Occupational hazards and gender differences: a narrative review

Personalized medicine, and particularly gender medicine, is becoming essential in daily medical practice. This narrative review aims to assess sex and gender differences in occupational risks among workers. We point out that female workers are more exposed to biological risks (i.e., 70% of healthcare workers during the COVID-19 pandemic were women), but also seem to be more protected against microorganisms (i.e., for HBV vaccination: OR 1.21, p = 0.0023);with regard to physical risks, women are more susceptible to radiations (the estimated incidence of solid tu-mors for 0.1 Gy of exposure is 0.013% in females and 0.008% in males), while men are more susceptible to heat (infertility prevalence was 22.7% in exposed workers vs 3.0% in con-trols);female video terminal workers are more susceptible to both computer vision syndrome (aOR 2.57 and aOR 2.35) and musculoskeletal symptoms (OR 3.6). From a psychological point of view, women are more at risk for work-relat-ed stress and burnout, as well as workplace mobbing (65% of affected workers are women) and verbal violence, while physical violence was more common among men. In conclu-sion, important sex and gender differences are present with regard to occupational risks and hazards, thus showing the necessity to improve medical surveillance and to allow occupational physicians to personalize health surveillance. © 2022, Il Pensiero Scientifico Editore s.r.l.. All rights reserved.

Leadership in public health crisis: a review to summarize lessons learned from COVID-19 pandemic : Angelica Valz Gris

Background During the COVID-19 pandemic, several public health challenges were faced, requiring worldwide leaders able to direct, guide, and establish appropriate strategies. The aim of this review was to summarize evidence on public health leadership during the COVID-19 era. Methods The systematic literature review was conducted according to the PRISMA 2020 checklist. A search of relevant articles was performed in the PubMed, Scopus, and Web of Science databases. Eligible articles were any type of publication, published between 2020 and 2022, that outlined one or more characteristics of effective public health leadership during the COVID-19 pandemic We excluded all articles that did not explicitly address the COVID-19 pandemic or had a different setting. Results A total of 2499 records were screened, and 45 articles were included. We identified 93 characteristics, clustered in six groups, that were reported as fundamental to be an effective leader in public health crises worldwide. Emotional intelligence and human traits (reported by 46.67% of the articles) were considered essential to build trust in the population and ensure cooperation with working groups. Communication skills (47%) are considered necessary to enable people to understand and accept measures. A supportive, multidisciplinary team and accountability mechanisms (33,33%) were highlighted as central elements, especially in the international field, to ensure reliability and consistency in action. Management skills (35,56%), adaptability (44,44%), and evidence-based approach (33,33%) were reported as key capabilities to ensure a prompt and rapid response to the challenges created by the pandemic. Conclusions The identification of the attributes of an effective public health leader conducted in this study is useful in choosing the key personalities who must lead public health today and in the training of tomorrow's European and worldwide leaders to be ready to face future threats. Key messages • Effective public health leaders in crisis are empathetic and trustworthy people, who have developed management and communication skills, and are able to make timely and evidence-based decisions. • In order to create leaders capable of facing future threats, more emphasis in the training of public health workforce on soft skills and management competencies should be recommended.

COVID-19 sequelae among competitive athletes: a systematic review : Valerio Flavio Corona

Background During the COVID-19 pandemic, several professional athletes from different sports were infected by SARS-CoV-2. The aim of this systematic review was to evaluate the currently available scientific evidence regarding the cardiological, pulmonary, psychological, and combined sequelae, in professional athletes. Methods The present systematic review was performed following the PRISMA statements, thereby searching on 3 databases: PubMed, ISI Web of Science, Scopus. Primary studies published between January 2020 and March 2022, investigating symptomatic and instrumental sequelae in competitive athletes after COVID-19 infection, were included. Results A total of 1,957 articles were screened, finally 18 were included (6 cohort studies, 2 case-control studies and 10 cross-sectional studies). Studies’ sample size ranged from a minimum of 12 to 1908 athletes playing different sports. In addition, the studies examined the following type of sequelae: 12 cardiological, 2 psychological, 1 pulmonary and 3 combined. Regarding the cardiological field, the prevalence of anomalies in instrumental examinations ranged 0-27.89% for first level tests (echocardiography, electrocardiogram, troponin), and 0-6.21% for second level tests (cardiac magnetic resonance). The prevalence of myocarditis and pericarditis in the athletes ranged from 0 to 3.33%, whereby the prevalence of myocarditis was in the range 0-2.32% and that of pericarditis in the range 0-2.22%. Conclusions The results show that post SARS-CoV-2 infection cardiac sequelae have a quite low prevalence among competitive athletes included in our review, but it would be important to set up a gradual and continuous testing approach to preserve sports performance. Public health framework, such as vaccination campaign, is important both at European and international level in order to address potential consequences of infectious diseases among competitive athletes. Key messages • It is important to monitor all COVID-19 sequelae in European competitive athletes playing different sports. • Considering anti-COVID-19 vaccination in competitive athletes as an important preventive measure, to limit the circulation of the virus and the physical consequences that may occur.

Italian health care workers and Adverse skin reactions to personal protective equipment during Covid-19 pandemic

Introduction: During the pandemic, the use of personal protective equipment (PPE) has become essential for Healthcare Workers (HCWs) to fight safely against the virus. However, the extensive and prolonged use of PPE may cause various adverse skin reactions due to the use of alcohol hand cleanser and protracted use of masks and goggles. The aim of this study is to evaluate the skin problems caused by PPE in HCWs and the possible consequences on their work. Materials and methods: An online ad hoc questionnaire, composed by 35 questions about sociodemographic characteristics, work related issues and exposure/habits about PPE, was administered to a sample of Italian HCWs. Univariate and multivariate analyses were performed in order to explore possible associations between variables. Results: We tested 3 types of PPE: Gloves, Hair Bonnets and Masks for different time of utilization (<1, 1-3, 3-6, >6 hours). The sample included 1184 participants: 292 workers reported a dermatological pathology nested in four different pathological groups: 45 (15%) had Psoriasis, 54 (19%) Eczema, 38 (13%) Acne, 48 (16%), seborrheic dermatitis and 107 (36%) other. 25 workers had a loss of occupational days due to dermatological illness;56 occupational physician surveillance visits were asked for;in 30 cases were recognized limitations in working duties. Conclusions: Protecting HCWs requires the use of PPE, but occupational dermatitis is an emerging problem in the midst of the COVID-19 pandemic. National data for affected healthcare professionals could contribute to a better understanding of the problem and prevention initiatives in the workplace

Is the pandemic leading to a crisis of trust? Insights from an Italian nationwide study.

OBJECTIVES: Along with mistrust toward politics and journalism, the pandemic is amplifying mistrust in healthcare. To explore trust in key professionals among the Italian population, we focused on perceived change in trust during the pandemic. STUDY DESIGN: Nationwide online cross-sectional survey (called COCOS). METHODS: COCOS was conducted in Italy in two periods: the end of the first lockdown (T1: April-May 2020) and the end of 2020 (T2: November-December 2020). Descriptive analyses and multivariable logistic regressions were performed (sample size = 2673). RESULTS: Trust in healthcare workers (HCWs) was reduced in 1.5% of participants (T1) and 2.8% (T2). Trust in scientists/researchers was reduced in 5.8% (T1) and 7.6% (T2). Trust in politicians was reduced in 37.6% (T1) and 52.3% (T2). Trust in journalists was reduced in 41.7% (T1) and 48.3% (T2). Considering multivariable models, participants of the second period, participants who were HCWs, participants with anxiety symptoms, and those experiencing economic struggle due to the pandemic had a higher likelihood of having a reduced trust. The period had the strongest association with reduced trust. CONCLUSIONS: We argue that a central role might be played by the pandemic fatigue. We suggest leading figures should be more aware of the relationship between communication and trust. The pandemic is a real-world experiment in reshaping mediated communication and, although social media play an important role, other approaches might be successful. As a notable part of the population is trusting politicians and media less and less, Italian key professionals should implement initiatives to reinvigorate public support.

Mental health and access of care during Covid-19 pandemics: an italian cross-sectional study

Background COVID-19 emergency forced nations to introduce containment measures to reduce the spread of the virus. This study assessed the possible effects of the pandemic on mental health and care access. Methods A cross-sectional study was conducted in Italy in two observation periods in 2020: April-May (first lockdown) and November-December (no lockdown). Categorical variables were compared with χ2 tests. Mental health outcomes (PHQ-2 ≥ 3;or GAD-2 ≥ 3) and outcomes related to care access were considered. Multivariable logistic regression models were performed. Results Participants were 2673 (66.8% female;mean age=44 years, SD = 15). Depressive symptoms were found in 24.7% of participants, while 24.2% showed an anxious symptomatology. A total of 12.5% said they voluntarily gave up scheduled medical service, 6.4% avoided acute treatments, and 5% changed therapy themselves. Comparing the two periods, there were no significant differences in the outcomes under study. Students were at higher risk of depressive symptoms (OR = 2.23;95% CI 1.42-3.52;p = 0.001). Women and those who increased the time on internet presented an increased risk of developing depressive and anxious symptomatology. The scheduled medical service was mainly postponed by those who said they were afraid to go out of necessity (OR = 2.49;95% CI 1.87-3.32;p < 0.001) or to cause themselves an injury (OR = 1.78;95% CI 1.32-2.40;p < 0.001). Foreigners (OR = 4.24;95% CI 1.70-10.55;p < 0.002) are more likely to avoid acute treatment. Workers and those with anxious disorders appear to be more inclined to self-medicate (OR = 2.05;95% CI 1.29-3.26;p = 0.003). Conclusions Compared to the pre-pandemic period, higher levels of anxiety and depression were observed. No differences in mental health and care access were shown between the two observation periods. Being afraid to go out of necessity and avoidance of physical activity for fear of injury is related to reduced access to care, but not to self-medication. Key messages The 24.7 % of the sample reported depressive symptoms, and 24.2 % anxious symptoms. Similar increases were observed in both periods: April-May (first lockdown) and November-December (no lockdown). During the pandemic, delayed access to planned and acute care, avoidance of physical activity for fear of injury, and self-medication pose a major public health challenge in the coming period.

Effects of Covid-19 lockdown on mental health and sleep disturbances, results from an Italian survey

Background The Covid-19 pandemic is affecting different aspects of our society and brand-new conditions are expected after the lockdown. Italy was the first European country that entered a nationwide lockdown during the COVID-19 pandemic. Since quarantine can impact on mental health, this study aimed to estimate the prevalence of depressive symptoms, anxiety symptoms and sleeping disturbances in the Italian population during lockdown. The factors that might influence such outcomes were explored. Methods The COvid COllateral ImpactS (COCOS) project was a national cross-sectional survey performed during the last 14 days of the Italian lockdown. Questionnaires were online and included items on socio-demographics, behaviours, and healthcare access. Depression was assessed through the Patient Health Questionnaire-2, anxiety through the Generalized Anxiety Disorder-2. Participants referring sleep disturbances completed the Insomnia Severity Index. Descriptive analyses, univariable and multivariable logistic regressions were performed (p-value<0.05 significant). Results The sample size was 1515. Females were 65.6%, and the median age was 42 years (IQR=23). Depression and anxiety symptoms prevalence were 24.7% and 23.2%. The 42.2% had sleep disturbances and, among them, 17.4% reported moderate/severe insomnia. Being female, increased time spent on internet, and avoidance of activities for peer pressure increased the likelihood of at least one of mental health outcomes. Increasing age, not experiencing work-related troubles, being married/cohabitant reduced such probability. Females and participants with chronic conditions resulted positively associated with sleep disturbances. Conclusions The results showed a high prevalence of mental health issues. Since the impact might be long-lasting, it is crucial to study effective interventions, specifically planning strategies for more vulnerable groups, e.g. youths, and considering the role of internet. Key messages A high prevalence of mental issues and sleep disturbances was recorded during the last week of the lockdown. Age, gender, marital status and the time spent on internet affected mental health while gender and presence of chronic conditions were predictors of sleep disturbances.

Beyond COVID-19: a cross-sectional study in Italy exploring the Covid Collateral Impacts

Background The COVID-19 pandemic is a calamity affecting many aspects. In particular healthcare services (HCS) are facing a great stress-test worldwide. The present work aims to explore what were health needs, beyond COVID, not covered among Italian citizens, due to fear, lockdown measures and overload of HCS, also in order to understand if there are specific subgroups of populations that will need urgent access to health services in the next future. Methods COCOS (COvid COllateral impactS) is a cross-sectional study performed during the Italian lockdown between April and May 2020. A forty-nine items online questionnaire was filled by the respondents. Participation was voluntary and without compensation. Informed consents were obtained. Descriptive, univariable and multivariable (logistic regression models) analyses were performed: results are expressed in ORs. Results Totally, 1,515 questionnaires were collected. Median age was 42 years, 65.6% were females. Around 22% declared to suffer from chronic diseases. Interestingly, 32.4% of the sample faced a delay of a scheduled Medical Service (MS) by provider decision, while 25.6% reported that this issue hit a family member. More than 13% refused to access scheduled MS for the fear of contagion, and the 6.5% avoided HCS even if having an acute onset issue: this behavior was associated with scarce trust in physicians (AdjOR 0.75);alarmingly, 1.5% avoided Emergency Department when in need and 5% of the sample took medications without consulting any physician: patients suffering from chronic conditions resulted to be more prone to self-medication (AdjOR: 2.16;95% C.I.: 1.16-4.02). Conclusions COVID-19 immediate effects are just the tip of the iceberg. Large groups of population suffered delays and interruptions of medical services, and the most vulnerable were the most affected. To estimate the effects of the pandemic on non-COVID-19 patients is required, leading to aimed efforts, to reduce the backlog that HCS incurred in. Key messages COVID-19 biggest toll on public health is still to come if not prevented, due to temporary but widespread suspensions of scheduled medical services and the avoidance of these for fear of contagion. The most in need are the most vulnerable: older patients and those with chronic conditions are the most affected by suspension of medical services and will potentially pay the greatest cost.