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

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

Despite the advent of modern technologies, biological risks still cause concern in workplaces. Healthcare workers (HCWs) are exposed to a wide range of occupational risks including biological and psychosocial ones. During the COVID-19 pandemic, HCWs experienced unprecedented levels of distress, especially due to the risk of SARS-CoV-2 contagion and the fear of spreading the virus in the work and social community. This emotional overload led to an increase in mental health disorders (e.g., anxiety, depression, and burnout) that can hinder patients' safety and the quality of care. After outlining the international safety regulation on biological risks, we discussed the interplay between biohazard and psychosocial risk, focusing on how to prevent occupational infections in healthcare using comprehensive action strategies that aim to ensure a healthy work environment to improve, protect, and promote the health and safety of all workers. Occupational infections, particularly those caused by emerging agents and/or responsible for epidemics, still cause concern in health care workers globally and require prompt action to implement health and safety programs.

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

Introduction: Workplace violence (WV) against healthcare workers (HCWs) is a widespread phenomenon, which contributes to increasing occupational stress. The COVID-19 pandemic has exposed the world's population to intense stress. It is therefore questionable whether there is a correlation between the two phenomena, violence and COVID-19. This systematic review aimed to investigate the prevalence and risk factors of WV against HCWs during the COVID-19 pandemic. Methods: A systematic review was conducted across PubMed Central/Medline, Cochrane Library, PROSPERO and Epistemonikos databases using predefined search criteria. Only studies containing quantitative and mixed-method research from the inception of the pandemic to 22 February 2022 and published in English language were included. Results: Overall, 61 articles were retrieved, and a total of 15 studies met the full inclusion criteria and were included. Most of the studies reported both physical and psychological (verbal and non-verbal) WV, which was perpetrated by personal (family members, friends, neighbors) and/or professional relationships (bosses, co-workers, patients’ relatives, strangers). The overall prevalence of WV ranged from 18.5% to 84.5%. In many cases, victims of WV during the COVID-19 pandemic included frontline HCWs and staff working in emergency departments. Discussion: Our findings showed a high prevalence of WV against HCWs during the COVID-19 pandemic. Males, young people, those with less working experience, and those working in direct contact with patients infected by the virus were the most relevant risk factors for WV, that was mostly perpetrated by caregivers and COVID-19 patients’ family members. Occupational health services, hospital management and policymakers should cooperate to address these psychosocial risk factors to protect the mental health of HCWs during the COVID-19 pandemic. Take-home message: This systematic review showed a high prevalence of workplace violence against healthca

OH plays a new and insightful role in helping society achieve higher levels of health. In this regard, WHP programs offer an invaluable and inclusive chance to support workers and a cost-saving prospect for employers.

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

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.

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

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

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

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

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

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

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.

Breakthrough SARS-CoV-2 infections in fully vaccinated individuals are considered a consequence of waning immunity. Serum antibodies represent the most measurable outcome of vaccine-induced B cell memory. When antibodies decline, memory B cells are expected to persist and perform their function, preventing clinical disease. We investigated whether BNT162b2 mRNA vaccine induces durable and functional B cell memory in vivo against SARS-CoV-2 3, 6, and 9 months after the second dose in a cohort of health care workers (HCWs). While we observed physiological decline of SARS-CoV-2-specific antibodies, memory B cells persist and increase until 9 months after immunization. HCWs with breakthrough infections had no signs of waning immunity. In 3–4 days, memory B cells responded to SARS-CoV-2 infection by producing high levels of specific antibodies in the serum and anti-Spike IgA in the saliva. Antibodies to the viral nucleoprotein were produced with the slow kinetics typical of the response to a novel antigen.

Although counts of occupational neurological disorder compose only a small part of the overall occupational disorders, it has a significant impact on the occupational safety and health system. With this Research Topic, we have promoted an increased attention and interest in strengthening the existing ties and dialogue between neuroscience and occupational health from prevention, to diagnosis and management up labor reintegration strategies of workers. Workplace participation of individuals with disabilities continues to be a challenge. From a broader perspective, this improvement might help to reduce the percentage of work leave due to disease, reduce workplace accidents, and improve the mental health of workers

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.

Introduction: Burnout syndrome (BOS) is a psychological syndrome characterized by emotional exhaustion, depersonalization, and low personal accomplishment. This umbrella review aimed to investigate BOS among healthcare workers (HCWs). Methods: An umbrella review of systematic reviews and meta-analyses concerning the prevalence of BOS among physicians, nurses, medical students and other HCWs, and its associated factors was conducted across PubMed Central/Medline, Cochrane Library, PROSPERO and Epistemonikos databases. Only systematic reviews and meta-analyses from inception to 15 January 2020 and restricted to English language documents were included. Results: A total of 43 studies met the full inclusion criteria and were included. Among them, there were 3 meta-analyses, 26 systematic reviews, and 14 systematic reviews with meta-analysis. The prevalence of BOS was highest among nurses, younger persons, and trainees. The most frequent risk factors associated with BOS included stress, lack of family support, and organizational risk factors such as prolonged night shifts, length of experience, and exposure to traumatic events. Individual coping strategies such as exercise and communication with peers, and organizational strategies such as periodic review of shift schedule should be undertaken. Discussion: BOS has profound effects on the mental health states of HCWs. Individuals and the hospital authority need to pay specific attention to work-related stress risk factors to improve the psychological well-being of HCWs.

Introduction: Since the beginning of COVID-19 pandemic, healthcare workers (HCWs) have undoubtedly experienced overwhelming levels of strain associated with social and occupational stressors. This study aimed to investigate the potential psychological effects experienced by hospital workers and HCWs and their associated demographical and occupational characteristics during the COVID-19 pandemic. Methods: A cross-sectional study was carried out in a public hospital in Rome, Italy, from June 2020 to July 2021. 635 hospital workers (HCWs, administrative and technicians) were enrolled in the study. The “Psychological Injury Risk Indicator” questionnaire was used. Statistical analyses have been made using Student’s T test for categorical binomial variables and analysis of variance for multi-categorical variables. Logistic regression analysis was then performed. Results: 30.6% of the sample was at risk for general psychological impairment; reduced energy recovery was found in 48.0% and sleep problems in 44.7% of them. Female workers reported a two-fold risk for potential psychological impairment compared to male colleagues. Nurses presented a three-fold risk while physicians a two-fold risk for the overall score. Additionally, physicians had a four-fold risk to develop a lack of energy recovery and a three-fold risk for chronic fatigue. Technicians showed a significant double risk for sleep problems and chronic fatigue as well as a three-fold risk for reduced energy recovery. Administrative personnel reported a tendency on sleep problems. Interestingly, agile working was a two-fold protecting factor. No-night shifters have a half risk for reporting problems in energy recovery. Discussion and Conclusion: The measure of agile working is effective to mitigate the impacts of COVID-19 on mental health by protecting and promoting the psychological wellbeing of HCWs during and after the outbreak.

Ionizing radiation (IR) is a ubiquitous environmental agent whose effects on organisms are well known. This review pro-vides a summary about definitions and man-made low-dose ionizing radiation (LDIR) sources and dosimeters used in radiation protection. Moreover, the main purpose of this article was to overview the pro-oncogenic effects of LDIR, and to provide experimental evidence that reinforce the use of gene expression data as biomarkers of LDIR effects. Our review showed that basic studies on biological response to LDIR are considered priority. Further, understanding occupational exposure to LDIR may provide valuable information to organize the prevention and prevent from the onset of long-term health effects in radiation workers. Currently, the biodosimetry-based assessment in certain high-risk occupational groups may be performed by using peripheral blood cells as samples for testing and validation of biomarkers specificity and sensi-tivity. Most of the studies on this topic are aimed at establishing new biomarkers and approaches to biological dosimetry, for allowing non-invasive monitoring of long-term health effects of LDIR. Analysis on changes in gene-expression, which is an early specific biological response to LDIR, could provide rapid estimates of individual dose in occupational cohorts, improving the management of periodical medical examination in subjects exposed to LDIR sources.

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

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.

Modern societies are experiencing an increasing trend of reduced sleep duration, with nocturnal sleeping time below the recommended ranges for health. Epidemiological and laboratory studies have demonstrated detrimental effects of sleep deprivation on health. Sleep exerts an immune-supportive function, promoting host defense against infection and inflammatory insults. Sleep deprivation has been associated with alterations of innate and adaptive immune parameters, leading to a chronic inflammatory state and an increased risk for infectious/inflammatory pathologies, including cardiometabolic, neoplastic, autoimmune and neurodegenerative diseases. Here, we review recent advancements on the immune responses to sleep deprivation as evidenced by experimental and epidemiological studies, the pathophysiology, and the role for the sleep deprivation-induced immune changes in increasing the risk for chronic diseases. Gaps in knowledge and methodological pitfalls still remain. Further understanding of the causal relationship between sleep deprivation and immune deregulation would help to identify individuals at risk for disease and to prevent adverse health outcomes.

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

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.

The COVID-19 pandemic has severely tested the mental health of frontline health care workers. A repeated cross-sectional study can provide information on how their mental health evolved during the various phases of the pandemic. The intensivists of a COVID-19 hub hospital in Rome were investigated with a baseline survey during the first wave of the pandemic in April 2020, and they were contacted again in December 2020, during the second wave. Of the 205 eligible workers, 152 responded to an online questionnaire designed to measure procedural justice, occupational stress (effort/reward imbalance), sleep quality, anxiety, depression, burnout, job satisfaction, happiness, and turnover intention. Workers reported a further increase in workload and compassion fatigue, which had already risen during the first wave, and a marked reduction in the time devoted to meditation and mental activities. A low level of confidence in the adequacy of safety procedures and the need to work in isolation, together with an increased workload and lack of time for meditation, were the most significant predictors of occupational stress in a stepwise linear regression model. Occupational stress was, in turn, a significant predictor of insomnia, anxiety, low job satisfaction, burnout, and intention to leave the hospital. The number of workers manifesting symptoms of depression increased significantly to exceed 60%. Action to prevent occupational risks and enhance individual resilience cannot be postponed.

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.

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

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.

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.

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

Michele Usuelli1 raised two questions to the international scientific community. First, whether there were errors in the management of the COVID-19 health emergency in Lombardy, Italy. Second, whether having 20 regional health services across Italy is useful in controlling a pandemic. The answer to the first question will be useful to medical science and the civil conscience (by improving the decision making process) in Italy. Unfortunately, the process of a commission of inquiry is much slower than that of a pandemic, and therefore it is unlikely that the evidence gained will be useful during this pandemic. The answer to the second question is self-evident. Unfortunately, a strong political movement is pressing to accentuate the transfer of fiscal resources from the national level to the regions where income is produced. If the tax income remained in the region that produced it, then there would be no national budget. This transfer would increase health inequity, with an unfair burden of this pandemic on people who are disadvantaged2 and an inevitable negative effect on the health of the population.3 In the meantime, emergency conditions have changed the traditional way that doctors operate. Intensivists who treat patients with COVID-19 have high levels of compassion fatigue and occupational stress; they do not have daily contact with the patients’ relatives anymore and can inform families only at the end of therapy if the treatment has not been successful.4 The scarcity of interaction with relatives could increase misunderstandings and the risk of malpractice litigation, which is already high in Italy.5 We reasonably expect that the pandemic, in addition to many grievances, will leave many claims for compensation

we believe it is more prudent that in case of emergency, both lay and medical rescuers use respirators without EV, except when hospital HCWs assist patients with highly suspected or confirmed COVID-19 infection. Educational efforts, implementing fit testing and seal checking of masks, organizational measures as well as using appropriate PPEs are needed to offer safe emergency interventions to rescuer and casualty for this and other airborne-transmitted diseases.

We should discourage dishonest publications so that published scientific literature can be relied upon. The research outcome should not be the only criterion of a clinician’s dedication to his field

Pregnancy is an important as well as delicate stage in the life of female workers and should be protected not only as an individual condition but also as an indispensable value for a modern and fair society, in a balance between the right to work and the protection of the integrity and safety of both the mother and the foetus.

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

An editorial on the role of health surveillance in the workplace during the SARS/CoV-2 pandemic

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.

Introduction: Many occupational factors disturb sleep. This can have significant consequences because sleep 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 Obstructive 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 demonstrated 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.

The progressive ageing of the working population and the increase in related chronic diseases tend to affect working capacity. The aim of this study was to evaluate a Workplace Disability Management Program (WDMP) within a pediatric hospital. Absenteeism due to healthcare workers’ (HCWs) pre-and post-WDMP and the related costs were used for the program evaluation. The Return on Investment (ROI), the Break-Even Analysis (BEA) and the value of the average annual productivity of HCWs who took advantage of the Disability Management (DM) interventions to assess the economic impact of the program, were also used. The HCWs enrolled in the program were 131 (approximately 4% of hospital staff), of which 89.7% females and with an average age of 50.4 years (SD ± 8.99). Sick leave days of the HCWs involved decreased by 66.6% in the year following the end of WDMP compared to the previous one (p < 0.001). The total estimated cost reduction of absenteeism is 427,896 € over a year. ROI was equal to 27.66 €. BEA indicated that the break-even point was reached by implementing the program on 3.27 HCWs. The program evaluation demonstrated the particular effectiveness of the implemented WDMP model, acting positively on the variables that affect productivity and the limitation to work.

Healthcare workers employed in the COVID19 emergency are at high risk of stress, burnout and post-traumatic stress disorders. The most important occupational risk factors that employers should address include insufficient staff training and resources available, and lack of training and treatment protocols. In Italy, recent guidelines were released for providing all healthcare workers who are employed in this emergency with psychological support services based on coping strategies for managing stress. We suggest that preventive measures and a psychological intervention plan should be framed within the mandatory occupational health surveillance programme, and carried out by occupational physicians in cooperation with mental healthcare providers in the workplace.

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.

In workplaces, where no pollution problems are reported, a significant share of indoor workers (6% of males, 9% of females) suffer “often, at least once a week” from headaches attributed to the working environment.2 This symptom is significantly associated with occupational stress.3 The individual characteristics of workers, in particular anxiety and depression, significantly influence the reporting of headache.4 Among health care workers, headache is associated with occupational stress5 and with sleep problems,6 as well as with anxiety and depression that were significantly increased during the COVID-19 pandemics.7 This study did not take into account these variables. This may be a major limitation because the study population was drawn from high-risk hospital areas such as isolation wards (designated as “pandemic wards”), the emergency rooms and medical intensive care unit. In these settings, workers are highly likely to experience emotional overload. The association between Personal Protective Equipment (PPE) and headache could be, therefore, spurious and the real factor should be sought among the psychosocial factors associated with the pandemic. Furthermore, the study is entirely based on what workers remember of the situation before the epidemic, and this inevitably exposes to a possible recall bias. We are convinced that the association between PPE and headache is worthy of controlled longitudinal studies, which compare different types of PPE and take into account all confounding factors.

Postural orthostatic tachycardia syndrome (POTS) negatively impacts quality of life. The excessive increase in cardiac sympathetic modulation during standing, which characterizes POTS patients, leads to many symptoms and signs of orthostatic intolerance. Little is known about the consequences of the disease on work performance and its relationship with individual autonomic profiles. Twenty-two POTS patients regularly engaged in working activity (20 females, age 36 ± 12 years) and 18 gender-and age-matched controls underwent a clinical evaluation and filled out the Work Ability Index (WAI) questionnaire. POTS patients completed the Composite Autonomic Symptom Score (COMPASS31) questionnaire, underwent continuous electrocardiogram, blood pressure and respiratory activity recordings while supine and during a 75° head-up tilt (HUT). A power spectrum analysis provided the index of cardiac sympatho-vagal balance (LF/HF). WAI scores were significantly reduced in POTS patients (29.84 ± 1.40) compared to controls (45.63 ± 0.53, p < 0.01). A significant inverse correlation was found between individual WAI and COMPASS31 scores (r = −0.46; p = 0.03), HUT increase in heart rate (r = −0.57; p = 0.01) and LF/HF (r = −0.55; p = 0.01). In POTS patients, the WAI scores were inversely correlated to the intensity of autonomic symptoms and to the excessive cardiac sympathetic activation induced by the gravitational stimulus.

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.

Methods of estimating case fatality ratio

The airborne transmission of SARS-CoV-2 is still debated. The aim of this rapid review is to evaluate the COVID-19 risk associated with the presence of air-conditioning systems. Original studies (both observational and experimental researches) written in English and with no limit on time, on the airborne transmission of SARS-CoV, MERS-CoV, and SARS-CoV-2 coronaviruses that were associated with outbreaks, were included. Searches were made on PubMed/MEDLINE, PubMed Central (PMC), Google Scholar databases, and medRxiv. A snowball strategy was adopted to extend the search. Fourteen studies reporting outbreaks of coronavirus infection associated with the air-conditioning systems were included. All studies were carried out in the Far East. In six out the seven studies on SARS, the role of Heating, Ventilation, and Air Conditioning (HVAC) in the outbreak was indirectly proven by the spatial and temporal pattern of cases, or by airflow-dynamics models. In one report on MERS, the contamination of HVAC by viral particles was demonstrated. In four out of the six studies on SARS-CoV-2, the diffusion of viral particles through HVAC was suspected or supported by computer simulation. In conclusion, there is sufficient evidence of the airborne transmission of coronaviruses in previous Asian outbreaks, and this has been taken into account in the guidelines released by organizations and international agencies for controlling the spread of SARS-CoV-2 in indoor environments. However, the technological differences in HVAC systems prevent the generalization of the results on a worldwide basis. The few COVID-19 investigations available do not provide sufficient evidence that the SARS-CoV-2 virus can be transmitted by HVAC systems.

Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements. Design: Instrument development and cross-sectional study for psychometric testing. Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018–January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed. Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50–1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of “personal exposure” (4.06, SD 3.78) were reported by third-year students. Higher scores for “perceived benefits” of preventive behaviours (13.6, SD 1.46) were reported by second-year students.

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