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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 ( I 2 = 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., (Copyright © 2019 Magnavita, Di Stasio, Capitanelli, Lops, Chirico and Garbarino.)

This study aimed to find out which countries around the world require psychosocial hazards and workplace violence to be assessed by employers through a mandatory occupational risk assessment process and to compare the type of legislation between countries. We systematically searched the International Labour Office (ILO) "LEGOSH" database for documents published during the period between December 2017 and February 2018. The search included 132 countries, of which 23 were considered as developed and 109 as developing according to the United Nations. Our review showed that most countries (85, i.e., 64%) have not included mandatory psychosocial risk assessment and prevention in their national occupational safety and health legislation. Moreover, we found differences between developed and developing countries, showing that developed countries more frequently have legislative measures. Within developed countries, we also found differences between countries following the Scandinavian model of workplace health and safety culture and other countries. Moreover, in many countries, workplace violence was prohibited only if it involves an offence to moral or religious customs. In conclusion, the marked difference in psychosocial hazards and workplace violence regulations among countries leads to unequal levels of workers' protection, with adverse effects on global health.

Summary: Monoclonal gammopathy of uncertain significance (MGUS) identifies a clinically asymptomatic and laboratory-based situation characterized by a modest monoclonal component (MC). In a limited percentage of cases, on a probabilistic basis, the asymptomatic genepremalignant stage could lead to multiple myeloma (MM). Materials and Methods. Based on literature data and available Guidelines on the subject, the diagnostic criteria and a methodological path are here suggested to the Occupational Physician to formulate a judgment of suitability for the task with exposure risk to RI or pesticides. Results. Some studies have evaluated the prevalence of MGUS in subjects exposed professionally to pesticides. Numerous other studies conducted on the survivors of the atomic bombing of Hiroshima and Nagasaki have highlighted a possible association with exposure to ionizing radiation (IR). The guidelines relating to the diagnosis and management of MGUS cases (with respect to the potential evolution in MM allow) to draw important operational indications for the competent/authorized physician. Conclusions. The routinely use of laboratory tests for subjects exposed to the studied risk factors is generally indicated starting from the worker's 50 years of age. The finding of a MGUS in the absence of further laboratory alterations represents the situation most frequently and does not require further measures, other than those of foreseeing even blood controls at least every two years. In this situation, there are no justified restrictions on work activities with exposure risks to IR or pesticides. If alterations suggestive for an increased risk of evolution in a neoplastic way could be identified, a close periodicity - every 3-6 months - of haematological checks is recommended. In these cases, it appears justified an abstention from activities involving exposure to ionizing radiation for a period of time that will be evaluated based on the evolution of the framework and by the progress of laboratory tests in the monitored period., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by Aracne Editrice, Roma, Italy.)

Summary: Introduction. Burnout syndrome (BOS) can be defined as a chronic work strain characterized by three dimensions: emotional exhaustion, depersonalization (or cynicism), reduced professional effectiveness. BOS typically strikes the helping professions like the teachers. Objective. The aims of this study are: 1) clarify the concept of BOS, as currently configured in the international scientific literature; 2) analyze the psychosocial risk factors in teachers; 3) develop a methodology for the assessment and prevention of the risk of BOS in the teachers. Methods. The literature review followed some of the PRISMA guidelines criteria. Results and discussion. The results of the study highlight BOS as a risk factor specific and distinct from labor-related stress. A strategy called VA.RI.B.O is proposed (Burn-Out Recognition) for teachers., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by Aracne Editrice, Roma, Italy.)

Competing Interests: There are no conflicts of interest.

In their review, Kownacki et al. showed some practical and easy to use workplace heat indices that are useful for indoor environments, namely the "Wet Bulb Globe Temperature" (WBGT), the "Predicted Heat Strain" (PHS) model, the "Thermal Work Limit" (TWL), the "Equivalent Temperature" (ET) and the thermal comfort index "PMV/PPD". In this letter, the authors explain why the modified PMV/PPD method together with the indices combining temperature with humidity, such as the "Humidex Index" and the "Heat Index", could be a more feasible and useful tool for evaluating potential thermal stress in indoor environments for both the occupational and general population., Competing Interests: The authors declare no conflict of interest.

Background: A major concern regarding permanent lip fillers is difficulty with revision should this be required. Currently, the only way to treat lip sequelae is by surgical remodeling., Objectives: Based on the senior author's 6-year experience, the authors collectively suggest a surgical method to correct lip deformity in such situations., Methods: The records of 38 patients with lip deformity who underwent surgery between 2011 and 2017 after receiving permanent filler injections were analyzed retrospectively. A total of 38 consecutive patients (69 lips) with an average age of 38.8 years (range, 28-52 years) were treated surgically., Results: All patients experienced postoperative swelling (average duration, 15 days), and no infections were recorded. In 3 cases, a 1-cm dehiscence was documented, which healed by secondary intention. In 1 case, a hematoma noted several days after surgery resolved spontaneously within 3 weeks. In 2 upper lips, a minor touchup procedure (with the patient under local anesthesia) was performed 9 months after the initial surgery. Overall, patients noted that it took at least 6 to 9 months to achieve natural lip movement. The average time until softening of the lip tissue was 4 months., Conclusions: This study emphasizes the importance of informing patients that complete removal of permanent filler is not always possible. However, most of the authors' patients were pleased with the results. This study also highlights the importance of paying strict attention when approaching the area adjacent to the oral commissures in order to avoid potential reductions in mouth opening that can occur from postoperative scarring., (© 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.)

In order to address the heat stress hazard, the worker health surveillance makes a difference by providing information about individual factor, feedback, and evidence about efficacy of preventive measures and activities carried out through the risk assessment process, at individual and group levels. Every technical, procedural, or organizational measures could be ineffective without taking into account the results provided by health surveillance.

In these days, the West Nile virus (WNV), which is the most widespread arthropod-borne virus infection in the world, is an emerging issue in Europe, wherein 2018, partial figures (until 25 October) showed a number of WNV infection cases more than doupled in comparison with previous five years. This mosquito-transmitted disease is surely a challenge for policymakers, but it is an occupational hazard for outdoor workers, as well. Occupational medicine is a public health discipline based on the principles of epidemiology. Therefore, we argue that addressing the WNV hazard may be an opportunity for integrating the occupational health practice with public health activities to boost their respective preventive strategies.

Competing Interests: There are no conflicts of interest.

The oral tongue is the most common site for tumours within the oral cavity. Despite intense research, there has been no improvement in the survival rate for patients with oral tongue squamous cell carcinoma (OTSCC) during the last decades. Differences between oral cancer patients based on ethno-geographical distribution have been reported. The present study used immunohistochemistry to evaluate commonly used markers of cancer cell phenotypes, E-cadherin, β-catenin and cytokeratins 5 and 19, in 120 patients with OTSCC. To evaluate the impact of ethnicity, patients from Sweden and Italy were included. A higher proportion of Swedish patients exhibited high expression of E-cadherin in their tumours (P=0.039), and high levels of E-cadherin in Swedish OTSCC patients that had succumbed to their disease were associated with poor prognosis. These data demonstrated differences in the pathological characteristics of OTSCC between two different European populations. The findings emphasise the need to take ethnicity/geographical location of patients into account when comparing results from different studies of OTSCC.

Objectives: Aim of our study was to adapt the Claustrophobia Questionnaire (CLQ) to the Italian context., Methods: In our study, a sample of 50 claustrophobic patients was compared to 50 healthy people (control group). All of them answered the Claustrophobia Questionnaire and the Stait-Trait Anxiety Inventory Form Y1 and Y2, as well as demographic questions., Results: As it was theoretically expected, our results confirmed the two-factor structure and showed that the Italian version of the CLQ has good psychometric properties. Indeed, it was observed that claustrophobic patients scored higher in claustrophobia than those from the control group., Conclusions: In conclusion, the Italian version of the CLQ is a reliable and valid instrument to assess claustrophobic fear., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by Aracne Editrice, Roma, Italy.)

In Italy, the Parliament granted recently the final approval to a law introducing a long list of childhood vaccinations mandatory for preschool and school-age children. Before the approval, a vibrant public debate took place on the traditional media, in the social networks and among policymakers because of the so called "anti-vaccination movement". In this paper, we discuss about ethical aspects and relationship between individual rights and public health. The role of social networks and the Internet is also essential to disseminate correct informations, influencing health behaviours and contributing to educating people about this major public health issue in a right way. Finally, new and specific educational programmes are needed in order to transmit the young generation the means to correctly understand scientific research about this controversial issue.

Objectives: Little can be found in the literature about thermal comfort and indoor air quality (IAQ) in law enforcement workplaces. This study, based on environmental surveys carried out by the Centro Sanitario Polifunzionale of Milan (Italian State Police Health Service Department), aims to assess the thermal comfort and IAQ in some of the Italian State Police workplaces., Methods: Measurements were performed in some indoor workplaces such as offices, archives, laboratories and guard-houses in various regions (Lombardia, Emilia Romagna, Liguria, Veneto, Trentino Alto-Adige) of Northern Italy. The PMV/PPD model developed by Fangar for the evaluation of the thermal comfort was used. We measured both CO2 concentration and relative humidity indoor levels for the evaluation of IAQ. We used Chi square and t Student tests to study both prevalence of thermal discomfort and low IAQ, and their differences between summer and winter., Results: For the purposes of the present study we carried out 488 measurements in 36 buildings (260 in winter and 228 in summer). Our results showed that thermal comfort was reached in 95% and 68% of environmental measurements (in winter and summer, respectively). In summer, we measured different types of thermal discomfort. As regard to IAQ, CO2 exceeded the threshold limit value (1000 ppm) in 39% (winter) and 9% (summer) of our measurements. Chi-square test showed a statistically significant difference between summer and winter for all outcomes considered. Indeed, thermal comfort was better in winter than summer (X2 = 61.0795), while IAQ was found to be better in the summer than winter considering both the CO2 1000 ppm and 1200 ppm threshold values (X2 = 56.9004 and X2 = 8.8845 respectively). Prevalence of low relative humidity in winter was higher than in summer (X2 = 124.7764)., Conclusions: Even though this study did not report any situation of risk to Italian police officers health and safety, it has highlighted some potential issues in some of the examined workplaces, concerning thermal comfort in summer and IAQ in winter. Regarding the risk assessment process, simple and inexpensive preventive measures are already feasible in the 'observation phase' of the risk assessment, before execution of instrumental environmental survey. According to the technical standards and risk assessment models, this way might increase both comfort levels for workers employed in indoor environments and the effectiveness of the risk assessment process, through the optimization of available resources., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by Aracne Editrice, Roma, Italy.)

In Europe, employers of all private and public enterprises have a legal obligation to protect their employers by all the different types of workplace hazards to the safety and health of workers. The most important methods developed for the work-related stress risk assessment are based on the Cox's research commissioned by European Agency for Safety and Health at Work (EU-OSHA) and are the Management Standard HSE for work-related stress in United Kingdom, the START method in Germany, the Screening, Observation, Analysis, Expertise (SOBANE) in Belgium, and the National Institute for Prevention and Safety at Work (INAIL-ISPESL) model in Italy, the latter based on the British Management Standard. Unfortunately, the definition of "work-related stress" elaborated by EU-OSHA was criticized, because it is not completely equal to the broader "psychosocial risk," which includes new and emerging psychosocial risk factors, such as the combined exposure to physical and psychosocial risks, job insecurity, work intensification and high demands at work, high emotional load related to burnout, work-life balance problems, and violence and harassment at work. All these new emerging psychosocial hazards could require different and additional methodologies to save workers' health and safety. For this reason, the concept that stakeholders and policy makers should keep in mind in order to develop better national regulations and strategies is that work-related stress risk and psychosocial risk factors are not the same.

Since Herbert Freudenberger described Burnout Syndrome (BOS) in 1974, thousands of scientific papers have been published on this syndrome and this trend does not seem to diminish. After being internationally known as a syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment in helping professions, its construct has been criticized, questioned, and subjected to profound modifications. To date, however, in Italy and in many other Countries it is not possible to diagnose this syndrome, because World Health Organization, in its last ICD-10, did not indicate any clinical criteria to diagnose it. Unfortunately, not even in the recent DSM- 5 by American Psychiatric Association, contrary to what was expected, BOS found room as a specific psychiatric disorder. As a consequence, framing this syndrome from a medical-legal point of view is still widely debated from scholars.

There is compelling evidence that teachers and clergy are stressful occupations. This study aimed to compare the rate of job strain and burnout among lay and consecrated teachers and to study the effect of religious coping on the mental health of these two groups. A cross-sectional survey study was carried out in Catholic kindergarten, preschool and primary schools of an Italian Congregation of nuns, in South Italy. The Italian versions of the Maslach Burnout Inventory-Educator Survey (MBI-ES) scale, of the General Health Questionnaire (GHQ-12) and a study-specific questionnaire with sociodemographic variables and indicators of subjective (self-reported religiosity) and objective (prayer personal and church attendance) religiousness were used. Data were analyzed according to the guidelines for data processing and an analysis of the scales used. The participation rate of this study was 88 %. There was a significant difference between two groups in religiousness and job strain/burnout scores (lay teachers were the most affected group). Moreover, religiousness scores had a positive correlation with personal accomplishment, job satisfaction and perceived performance and a negative correlation with emotional exhaustion, turnover intention and morbidity psychiatric. Therefore, according to religious coping's research, prayer personal and church attendance can be recommended as two of the ways to prevent job strain and burnout in the teacher work.

Purpose: To develop and validate a tool aiming to support ophthalmologists in identifying, during routine ophthalmologic visits, patients at higher risk of falling in the following year., Methods: A group of 141 subjects (age: 73.2 ± 11.4 years), recruited at our Eye Clinic, underwent a baseline ophthalmic examination and a standardized questionnaire, including lifestyles, general health, social engagement and eyesight problems. Moreover, visual disability was assessed by the Activity of Daily Vision Scale (ADVS). The subjects were followed up for 12 months in order to record prospective falls. A subject who reported at least one fall within one year from the baseline assessment was considered as faller, otherwise as non-faller. Different tree-based algorithms (i.e., C4.5, AdaBoost and Random Forests) were used to develop automatic classifiers and their performances were evaluated by the cross-validation approach., Results: Over the follow-up, 25 falls were referred by 13 patients. The logistic regression analysis showed the following variables as significant predictors of prospective falls: pseudophakia and use of prescribed eyeglasses as protective factors, recent worsening of visual acuity as risk factor. Random Forest ranked best corrected visual acuity, number of sleeping hours and job type as the most important features. Finally, AdaBoost enabled the identification of subjects at higher risk of falling in the following 12 months with a sensitivity rate of 69.2% and a specificity rate of 76.6%., Conclusions: The current study proposes a novel method, based on classification trees applied to self-reported factors and health information assessed by a standardized questionnaire during ophthalmological visits, to identify ophthalmic patients at higher risk of falling in the following 12 months. The findings of the current study pave the way to the validation of the proposed novel tool for fall risk screening on a larger cohort of patients with visual impairment referred to eye clinics.

Aims: Glucagon like peptide 1 (GLP-1) analogues and dipeptidyl peptidase IV (DPP-4) inhibitors reduce atherosclerosis progression in type 2 diabetes mellitus (T2DM) patients and are associated with morphological and compositional characteristics of stable plaque phenotype. GLP-1 promotes the secretion of adiponectin which exerts anti-inflammatory effects through the adaptor protein PH domain and leucine zipper containing 1 (APPL1). The potential role of APPL1 expression in the evolution of atherosclerotic plaque in TDM2 patients has not previously evaluated., Methods: The effect of incretin therapy in the regulation of adiponectin/APPL1 signaling was evaluated both on carotid plaques of asymptomatic diabetic (n=71) and non-diabetic patients (n=52), and through in vitro experiments on endothelial cell (EC)., Results: Atherosclerotic plaques of T2DM patients showed lower adiponectin and APPL1 levels compared with non-diabetic patients, along with higher oxidative stress, tumor necrosis factor-α (TNF-α), vimentin, and matrix metalloproteinase-9 (MMP-9) levels. Among T2DM subjects, current incretin-users presented higher APPL1 and adiponectin content compared with never incretin-users. Similarly, in vitro observations on endothelial cells co-treated with high-glucose (25mM) and GLP-1 (100nM) showed a greater APPL1 protein expression compared with high-glucose treatment alone., Conclusions: Our findings suggest a potential role of adiponectin/APPL1 signaling in mediating the effect of incretin in the prevention of atherosclerosis progression or plaque vulnerability in T2DM., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

In Europe, the Council Directive 89/391 for improvement of workers' safety and health has emphasized the importance of addressing all occupational risk factors, and hence also psychosocial and organizational risk factors. Nevertheless, the construct of "work-related stress" elaborated from EU-OSHA is not totally corresponding with the "psychosocial" risk, that is a broader category of risk, comprising various and different psychosocial risk factors. The term "burnout", without any binding definition, tries to integrate symptoms as well as cause of the burnout process. In Europe, the most important methods developed for the work related stress risk assessment are based on the Cox's transactional model of job stress. Nevertheless, there are more specific models for predicting burnout syndrome. This literature review provides an overview of job burnout, highlighting the most important models of job burnout, such as the Job Strain, the Effort/Reward Imbalance and the Job Demands-Resources models. The difference between these models and the Cox's model of job stress is explored.

This paper examines the problem of assessing thermal conditions in moderate working environments. We reviewed all the laws and technical standards on the focus to propose a method of evaluation by steps including a subjective assessment and technical measurements.

Carboxyfullerenes (CF) act as free radical scavengers in many cell settings and prevent apoptosis in vitro and in vivo. CF protect normal human keratinocytes from UVB-induced apoptosis, although the mechanisms underlying this effect remain to be clarified. Double-staining confocal laser microscopy revealed that CF penetrate the cell and colocalize with cytokeratin-18 within cytoplasm. This localization was confirmed by transmission electron microscopy that showed CF intermingled with keratin filaments. Moreover, double-staining with the mitochondrial marker anti-F1-ATPase antibody demonstrated that CF are expressed in mitochondria. Transmission electron microscopy confirmed that CF actually localize within mitochondria. Then, normal human keratinocytes were UVB-irradiated in the presence or absence of CF at different doses. CF protected keratinocytes from apoptosis induced by reactive oxygen species. CF scavenging effect is associated with a partial blockade of the UVB-induced intrinsic apoptotic pathway by down-modulating caspase-9 activation and cytochrome c release, and by inhibiting the down-regulation of the inhibitor of apoptosis proteins (IAP) survivin, livin, IAP-1 and IAP-2. Finally, CF prevented the cleavage of Bid, up-regulation of Bad and down-regulation of Mcl-1 induced by UVB. Taken together, these results indicate that CF penetrate human keratinocytes, localize within mitochondria where they act both by scavenging free radicals and by protecting cells from apoptosis.