enterprises and the feasibility of a program of action for health. METHOD:The clinical risk of OSAS, the prevalence of metabolic syndrome, and the level of psychological disorders were assessed during routine medical examination at the workplace in 2012. The response to medical advice was assessed in 2013. RESULTS:12.3% of the workers were suspected of being affected by OSAS. One or more components of metabolic syndrome were present in 24.5% of cases. OSAS in "healthy" workers was significantly associated with the presence of one or more components of metabolic syndrome (OR = 3.83; 95%CI 1.45-10.13) and with a psychological disorders score in the highest quartile (OR = 4.67; 95%CI = 1.72-12.64). Workers with suspected OSAS were reluctant to follow advice about undergoing further tests under the NHS. However, in some cases, confirmation of the OSAS diagnosis and subsequent treatment led to an improvement in metabolic condition. CONCLUSION:Although participation in treatment was limited, anecdotal cases support the idea that prevention of obstructive sleep apnea in the workplace might be useful for workers' health.

Purpose. To perform a parsimonious measurement of workplace psychosocial stress in routine occupational health surveillance, this study tests the psychometric properties of a short version of the original Italian effort-reward imbalance (ERI) questionnaire. Methods. 1,803 employees (63 percent women) from 19 service companies in the Italian region of Latium participated in a cross-sectional survey containing the short version of the ERI questionnaire (16 items) and questions related to self-reported health, musculoskeletal complaints and job satisfaction. Exploratory factor analysis, internal consistency of scales and criterion validity were utilized. Results. The internal consistency of scales was satisfactory. Principal component analysis enabled to identify the model’s main factors. Significant associations with health and job satisfaction in the majority of cases support the notion of criterion validity. A high score on the effort-reward ratio was associated with an elevated odds ratio (OR = 2.71; 95% CI 1.86–3.95) of musculoskeletal complaints in the upper arm. Conclusions. The short form of the Italian ERI questionnaire provides a psychometrically useful tool for routine occupational health surveillance, although further validation is recommended.

BACKGROUND: A challenge in tuberculosis (TB) research is to develop a new immunological test that can help distinguish, among subjects responsive to QuantiFERON TB Gold In tube (QFT-IT), those who are able to control Mtb replication (remote LTBI, recent infection and past TB) from those who cannot (active TB disease). IFN-γ response to the Heparin-binding-hemagglutinin (HBHA) of Mtb has been associated with LTBI, but the cumbersome procedures of purifying the methylated and immunological active form of the protein from Mtb or M. bovis Bacillus Calmette et Guerin (BCG) have prevented its implementation in a diagnostic test. Therefore, the aim of the present study was to evaluate the IFN-γ response to methylated HBHA of Mtb produced in M. smegmatis (rHBHAms) in individuals at different stages of TB who scored positive to QFT-IT. METHODOLOGY/PRINCIPAL FINDINGS: 87 individuals at different stages of TB who scored positive to QFT-IT were selected. IFN-γ response to in vitro whole blood stimulation with rHBHAms was evaluated by short-term and long-term tests and detected by ELISA or flow cytometry. We demonstrated that the IFN-γ response to rHBHAms is mediated by CD4(+) T-cells with an effector-memory phenotype. This response, evaluated by short-term-tests, is significantly lower in active TB than in remote LTBI (p = 0.0010) and past TB (p = 0.0152). These results were confirmed by long-term tests. The qualitative data confirmed that IFN-γ responses higher than the cut-off point identified by ROC analysis are associated with the status of non-active disease. CONCLUSIONS: In this study we show that the T-cell response to a recombinant and methylated HBHA of Mtb produced in M. smegmatis is useful to discriminate between active and non-active TB disease among those responsive to QFT-IT in a whole blood system. Further studies are needed to improve the accuracy of the assay.