Quarantine and Mental Health Challenges for Occupational Medicine: The Case Report of a Nurse Infected With SARS-CoV-2.

This case study draws attention to the psychosocial difficulties that emerged in the context of the coronavirus disease 2019 (COVID-19) outbreak in relation to the remote management of subjects with psychiatric vulnerabilities following exposure to prolonged quarantine. The case involves a 56-year-old hospital nurse, followed by the Occupational Health Department of a major university hospital in central Italy for mood instability in the context of a cyclothymic temperament. She was quarantined for occupationally acquired COVID-19 and remained positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via swab test for more than 2 months between March and May 2020. In this case study, we discuss the challenges presented by the risk of a prolonged quarantine in a psychologically vulnerable employee, the need for occupational medicine to provide adequate health surveillance of all health care workers during the COVID-19 pandemic, the effectiveness of telepsychiatry, and the difficulties in formulating a proper treatment strategy.

[Role of reaction times in the health surveillance of a group of complex task workers: public transport drivers]. / Ruolo dei tempi di reazione nel protocollo di sorveglianza sanitaria di una categoria di lavoratori adibiti a mansioni complesse: autisti di mezzi pubblici.

In order to assess the relationship between impaired reaction times and other clinical parameters a study was conducted on a population of public transport drivers, 26 impaired reaction times subjects and 114 controls, matched for age, sex and type of job-task, compared for years of employment, blood pressure, audiometric test, mood disorders, sleepiness and body mass index (BMI). Statistical analysis indicates a close trend to relationship of reaction times impairment with BMI and hypertension; these two variables are also correlated. Our results agree with previous literature: despite the fact that mechanisms underlying the relationship between BMI and cognitive impairments remains unknown, subclinical levels of pathophysiologic changes associated with elevated BMI, could account for the observed differences in our samples. Assessing eligibility in occupational medicine, it could be suitable to evaluate some preventive measures evaluating the efficacy of weight loss on cognitive function and on the ability to work safely.

[Obstructive sleep apnea syndrome in bus drivers: clinical and polysomnographic study]. / Sindrome delle apnee ostruttive nel sonno in guidatori di autobus: uno studio clinico e polisonnografico.

A Questionnaire on sleep and vigilance disorders has been developed by the Italian Association of Sleep Medicine to help the occupational health physicians in screening for sleep disorders. Aim of this study was to compare the Questionnaire with standardized questionnaires for sleepiness and sleep apnea and with a polysomnographic evaluation. Four hundred sixty-three (463#) commercial bus drivers (454M, 9F; mean age +/- S.D. 41.6 +/- 8.1 yrs; mean body mass index 26.2 +/- 3.6 kg/m2) underwent clinical evaluation that included the Italian Association of Sleep Medicine Questionnaire on sleep and vigilance disorders and two standardized questionnaires (Berlin Questionnaire and Epworth Sleepiness Scale). According to the Italian Association of Sleep Medicine Questionnaire on sleep and vigilance disorders 40 subjects presented an high risk for sleep disturbance and in 28 subject the questionnaires were concordant. Preliminary results (16 patients) showed an high rate of concordance between questionnaire and PSG. These data strongly suggest that sleep disorders and symptoms, that are frequent in a population of professional bus drivers, should be better evaluated during occupational health visit.

[Proposal of a computerized method to assess work related stress according to legal requirements in Italy]. / Aggiornamento delle Linee di indirizzo della Regione Toscana sullo stress lavoro-correlato. Realizzazione di un software per l'applicazione facilitata del modello di valutazione proposto alla luce delle indicazioni tecniche del documento di coordinamento tecnico delle regioni.

Assessing psychosocial factors in occupational environment requires complicated procedures according to most methods. The project of Tuscany region has the aim to realize a free computerized instrument for a gradual risk assessment with two different modes, expert and beginner. A decisional flow chart helps to approach the risk assessment step by step on the basis of company features, management and organization problems and company symptoms of stress. This experience means a proposal of a computerized method for a quantitative assessment of psychosocial risks at workplace, but at the same time offers a detailed analysis of the problems in the organization suggesting different priority to solve them.

[Company occupational physician and work related stress: from risk assessment to health surveillance]. / II medico competente e il rischio stress lavoro correlato: dalla collaborazione alla valutazione del rischio alla sorveglianza sanitaria.

In Italy the recent safety legislation requires a new committment for the company occupational physician. His duty is a balance between legal requirements and the state of art of prevention. There are many tools to tackle stress at work as a general preventive intervention. The hard challenge of the company physician is to keep all the garantees in terms of prevention and social security for the worker at risk of stress. This paper examines some of the difficulties with current approaches and looks at possible solutions.

[Psychiatric support of healthcare workers undergoing periodic health assessment]. / Supporto psichiatrico ai lavoratori della sanità sottoposti a sorveglianza sanitoria periodica.

INTRODUCTION: An integrated mental health surveillance program was developed by the department of occupational medicine at S. Chiara University Hospital in Pisa, Italy, in order to better assist and treat hospital staff suffering from psychiatric disorders in a preventive medical setting. MATERIAL AND METHODS: During the occupational medical surveillance of 4000 employees of S. Chiara Hospital in Pisa (Italy), 30 health care workers with psychiatric disorders were included in our program, which provided psycho-educational support and pharmacological treatment. Measures of effectiveness were: Clinical Global Impression (CGI scale) and a comparison between the average number of lost workdays due to mental illness before and after treatment. RESULTS: At the end of the observation period there was a decrease in the CGI severity score with a improved CGI score ranging from 1 to 2 and a reduction in absenteeism, from an annual average of 36.70 to 25.10 lost workdays. CONCLUSION: Our outcome measures data seem to indicate that a preventive medicine setting can offer effective psychiatric support that is better accepted and tolerated by health care workers and that this approach may reduce absenteeism.

[Updating in occupational health for health care workers]. / Aggiornamenti in tema di tutela della salute occupazionale dei lavoratori della sanità.

The board of the Thematic Section on Preventive Medicine for Health Care Workers of the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII) programmed a national conference on occupational risks of health care workers to be held in late 2009. Main topics will be: a) biohazards; b) biomechanical risk; c) psychosocial factors. Three different working groups were established to tackle critical aspects and suggest practical recommendations to occupational health professionals. Preliminary issues are presented while final results will be presented at the conference on September 2009.

[Evaluation of a series of serum mesothelin in patients with pleural malignant mesothelioma]. / Valutazione di dosaggi seriati di mesotelina sierica in pazienti affetti da mesotelioma maligno della pleura.

Pleural Malignant Mesothelioma (MM) is a highly aggressive neoplasm with a poor survival rate, hard diagnosis and treatment. The incidence of MM in Western Europe countries is expected to increase drammatically in the next 10-15 years. In spite of this drammatic scenario, at this time the only instruments for screening and early diagnosis are based on radiological tests with evident ethical and economical problems. For this reason, some authors are evaluating biological indicators with the significance of screening and early diagnosis markers. One of the most promising marker is serum mesothelin (SMRP). SMRP levels appeares to be significantly related to MM and its clinical (diagnostic/prognostic) usefulnes has been suggested. The purpose of this research is to show SMRP trend in relation both to the course of the disease and the response to therapies in some Epithelioid MM patients. The analysis of SMRP levels in these patients suggests that it may be a useful marker for monitoring the response to treatment. In fact, it was observed that SMRP increases in patients who did not respond to therapy, it tends to remain stable when therapies results into a clinical stabilization, while it decreases after surgical procedure and in case of clinical improvement.

[Medical surveillance of previously asbestos-exposed workers: report of a case of lung cancer with high level of serum mesothelin]. / Sorveglianza sanitaria degli ex- esposti ad amianto: riscontro di un caso di tumore polmonare in un soggetto con elevati valori di mesotelina.

Recently, the number of previously asbestos-exposed workers performing, at our department, medical exams aimed at an early diagnosis of asbestos-related tumors, has been progressively increasing. The diagnostical protocol we propose to these subjects include both radiological exams and some serum markers such as mesothelin and osteopontin. In this case-report we illustrate the history of a worker who, after having diagnosed a pulmonary asbestosis, developed a Lung Cancer. The significance of this case is based on the importance of the high mesothelin dosage which prompted further radiological exams resulting into the final diagnosis. In spite of the early diagnosis and treatment the patient finally died. Nevertheless, serum markers like mesothelin and osteopontin (especially the first) may result very helpful in monitoring and screening the population of workers previously exposed to asbestos.

[Serum mesothelin dosages in follow-up of previously exposed workers]. / Il dosaggio della mesotelina sierica nel follow-up dei lavoratori ex esposti ad amianto.

High dosages of Serum Mesothelin have been demonstrated to be significantly associated to Pleural Malignant Mesothelioma. We recently demonstrated that Serum Mesothelin may be clinically helpful both for diagnostic and prognostic purposes, with the best cut-off corresponding to 1 nM. We also discovered that high levels of Serum Mesothelin are significantly associated to Lung Cancer. The usefulness of this marker in secondary prevention has been suggested, though never demonstrated. We therefore started a long-term prospective cohort study including previously asbestos-exposed workers. These subjects periodically underwent both radiological tests and serum mesothelin dosages. As a mid-term goal of this longitudinal study we decided to check the variability of mesothelin dosages, comparing baseline and follow-up values, as well as the possible correlation with age, duration of exposure, smoking, any abnormality of respiratory functional tests (RFT) and/or radiological tests. At baseline, Mesothelin mean value was 0.66 +/- 0.4 (range 0.08-2.2 nM). Both age (p = 0.04) and abnormal thoracic TC (p = 0.04) were significantly correlated with increased serum mesothelin levels and increasing age. No association was found between baseline mesothelin levels and duration of asbestos exposure (p = 0.5), smoking habits (p = 0.2), abnormal RFT, DLCO (carbon monoxide diffusing capacity) or thoracic X-ray. No significant variation was observed between mesothelin values at baseline and at follow-up (p = 0.2).

[Risk assessment method for psychosocial factors at workplace: a North-West Tuscany area project]. / Metodologia di valutazione dei rischi psicosociali in ambiente di lavoro: un progetto toscano di area vasta.

The rising awareness of psychosocial risks at workplace means that it is ever more important to prepare methods to assess psychosocial factors in occupational environment. This project of north west tuscany area has the aim to realize an instrument for a gradual risk assessment for this kind of factors without the support of specialists. A decisional flow chart helps to approach the risk assessment step by step on the basis of company features, management and organization problems and company symptoms of stress. The final assessment combines the evaluation of perceived risks with job analysis realizing a matrix containing 5 risk levels, which suggests the priority of preventive measures. The intermediate level (level three) represents the activation level for the medical surveillance. This experience means a proposal for a quantitative assessment of psychosocial risks at workplace.

[Management of latex allergy in the Pisa University Hospital: analysis of data deriving from the Registry filing both allergic patients and employees]. / Gestione dell'allergia al lattice naturale nell'Azienda Ospedaliero-Universitaria Pisana: analisi dei dati relativi alla istituzione dei registri dei pazienti e dei dipendenti allergici.

Recently, Tuscany regional government has promulgated (Regional law n. 464/07) guidelines for setting up suitable sanitary rooms for patients allergic to latex. These guidelines enforced the managers of the Tuscany Local Health Units to promote educational activities and a correct methodology for the safe management of both health workers and patients who need latex-free diagnostical and/or therapeutical procedures. An other Regional law (n.345/05) had previously enforced all the Tuscany Local Health Units managers to implement and update a Registry of every latex-allergic patients ever hospitalized in their own local facilities. Since 2002 a multi-disciplinary task force of health operators, lead by the Preventive Medicine Section, has been elaborating and implementing a plan for the safety of latex-allergic patients of the Pisa University Hospital, along with a Registry where each of these patients were recorded. Moreover, since 2005 under the responsabilities of the staff of the Preventive Medicine Section, another Registry has been implemented and updated. In this Registry all the Hospital employees who have been diagnosed a latex allergy, through the medical exams performed within the occupational medical surveillance activity, have been filed. In this study we report the results of this preventive activity both aimed at patients and heatlh operators safety.

[Experience of a centre for the study of occupational adjustment disorders referred to psychological harassment-related diseases at the workplace]. / Esperienza di un centro per lo studio dei disturbi da disadattamento lavorativo in tema di patologie mobbing correlate.

BACKGROUND: The rising awareness of psychological harassment at the workplace means that it is ever more important to collect clinical data and test tools to assess psychiatric disease connected with this phenomenon. OBJECTIVES: The aim of the study was to assess the experience gained by the centre for work maladjustment of the University Hospital of Pisa on a sample of patients, using the methods proposed by the centre at the Clinica del Lavoro "Luigi Devoto". MATERIALS AND METHODS: The patients were submitted to a diagnostic protocol consisting of work history, medical examination, psychological assessment, psychiatric examination, subjective questionnaires, mood scale and Neutest. The analysis was made in two phases in which 109 subjects were examined to check occupational stress effects in the period March 2002 - July 2004, after which 50 subjects were selected (45.9%) with the adaptation disorder and a history of adverse working conditions. RESULTS: The data gathered showed a slight predominance of workers from the public administration sector. The most representative range of duration of the psychological violence varied from 6 months to 2 years (46%). From close examination of the causes of the maladjustment disorders, structural changes in organization appeared to be the most frequent (13 cases). Among patients with positive diagnosis of disorder caused by psychological violence at the workplace, three situations were prominent: attitude to being a social outcast, behaviour to ignore proposals, and professional declassing. CONCLUSIONS: The multidisciplinary approach was culturally very stimulating and fundamental in reaching a final diagnosis of occupational disease: diagnosis of bullying at work and related disease was possible only thanks to the fact that three specialists agreed on the aetiological role of psychological harassment at the workplace. Our experience confirms that psychological harassment can cause health impairment and the most common diagnosis is maladjustment disorder.

Medical surveillance of workers previously exposed to asbestos.

According to current Italian law health surveillance of workers exposed to asbestos in the past must be maintained even after cessation of asbestos exposure (D.Lgs. 277/91). The law, however, makes no reference to timescales or time limits for clinical monitoring, nor to who is responsible. The main aims of health surveillance of individuals formerly exposed to asbestos can be summarized as follows: early diagnosis of the principal diseases associated with asbestos; counselling for workers; work-related disease certification; epidemiological studies. Medical check-ups entail a complete personal and work history, Chest X-Ray, respiratory function tests, TLCO. In all cases the worker must undergo a LDCT. We propose two new possible biological markers for the health surveillance of past-exposed patients: serum mesothelin and osteopontin.

Expression of Cyp6g1 and Cyp12d1 in DDT resistant and susceptible strains of Drosophila melanogaster.

The Rst(2)DDT locus (loci) in Drosophila is associated with the over-expression of two cytochrome P450 genes, Cyp6g1 and Cyp12d1. Using northern and western blot analysis we observed the expression pattern of these two genes in two DDT susceptible (Canton-S and 91-C) and three DDT resistant strains (Wisconsin, 91-R and Hikone-R). In Canton-S and 91-R, the CYP6G1 protein was constitutively expressed throughout development. In the Wisconsin strain, CYP6G1 was not expressed in third instar larvae unless the larvae are exposed to DDT. CYP12D1 protein was only expressed in adults. Cyp12d1 mRNA is induced in DDT resistant strains post-exposure to DDT and the expression patterns of Cyp12d1 mRNA varied across DDT resistant strains. Our data support the hypothesis that there is evolutionary plasticity in the expression patterns of P450s associated with metabolic pesticide resistance.

[SV40: a possible co-carcinogen of asbestos in the pathogenesis of mesothelioma?]. / SV40: un possibile co-cancerogeno dell'amianto nella patogenesi del mesotelioma?

BACKGROUND: The etiopathogenic role of asbestos in causing malignant mesothelioma of the pleura is clearly supported by an impressive amount of data. Despite the frequent association with previous exposure to asbestos, only a relatively small fraction of those exposed develop malignant mesothelioma. The long latency period between initial exposure and onset of the tumor suggests that human mesothelioma, like many other tumors, has a multi-stage evolution with the occurrence of many mutating events involving various tumorigenic agents, probably in part initiating and in part promoting development. Recently this has raised great interest in the scientific world, in an attempt to identify possible factors which together with asbestos may have a role in developing this rare malignant tumor. Ionizing radiations and genetic susceptibility have occasionally been identified as the culprits. A virus called SV40 has been gaining increasing scientific credibility since the mid 1990's as a potential co-carcinogen of asbestos. OBJECTIVES: The aim of this article was to examine the supposed interaction between asbestos and SV40 in the pathogenesis of mesothelioma and the way this simian virus has become a human virus. METHODS: All biomolecular and epidemiological data available from medical literature along with the results of the experiments performed during the last 7 years in our department laboratories were reviewed and compared. RESULTS: The first two pieces of experimental evidence of the presence of SV40-like DNA sequences in mesothelioma samples were obtained in 1994 in the United States, and one year later in our laboratories. After these two studies many research groups started carrying out similar experiments, obtaining comparable results in most cases. Moreover, beyond the mere detection of viral DNA sequences large amount of biomolecular data has recently been added in favour of its role in the pathogenesis of mesothelioma. Epidemiological studies published to date were unable to provide similar unanimous results. Data regarding the source of human infection are still debatable, even if the inadvertent administration of contaminated poliovaccines to millions of people in Europe and the United States between 1955 and 1963 remains one of the most reasonable hypotheses. CONCLUSIONS: On the basis of all the biomolecular data reviewed and partially on the basis of epidemiological studies, SV40 seems to be the best candidate as a cofactor with asbestos in the development of human mesothelioma.

SV40 can be reproducibly detected in paraffin-embedded mesothelioma samples.

We studied tissue sections from 18 paraffin embedded mesothelioma specimens diagnosed by the Pathology Department of S. Chiara Hospital of Pisa. Using PCR analysis and Southern blot hybridization we examined the specimens for the DNA regulatory region of the virus. 10/18 (55.5%) of the samples tested contained SV40 DNA regulatory sequences, and of these positive samples, 80% were found to contain Tag sequences by PCR and Southern Blot hybridization. These results confirm that SV40 can be amplified and detected in paraffin embedded mesothelioma samples.