The European Directive 2020/2184 concerning the quality of water for human consumption now includes Legionella among the pathogens for assessment in domestic water systems. It states that "for risk-based verification and to complement spread-plate culture methods, rapid culture methods, non-culture-based methods, and molecular-based methods may be used." In this study, 33 laboratories across Italy analyzed a number of unique water samples ranging from 10 to 30 for the presence of Legionella pneumophila. All laboratories used the standard spread-plate culture method, 31 laboratories also performed the Legiolert rapid liquid culture method (IDEXX Laboratories), and 27 out of 33 performed the DI-Check Legionella pneumophila real-time PCR method (Diatheva). In all, 23 laboratories executed all three methods. Data generated from 817 samples were collected and statistically analyzed. The Legiolert method allowed analysis with a smaller sample volume (100 mL and 10 mL), compared to the standard culture method with which it was shown to be comparable with K agreement values of 0.785 and 0.840 in the two mentioned volumes, respectively. The standard real-time PCR method was more sensitive (93%) than the spread-plate culture method. Sensitivity values of 95.2% and 98.8% were also obtained by comparing two new real-time PCR procedures with the spread-plate culture method, tested to shorten the analysis, and the standard culture method. Finally, data obtained from the analysis of drinking water samples with the spread-plate culture method using both Buffered charcoal yeast extract and non-selective glycine vancomycin polymyxin cycloheximide media showed the greater capacity of the latter in the recovery of Legionella (P < 0.0001).IMPORTANCELegionella is a waterborne fastidious pathogen that occasionally infects humans and can cause a severe form of pneumonia, called Legionnaires' disease (LD), which, if not identified in a timely manner, can progress to multiorgan failure. The trend for LD cases is steadily rising, and prevention and control of water system contamination is the only way to stop or prevent the spread of further cases. In Italy, since 2005, a network of regional reference laboratories for Legionella prevention has made an important contribution to Legionella surveillance. According to the European Directive 2020/2184, techniques already known can be used for Legionella detection in addition to the standard culture method. To ensure the reliability of the results and guarantee the correct risk evaluation, a comparison between the standard culture method and real-time PCR and the Legiolert rapid liquid culture method was required.
The rapid growth of the delivery sector, driven by online shopping and the COVID-19 pandemic, has raised safety concerns for delivery drivers, particularly work-related accidents and injuries. This study aimed to estimate the frequency of work-related accidents and injuries among delivery drivers and to identify potential predictors associated with these accidents in Egypt. A descriptive cross-sectional study with an analytical component was conducted among 172 delivery drivers recruited from gathering areas in Mansoura, Egypt. Participants were interviewed using a semi-structured questionnaire. Among participants, 57.0% reported at least one work-related road accident during their career, with most accidents (91.8%) resulting from collisions with other vehicles. All injured drivers sustained at least one post-accident injury, most commonly contusions (93.9%). The lower limbs were the most frequently affected body parts (80.6%). After adjusting for confounders, the multivariable logistic regression analysis revealed that the following workplace exposure factors were significantly independent predictors of work-related accidents: being a university student or graduate (AOR = 2.86, 95% CI: 1.35-6.08), having more than five years of driving experience (AOR = 4.62, 95% CI: 2.15-9.94), and using mobile phones while driving (AOR =3.22, 95% CI: 1.56-6.64). This study showed a high frequency of work-related road accidents among delivery drivers in Egypt. Key predictors included higher education, extensive driving experience, and mobile phone use while driving. These findings underscore the need for targeted interventions, including safety training, regulation of mobile phone use, and awareness campaigns, to mitigate accident risk among delivery drivers.
Pneumoconioses remain an important occupational health issue, particularly in low- and middle-income countries. The International Labour Organization (ILO) Classification standardizes chest radiograph interpretation but requires trained readers and is affected by inter-reader variability. This study evaluated whether generative multimodal artificial intelligence (AI) models can approximate ILO-based diagnostic reasoning. Eighty-two chest radiographs from the official NIOSH B Reader syllabus were analysed using four AI systems (GPT-4o, GPT-5, MedGemma-4B, MedGemma-27B). Each image was evaluated with a standardized prompt based on the 2022 revised ILO guidelines using deterministic settings. Model outputs were mapped to ILO codes and compared with the official answer keys of the ILO Standard Radiograph Set used for B Reader training and examination. Performance metrics included balanced accuracy, sensitivity, specificity, precision, and Matthews correlation coefficient (MCC). Bootstrap 95% confidence intervals, McNemar's test, and Cohen's κ assessed performance variability and agreement. All four AI models showed moderate diagnostic performance, with balanced accuracy ranging from 60.8% to 70.3%. Sensitivity remained limited (35.5%-54.9%), while specificity was consistently high (84.6%-86.2%). MedGemma-27B performed best for small opacities, GPT-5 for pleural abnormalities and for technical quality. Large opacities and rare findings were systematically under-detected. Statistical comparisons showed significant differences between models, although agreement patterns were broadly similar. All AI models partially followed structured ILO radiographic criteria but did not achieve expert-level performance, confirming that they cannot replace certified B Readers. Larger, real-world datasets are needed to assess their potential clinical utility as supportive tools in occupational health surveillance programs.
Italian Cystic Fibrosis Registry (ICFR) collects data of people with cystic fibrosis through the collaboration with Italian CF referral and support Centres (Italian law 548/93). It aims at analysing medium and long-term clinical and epidemiological trends, identifying healthcare needs at regional and national levels, contributing to healthcare programs and resource allocation (sharing the population of FC centres with the Ministry of Health). Finally, the RIFC shares some of its data with the Italian Medicines Agency (Agenzia Italiana del Farmaco, AIFA) to better define the number of people with cystic fibrosis with early access to specific treatments with innovative therapies. Moreover, ICFR data are shared with the European CF Patients' Registry (ECFSPs' Registry) to contribute to the estimation of the European incidence of the pathology and to bridge knowledge gaps on specific topics as well as to the adoption of common strategies for the standardized collection of data on people with cystic fibrosis. The objective of this report is to provide updated data from ICFR for the years 2023 and 2024. It is essential to consider that the analyses and specific studies carried out refer to a limited number of variables collected in the Registry, and that the selection of the topics covered in the chapters of this report was agreed by the scientific committee of the ICFR. The analyses and results presented in this report pertain to people with cystic fibrosis currently under care Italian National Referral Centres (CRR) and Support Centres (SS) for Cystic Fibrosis and Paediatric Hospital 'Bambino Gesù' (OPBG). Data are collected using web-based software adopted by almost all participating centres, except for the centres in Verona (which also includes the data from Treviso and Rovereto) and Messina, where data collection is carried out using a different software. The submitted data are then subject to both quantitative and qualitative quality control (QC) procedures, aimed at verifying the consistency and continuity of the information previously transmitted and shared with the European CF Registry. In the two-year period 2023-2024, 28 and 27 CF Centres, respectively, submitted their data to ICFR. However, the information from the two CF centres in Sardinia is still partial, since the data provided is limited to a small number of people with cystic fibrosis from 2023. The results section provides a comprehensive overview of various aspects of CF epidemiology and people with cystic fibrosis characteristics. 1. Demography: in 2023 and 2024, 6,127 and 6,182 people with cystic fibrosis were, respectively, included in the ICFR (median ages of 24.1 and 24.9 years). On average, 52.2% of people with cystic fibrosis are male, and most of the population (65.3%) is older than 18 years. This reflects the growth of the adult population, the number of paediatric people with cystic fibrosis remains almost unchanged compared to previous years. 2. in 2024, 66.5% of the Italian CF population received a diagnosis before reaching two years of age, 61.8% within the first year of life, while 15.5% of diagnoses were made in adulthood (>18 years). New diagnoses were 103 in 2023 and 134 in 2024, with an incidence of 1 in 5,587 live births in 2023 and 1 in 8,808 in 2024. 3. the genetic analysis of people with cystic fibrosis was performed in 99.9% of cases. The results allowed the characterization of at least one of the two alleles in 6,040 individuals (97.7%). The most frequent variant in Italy, consistent with previous years, is F508del, present in 43.6% of cases. A higher frequency, compared with other European countries, is also confirmed for the genetic variants N1303K, G542X, and 2789+5G>A. Only 1.3% of alleles carry a CFTR gene variant that has not yet been identified (unknown). 4. Lung function: lung function, measured by percent predicted FEV1%p, declined progressively before adulthood. In detail, 96.4% (in 2023) and 95.5% (in 2024) of paediatric people with cystic fibrosis aged between 6 and 17 maintain a FEV1%p>=70%. On the other hand, the percentage of paediatric people with cystic fibrosis with severely impaired respiratory function (FEV1%p<40%) is 0.2% (2023) and 0.1% (2024). In the adult population, FEV1%p values are encouraging, with an increasing proportion of people with cystic fibrosis showing preserved lung function (85.7% in 2023 and 87.1% in 2024). This report introduces a brief focus on pulmonary exacerbations, which decreased between 2023 and 2024 (from 19.8% to 15.4%; recurrent forms from 8.6% to 4.9%), with reductions across all age groups, though less marked in those over 40. The most affected remain children (1-6 years) and those over 55; the 4.9% with recurrent episodes represent the priority for therapeutic optimization. Overall, trends in respiratory function suggest a progressive improvement in health status among the adult population, likely associated with the increasing use of new targeted pharmacological therapies. 5. Nutrition: ICFR data confirm the critical nature of the first months of life, which usually precede the definitive diagnosis of CF and the subsequent initiation of specialized care. In the 12-17 years age group, the median body max index (BMI) z-score is close to zero, documenting an adequate nutritional status in half of the subjects. The proportion of malnourished males was 6.2% and 5%, while among females it was 2.3% and 2.6%, respectively, in 2023 and 2024. In the >=18 years age group, a higher percentage of underweight BMI is observed among females (9% in 2023 and 8% in 2024) compared with males (4.2% and 4.4% in 2023 and 2024, respectively). 6. in 2024, in both paediatric and adult people with cystic fibrosis, the most frequent complications were the same, but occurred at different rates, such as CF-related liver disease (24.1% and 49.4%, respectively), diabetes (3.8% and 26%), and osteoporosis (4.2% and 18.7%). A total of 50 people with cystic fibrosis with cancer were recorded in 2023 and 2024, of whom 4 were of paediatric age. 7. Transplantation: over the two-year period, 21 people with cystic fibrosis underwent double-lung transplantation, with median ages of 36.2 e 36.8 years in 2023 and 2024, respectively, with ages ranging from 15.1 to 64.7 years across the two years. 8. Microbiology: in 2024, the prevalence of adult people with cystic fibrosis with chronic Pseudomonas aeruginosa infection is 30.1%, while in paediatric people with cystic fibrosis is 5.5%. The prevalence of Staphylococcus aureus infections is 28.7% and 26.4%, respectively, in adults and paediatric people with cystic fibrosis; prevalence of infections of Burkholderia cepacia is 1.6% and 0.2%. 9. in the two-year period, ICFR data show that 36 people with cystic fibrosis died (16 males and 20 females), with median ages at death of 48.3 years in 2023 and 57.2 years in 2024 (excluding transplanted people with cystic fibrosis). The crude mortality rate ranged from 3.1‰ in 2023 to 2.8‰ in 2024; excluding transplant recipients, the crude rate was 1.6‰ and 1.0‰ in the respective years. 10. Motherhood and fatherhood: over the two-year period, 80 pregnancies were recorded, of which 62 were successfully completed (77.5%). Additionally, 22 pregnancies were still ongoing as of 31.12.2024. In 2024, 25 people with cystic fibrosis became fathers. The present report updates data published in previous years thus summarizing 2023 and 2024 results. The number of registered people with cystic fibrosis was 6,127 in 2023 and 6,182 in 2024. Population coverage estimates for 2024 to be around 98%. Over the two-year period 2023-2024, the number and percentage of people with cystic fibrosis aged over 18 years increased. In detail, the ICFR recorded 3,927 adult people with cystic fibrosis (64.1%) in 2023 and 4,034 (65.3%) in 2024. An increase in the median age of Italian people with cystic fibrosis has been observed over time, reaching 24.9 years in 2024. The absolute number of new diagnoses per year is comparable with that of the previous biennium (237 vs 234); the percentage of new diagnosis in adulthood was 39.6% in 2024. In 2024, the median age at diagnosis was 3.9 months; 61.8% of subjects are diagnosed within the first year of life; 95.1% of them were identified through neonatal screening. Analysis of different CFTR genotypes in the Italian CF population confirms the high allelic variability observed in Italy, with a substantial proportion of subjects not eligible for CFTR modulator therapy. Regarding respiratory function, findings are consistent with previous reports, showing an increasing percentage of subjects under the age of 18 with a normal respiratory function. This marked improvement observed in the adult population seems to be mainly due to the introduction of highly effective CFTR modulator therapies in Italy from 2021. In 2024, a reduction in the percentage of chronic Pseudomonas aeruginosa infection was observed in both adults (30.1% vs 38.8% in 2020) and paediatric people with cystic fibrosis (5.5% vs 7.6% in 2020). Liver disease remains the most frequent complication in both paediatric and adult populations, affecting 24.1% and 49.4% of people with cystic fibrosis, respectively. During the two-year period, 36 people with cystic fibrosis died with a median age at death between 48.3 and 57.2 years (transplant people with cystic fibrosis excluded). Only one transplanted people with cystic fibrosis under the age of 18 died in the period 2023 and 2024, confirming once again that mortality in paediatric age is a rare event. Finally, for the first time, this report introduces data related to maternity and paternity, highlighting that in more than 77% of cases pregnancies were successful; as well as estimates of tumour and pulmonary exacerbations incidence as possible complications.
The risk assessment for video display terminal (VDT) operators in occupational settings often relies on indirect estimates, such as self-reported screen time, which may not accurately reflect the true visual workload. The objective is to assess visual workload in VDT workers by measuring active screen fixation time with a non-invasive monitoring system and to explore its relationship with ocular surface alterations and fatigue-related indicators. An observational cross-sectional study was conducted on 38 administrative workers employed at a hospital booking center. Active VDT screen fixation, as well as shift duration and time spent in front of the VDT screen, were objectively measured using a patented video-based monitoring system. Ophthalmological evaluation included the Ocular Surface Disease Index (OSDI®), tear break-up time (BUT), and slit-lamp examination. Other investigated markers included blink rate, the Percentage of Eyelid Closure over the Pupil over Time (PERCLOS), and the Fatigue Assessment Scale (FAS). Active screen fixation accounted for approximately 60% of the total recorded working time. Ophthalmological assessment identified alterations of the ocular surface in a substantial proportion of workers, with pathological BUT values observed in nearly half (47%) of the study population. No statistically significant associations were found between objectively measured fixation time and ocular or fatigue-related outcomes. PERCLOS80 and blink rate values remained within physiological ranges across the work shift. Objective measurement of screen fixation provides a more accurate characterization of visual workload among VDT workers than indirect exposure estimates and may support occupational health surveillance and risk assessment in VDT-exposed workers.
This study was conducted to determine whether occupational exposure to high sound levels, typical of an opera orchestra, can cause hearing loss. The orchestra professors at Teatro alla Scala in Milan underwent ear examinations, pure-tone audiometry, and other audiological tests. The hearing thresholds of these musicians were compared with those of populations not exposed to occupational noise and with populations exposed to industrial noise. Noise exposure levels were estimated through a phonometric survey conducted at our theater in 2011, which largely confirmed the exposure levels outlined in European guidelines. The average audiometric thresholds of the orchestra musicians were slightly worse than the median thresholds of a healthy, non-noise-exposed population. In three subjects (2.8%), bilateral hearing impairment (PTA 0.5, 1, 2, 3, 4 kHz > 25 dB HL) was observed; in four violinists (3.7%) left unilateral hearing impairment was found. This rate is lower than the expected risk from similar industrial noise exposures. Comparing these audiometries with those from about ten years earlier shows that the hearing threshold decline in the study group is comparable to that caused by presbycusis. The risk of noise-induced hearing loss among professional orchestra musicians appears lower than predicted by the UNI ISO 1999:2015 standard. A few cases of hearing loss due to chronic acoustic trauma were noted, particularly among violinists who demonstrated a higher incidence of left unilateral hearing loss. The high levels of sound exposure and the presence of some hearing loss cases highlight the need for targeted preventative measures in this work activity.
In Italy, lung cancer is the second most frequent neoplasm in men and the third in women. Exposure to carcinogens in workplaces plays a significant role. Still, cases attributable to occupational exposure are currently under-reported as occupational diseases: the current National Prevention Plan also encourages active research projects for the detection of cancers attributable to occupational exposure. The Unit of Prevention and Safety in the Workplace of Bologna Local Health Authority (Azienda Unità Sanitaria Locale-AUSL-)created a network for active surveillance of occupational lung cancer cases with the dedicated Diagnostic and Therapeutic Care Pathways(PDTA). Possible occupational exposure cases were selected within all incident PDTA cases using a self-completed patient filter form. Only patients selected through the form were interviewed; occupational physicians collected personal, occupational, and clinical history. Definition of a cooperation system with the local office of the National Institute for Insurance(INAIL)for monitoring the process during the medico-legal assessments conducted by the insurance institute up to resolution. 453 cases completed the filter form, 177 had a potential occupational exposure. Of these, 140 accepted the direct interview with occupational physicians. One hundred eleven cases interviewed were assessed with sure or suspect occupational origin: for 82, a claim for recognition was sent to the INAIL, while for the other 29 was sent to INAIL a report for epidemiological purposes. Out of 82 compensation claims, 18 individuals (4 females and 14 males) received compensation, while 4 cases remain under investigation. A total of 53 claims were rejected: 54.7% for lack of exposure to risk factors, 24.5% for insufficient exposure, 9.4% due to inadequate administrative documentation, 7.5% because of insufficient clinical documentation, and 3.8% for the absence of causal association. Several occupational lung cancers were found that otherwise would have been unrecognized. Asbestos was the most frequent agent occurring in the most widespread work sectors-construction and manufacture of metalworking products-and in the period of exposure from 1970 to 1980. Other relevant agents were welding fumes and polycyclic aromatic hydrocarbons. Active surveillance, direct patient interviews, and claims for recognition integrated by a complementary report are essential to increase the INAIL compensation rate.
To investigate the current status, morbidity, and risk factors of functional dry eye disease (DED) in Shanghai's working-class population and explore measures to fundamentally cure and prevent functional DED. A questionnaire form was used to record the data of the diagnosed functional DED working-class subjects in Shanghai, the results were recorded and analyzed. Additionally, the subjective symptoms of DED subjects and the respective clinical results were also recorded. The classification and corneal staining between subjects who wear contact lens or without were compared. The correlation of classification and corneal staining with their risk factors were also analyzed. The risk factors of functional DED showed much in common though their works have professional particularity. Evaporative dry eye (EDE) accounts for a large proportion of DED (45.35%), many subjects co-exist symptoms and signs of mixed DED (32.64%). The age of 21-40 is the peak year range (70.4%). Contact lens, visual terminals, air-conditioner, decoration, stay up later, sleep disorder, smoking were risk factors in most functional DED subjects. Notably, contact lens is a leading risk factor to cause functional DED and ocular surface complications (both were p<0.01), while deep sleep seems to be a protective factor (p<0.01%). The incidence of functional DED in Shanghai is kept in a high level. Most risk factors are closely related to daily work and life, while they are almost reversible. Exploring and eradicating these daily risk factors seems to be a more preferable way to fundamentally control and prevent functional DED.
Alcohol consumption is an important occupational risk factor, especially in safety-sensitive sectors such as construction. Alcohol-related psychomotor impairment may increase the risk of workplace injuries and may also affect the safety of third parties. However, data on alcohol-related behaviors, workers' risk perception, and alcohol-focused health surveillance among Italian construction workers are still limited.  Methods: We conducted a cross-sectional survey between September 2023 and June 2024 in 315 construction workers employed in small Italian companies. All participants performed work activities for which local legislation mandates alcohol-use and alcohol-dependence checks as part of occupational health surveillance. Data were collected through an anonymous 27-item questionnaire exploring sociodemographic characteristics, alcohol consumption (AUDIT-C; cut-off ≥5 for men and ≥4 for women), alcohol use at work, knowledge of national regulations, alcohol-related risk perception, and accident/injury indicators. Nonparametric tests and multivariable linear regression were used to identify factors associated with AUDIT-C scores. Logistic regression analyses examined associations between perceived alcohol-related risks and awareness of, and exposure to, alcohol-dependence checks during health surveillance. The sample was predominantly male (274/315; 86.98%), and 26.03% of workers were aged 46-55 years. The mean AUDIT-C score was 2.85±2.49 (3.13±2.47 in men; 0.95±1.75 in women); 32.7% of workers screened positive, mainly men. Alcohol consumption during the work shift was reported by 1.9% of participants (7.94% occasionally), and during breaks by 5.08% (19.37% occasionally). Most workers were aware of the workplace alcohol ban (90.48%), and 83.49% reported having undergone alcohol-related checks. Higher AUDIT-C scores were associated with alcohol consumption during the work shift and occasional drinking during breaks. Although average AUDIT-C scores were not high, a relevant subgroup of workers showed risky drinking patterns and some alcohol consumption at work.  These findings highlight the need to strengthen prevention strategies and ensure consistent alcohol-related health surveillance in construction settings.
Workplace violence is steadily rising, and the healthcare sector is one of the most impacted areas. Several studies have shown that patients' long management times are a key factor in workplace violence in this setting. This study aims to analyze the prevalence and characteristics of aggressions against healthcare workers (HCWs) that occurred in 2023 in the Emergency Rooms (ER) of a large university hospital and to evaluate the potential relationship between the management time of a patient in the ER and the risk of violence incidents. To evaluate the prevalence and characteristics of aggressive events against HCWs that occurred in 2023, data from the "incident reporting" form were analyzed. Then, using the 2023 report on daily ER accesses, the management time of a patient at the ER was calculated. Finally, the average management times of patients on days when there were no aggressions were compared with those on days when there was one or more assaults against HCWs to evaluate the potential relationship between the average length of stay of a patient at the ER and the risk of aggression. In 2023, 271 violent incidents were reported. Verbal aggressiveness was the most common (82.7%), and working the night shift was riskier (42.8%). In 36.2% of cases, patient management time was identified as a potential predictor of aggression. Other identified potential predictors included the patient and/or caregiver relationship with HCW (30.6%), the refusal to accept diagnostic-therapeutic protocols (27.3%), and the cultural background and temperamental traits of the patient or caregiver (18.8% and 11.8%, respectively). According to the logistic regression analysis, the likelihood of a violent incident during a 150-minute stay was less than 10%; it increased to 53% after 650 minutes. Workplace violence in healthcare settings results from a complex interaction of internal and external factors. Understanding how these elements interact and contribute to the development of incidents is essential for identifying key actions to reduce and mitigate violence.
This cross-sectional study aims to assess cumulative loads affecting the lower back, shoulders, and distal upper extremities among automotive mechanics. The survey was conducted in automotive repair workshops in Shiraz, involving 157 independent mechanics selected through convenience sampling. Data were collected using a multiple-questionnaire including the Persian Cornell Musculoskeletal Discomfort Questionnaire (P-CMDQ), the Lifting Fatigue Failure Tool (LiFFT), the Shoulder Work Assessment Tool (SWAT), and the Distal Upper Extremity Tool (DUET). Descriptive statistics were used to assess musculoskeletal discomfort, and Partial correlation analyses, adjusted for age and Body Mass Index (BMI), examined the relationships between risk levels from LiFFT, SWAT, and DUET and discomfort reported in the P-CMDQ. The results showed a high level of musculoskeletal discomfort, especially in the lower back, shoulders, and hands. Risk assessments indicated that the cumulative loads are in the high range for the lower back in 42.7% of cases, the shoulders in 40.8%, and the distal upper extremities in 36.3%. A strong correlation was observed between cumulative load on the lower back and perceived discomfort in this region (r = 0.730), whereas the correlations for the shoulders (r = 0.611) and distal upper extremities (r = 0.537) were moderate. The findings highlight the significant influence of workplace factors on the musculoskeletal health of automotive mechanics, emphasizing the importance of preventive measures and ergonomic solutions to enhance their health and productivity.
The study provides a comprehensive ergonomics assessment of the postures encountered by rubber tappers using the OWAS, REBA, RULA, and PERA methods and compares the risk levels across various ergonomic assessment methodologies. The research examines the postures of fifty-one selected rubber tappers from the state of Kerala, India, during rubber tapping, analyzing 1111 different working postures. The postural assessment was conducted by analyzing video recordings of the work tasks and evaluating the postures using OWAS, REBA, RULA, and PERA. Each method's focus and application were considered to comprehensively evaluate the postural risks. The demographic characteristics indicate that the workforce mostly consists of middle-aged males involved in physically strenuous activities. The result shows that the RULA method, emphasizing upper limb postures, is particularly suited for assessing postural loads in rubber tapping, highlighting the need to match ergonomic tools to the specific demands of work activities. While OWAS provides a general overview, RULA focuses on upper limbs, REBA assesses whole-body postures, and PERA incorporates cyclic work factors, enabling targeted ergonomic interventions. Additionally, it is crucial to consider that each method OWAS, RULA, REBA, and PERA has distinct strengths and applications. The research highlights the need for tailored ergonomic interventions for tasks such as 'Incision on the Channel'. Ultimately, the study validates implementing a context-specific approach for assessing ergonomic parameters and intervention measures aimed at enhancing the overall occupational health of rubber tappers.
The current limited availability of patch tests for diagnosing Allergic contact dermatitis (ACD) and occupational or non-professional diseases, in accordance with AIFA regulations, has significantly affected the diagnostic approach for patients and affected workers. The issue is even more severe for haptens of occupational origin. In occupational medicine, the patch test is crucial for establishing the causal link between the skin disease and the patient's work activities. Accurate diagnosis is essential for occupational physicians both to determine the need for a job change and to assess workers' compensation. Due to limited diagnostics and regulatory restrictions, it remains impossible to diagnose occupational ACD. In this context, occupational doctors will focus on primary prevention by avoiding risk products and replacing them with non-sensitizing or non-cross-reactive alternatives. This paper addresses the challenges posed by the new AIFA (Italian Medicines Agency) diagnostic restrictions and explores potential solutions and future perspectives.
Aluminum (Al) is a widely encountered heavy metal with known neurotoxic effects. Occupational exposure, particularly in industrial settings, may impair cognitive functions. This study aimed to evaluate the relationship between Al exposure and cognitive function. A retrospective study was conducted at Gazi University Faculty of Medicine Hospital, Occupational Diseases Outpatient Clinic, between December 5, 2024, and January 5, 2025. The exposed group consisted of 20 male cement factory workers with elevated urinary Al expressed as a function of creatinine, and the control group included 40 age-matched males without occupational Al exposure (1:2 matching). Cognitive status was assessed using the Mini Mental State Examination (MMSE). Urinary Al levels were measured by inductively coupled plasma mass spectrometry (ICP-MS). Statistical analyses were performed with SPSS 29.0. The mean MMSE score was significantly lower in the exposed group compared with controls (24.3±3.7 vs. 28.5±2.3, p<0.001). Subscale scores for orientation, attention/calculation, recall, and language were also lower in exposed workers. All such workers had elevated aluminum (mean 42.3±21.4 mcg/g creatinine). Urinary Al was positively correlated with working duration (r=0.453, p=0.045) and negatively correlated with MMSE (r=-0.486, p=0.030) and orientation scores (r=-0.494, p=0.027). Workers occupationally exposed to aluminum exhibited significantly lower cognitive performance than non-exposed controls. Higher urinary Al levels were associated with poorer cognitive outcomes, suggesting neurotoxic effects of aluminum and underscoring the importance of preventive strategies and cognitive monitoring in exposed populations.
Butylated hydroxytoluene (BHT) is an antioxidant which is used in a vast array of consumer products. The most sensitive toxicological endpoints of BHT are hepatic enzyme induction and reproductive effects. Because of its wide dispersive use and its potential relevance for human health, BHT was included in the human biomonitoring (HBM) cooperation between the German Federal Ministry for the Environment and the German Chemical Industry Association. An analytical method for the sensitive determination of 3,5‑di‑tert‑butyl‑4‑hydroxybenzoic acid (BHT acid)-an oxidized metabolite of BHT which is excreted in urine-was developed. This method was then applied in several environmental and occupational HBM surveys, and BHT acid was detected in the vast majority of samples. Health-based guidance values as well as reference values for the interpretation of HBM results were derived for BHT acid. Thus, a fine-grained picture of the current state of BHT exposure in different populations in Germany is now available. Uncertainties arise from large variability in the fraction of dose excreted as BHT acid and incomplete understanding of human metabolism, which limits reverse dosimetry and risk assessment, particularly for children.
Due to the nature of shift work, nurses experience very high mental and physical pressure, which can ultimately affect their work ability (WA). One factor that affects work ability is the level of physical activity (PAL). Since nurses are responsible for providing healthcare for the public, it is necessary to evaluate their WA and PAL. Therefore, the present study used subjective and objective evaluation to test the relationship between PAL and WA among nurses in different hospital departments affiliated with Isfahan University of Medical Sciences. A descriptive-analytical study was conducted over 6 months. A questionnaire was used to measure the work ability index (WAI). The International Physical Activity Questionnaire (IPAQ) was used for subjective evaluation, and the Xiaomi smart wristband Mi Band Five was used for objective assessment. These tools extracted the components of behaviors related to physical activity for 7 days. One hundred nurses were selected for subjective evaluation, and then 40 of them were randomly selected for objective assessment. The SPSS software version 23 was used for data analysis. Multiple regression analysis was used to test the effect of physical activity on the work ability index by controlling other demographic variables. 7% of participants had poor WAI, and 45% had moderate work ability. Also, the ability to do good and excellent work was 32% and 16%, respectively. In this study, 31% of participants had low PAL, 42% moderate PAL, and 27% high PAL. In the objective evaluation, 12.5% of participants had a PAL of 100, 35% less than 100(poor), and 52.5% had a PAL above 100(High). In the subjective evaluation, the highest PAL belonged to the emergency department. The results of the subjective and objective methods to check the correlation between WAI and PAL showed a positive and significant correlation. In the present study, subjective and objective evaluations showed a significant relationship between work ability and PAL. The present findings can be used to develop future interventions to improve nurses' health and work performance.
Workplace violence (WPV) is a prevalent issue globally among Healthcare Workers (HCWs). Moreover, WPV may disproportionately impact marginalized groups within the healthcare workforce, such as women and gender minorities. This study aims to examine the prevalence of WPV experienced by HCWs through a gender-focused lens and to investigate factors influencing the risk of WPV. A cross-sectional observational study was conducted over a month in Apulia, Italy, involving employees from major healthcare institutions, including hospitals, Local Health Authorities, selected correctional facilities, and Residences for Execution of Security Measures. The study used the Italian-validated WHO Workplace Violence in the Health Sector questionnaire, modified to include 'Other' in the gender definition. 3,259 HCWs participated, representing 88.8% of the 3,670 invited participants. The prevalence of violence incidents within the last 12 months was 29.6% in the HAW group and 57.1% in the CRW group. Within the HAW group, transgender and gender expansive (TGE) workers exhibited a higher prevalence of verbal, physical, and sexual harassment. Logistic regression analysis identified gender, job type, night shifts, interactions with specific patients, and the type of medical settings as significant predictors of experiencing various kinds of violence. The study underscores the vulnerability of TGE and female HCWs to workplace violence. These findings underscore the imperative for comprehensive yet gender-sensitive interventions promoting safety, equity, and inclusion in the healthcare workplace.
Volatile anesthetics (VA) are essential agents for inducing and maintaining unconsciousness during specific surgical procedures, but they pose several health risks for exposed workers. The aim of the systematic review was to assess the effects of long-term VA occupational exposure in operating rooms. The review was conducted in accordance with the PRISMA Statement, and the search was conducted in PubMed, Scopus, and Web of Science to identify articles published between January 1, 1994, and December 31, 2024, that reported data from observational, quasi-experimental, and experimental studies. The protocol was registered in PROSPERO (ID: CRD42024500838). The quality of the studies was assessed using the standard Newcastle-Ottawa Scale versions for cohort and case-control studies, and an adapted version for cross-sectional studies. A total of 65 studies were included. Adverse effects were categorized into four groups: reproductive and Adverse pregnancy or offspring outcomes, neurotoxic alterations, laboratory parameter changes, and cyto- and genotoxicity. Overall, no significant associations were found between VA exposure and reproductive or pregnancy outcomes. One study reported neurological alterations (prolonged reaction times). Additionally, some studies have documented impairments in immune function and minor alterations in renal and hepatic function parameters. Finally, several studies indicated an increased risk of genotoxicity and oxidative stress. Given this evidence, protective measures and health surveillance for exposed workers remain crucial preventive measures.
Risk perception is crucial in occupational health and safety, particularly in high-risk sectors like agriculture and construction. This study investigates the influence of personality traits, emotional states, and socio-demographic variables on perceived risks, explicitly focusing on carcinogenic exposure. The aim is to identify key factors shaping risk perception to inform safety interventions. Using a correlational research design, 91 Italian workers (49 from construction and 42 from agriculture) completed a comprehensive questionnaire assessing personality (Big Five model), emotional state, self-perceived safety knowledge, and risk perception across 14 dimensions. Statistical analyses included correlations, ANOVA, and regression models to explore relationships between variables. Open-mindedness, emotional stability and extraversion were inversely related to perceived risk levels, while conscientiousness and friendliness correlated positively. Workers in agriculture reported higher awareness of carcinogenic risks than construction workers, though no significant differences emerged in perceived risk levels. Negative emotional states predicted higher risk perception, while self-perceived safety knowledge had only minor correlations with specific risk dimensions. Gender, age, and service length did not significantly influence risk perception. Personality traits, particularly openness and emotional stability, strongly influence risk perception, highlighting the importance of considering individual psychological profiles in occupational safety interventions. Although emotional state plays a notable role, self-perceived safety knowledge showed limited impact, suggesting a need for targeted education.
Coal workers' pneumoconiosis (CWP) is a parenchymal lung disease resulting from the prolonged inhalation of coal dust. Coal dust exposure may also lead to a spectrum of airway and parenchymal disorders. This study aimed to investigate the clinical characteristics, radiological and functional findings of CWP, as well as the presence of interstitial changes and associated risk factors. Patients with CWP who were admitted to the occupational diseases clinic of a tertiary hospital between 2017 and 2023 were included. Demographic, radiological, and pulmonary functional data were analyzed. High-resolution computed tomography scans were reviewed for interstitial lung abnormalities (ILA) and interstitial lung disease (ILD). Factors associated with ILD were assessed using logistic regression analysis. Statistical significance was defined as p<0.05. A total of 100 male patients with CWP (mean age, 61.7 ± 11.7 years) were evaluated. Large opacities were present in 37% of cases. Pulmonary function testing revealed restrictive impairment in 35% and obstructive impairment in 38%of patients. Compared with those working lignite mines, bituminous coal miners exhibited a significantly higher prevalence of large opacities and lower lung function values. ILAs were identified in 63% of patients and ILD in 42%. ILD prevalence was significantly higher among those with exposure durations exceeding 10 years, working in bituminous coal mines, and with predominant small opacities larger than 3 mm. Coal dust exposure represents a major risk factor not only for CWP but also for lung function impairment, ILA, and ILD. Comprehensive surveillance of coal workers is essential for early detection and timely management of these conditions.