Occupational health and psychological wellbeing in first line nurses during health crisis periods: reliability study of the SOIC tool.

Background: In 2020, the emergence of the new Coronavirus has put health professionals under enormous pressure, as they had to work in difficult and often disadvantaged situations. Prevention of symptoms such as stress, anxiety and burnout therefore become important health management goals. Aim: The aim of this pilot cross-sectional study was to assess the reliability and feasibility of a tool on Occupational Health Nurses after a Pandemic Period such as the COVID-19 pandemic (Salute Oc-cupazionale negli Infermieri in Periodo Pandemico Covid19 - SOIC) that aims to assess the occupational health and psychological wellbeing of nurses during periods of health crisis. Methods: This study was conducted from September to November 2022. The SOIC tool is composed by two preliminary sections and a third part including five validated questionnaires (measuring burnout, work engagement, psychological symptoms, resilience, and mindful awareness). An opportunistic sample of 202 nurses working in a Teaching Hospital of Rome and members of NurSind union were invited to participate: of these, 24 nurses completed the SOIC in two subsequent occasions (T1 and T2). Results: The test-retest assessment showed no differences between the two waves (T1 and T2) in terms of median scores for all questionnaires included in the SOIC tool. The Cronbach alphas, considering all items of each questionnaire included in the SOIC tool, showed good or excellent internal consistencies. Conclusion: The test-retest assessments and the reliability analyses encouraged the usability of the SOIC tool. Furthermore, consistent associations between the five questionnaires were obtained.

"Fare male farsi male" project - Are cyberbullying and cyber victimisation associated with physical activity levels? a cross sectional study in a sample of Italian adolescents.

Background: The aim of this project is to study the prevalence of cyberbullies (CB) and cybervictims (CV) and cyberbully-victims(CBV) in Italian adolescent students and a possible correlation with physical activity (PA) levels and as potential protective factor. Methods: The Italian version of the European Cyberbullying Intervention Project Questionnaire (ECIPQ) was used for categorized cyberbullies (CB) and cybervictims (CV). Six items of the IPAQ-A Italian version were considered to measure the PA levels. Results: 2112 questionnaires were collected, with response rate of 80.5%. The sample reported 9% was CV only, 5% was CB only, and 6% was cyberbully-victims (CBV). The factors that are significant associated to the CV students were: female gender (OR=1.7; 95%CI:1.18-2.35); stay at middle school (OR=1.56; 95%CI:1.01-2.44); spent more than 2 hours on IT devices (OR=1.63; 95%CI:1.08-2.47). The variables significant associated to the CB students were: gender male (OR=0.51 95%CI:0.320.80); spent more than 2 hours on IT devices (OR=2.37; 95%CI:1.32-4.26); tobacco use (OR=2.55; 95%CI:1.63-3.98); an inverse proportion with the number of days spent in vigorous physical activities (OR=0.82; 95%CI:0.68-0.98). The CBV students were significant associated with a male gender (OR=0.58; 95%CI:0.38-0.89) and tobacco consumption (OR=2.22; 95%CI:1.46-3.37). Conclusions: The physical activity at vigorous level seem to be related to less involvement in cyberaggression, so it is recommended that those responsible for training adolescents' favour this aspect. Research on effective prevention is insufficient and evaluation of policy tools for cyberbullying intervention is a nascent research field an any prevention or intervention program could consider this factor.

International Physical Activity Questionnaire for ITalian Elderly (IPAQ-EIT): reliability in an Italian sample.

Background: The aim of the paper was to perform an Italian version of the International Questionnaire of Physical Activity in the Elderly: IPAQ-EIT. Methods: Adults with age over 64 years with normal neurological status and without difficulty in ambulation were enrolled in opportunistic way and on voluntary basis in different Italian regions. Two independent researchers have translated the English version independently. The final IPAQ-EIT version was submitted twice, with an interval of one day between each administration (T0 and T1). McNemar's Test was used to assess the agreement between qualitative variables; Wilcoxon Signed Ranks Test and Spearman correlation coefficients were used for continuous data. Cronbach's alpha was used as a measure of the internal consistency. Results: Thirty-three questionnaires were collected at T0 and T1. 100% of response rate was obtained. The Cronbach's alpha at T0 was α= 0.79 and at T1 α= 0.84. The Spearman's coefficient reported significant associations (p<0.001) between the two administrations for all items. The test-retest analysis for two paired samples underlined for all items not significant differences. Conclusions: The IPAQ-EIT short form shown an acceptable consistency, feasibility to administer and easy to combine with other questionnaires. It is an additional valid measuring tool for physical activity levels in the elderly.

Changes in vital signs before, during and after bed bathing in the critical ill patient: an observational study.

Aim: The aim of the study was evaluate the variability of the vital signs of patients hospitalized in intensive care unit (ICU) before, during and after bed bathing. Secondly to evaluate the possible relationship of vital signs changes and the perception of pain in patients ICU who do not have painkilling therapy. Materials and Methods: The study is cross-sectional. The critically ill patients, adults, hospitalized for at least 24 hours and daily bathing in bed were recruited. The socio-demographic information and clinical data were collected using the clinical record. The vital functions data trend was collected at four different times of the bad bathing: before (T0), during (T1), immediately after (T2), 20/30 minutes from the term (T3). For each patients three observations of the vital parmeters trend were detected. Results: 19 patients were enrolled. All vital functions show statistically variations during the follow-up (p <0.05), particularly between T0 versus T1. The trend of the all vital parameters in the subgroup of the females reported significantly changes (p<0.05) except for the pain score (p=0.390) and diastolic blood pressure (p=0. 183); the men reported significant differences in the trend of the all vital funcitons (p<0.05) except for the body temperature (p = 0.06) and diastolic blood pressure (p=0.123). Conclutions: This study confirms that the procedure for bed bathing modifies the parametric values of patients in a critical area; however, the potential influence of certain factors that may have compromised the data cannot be limited. The application of innovative techniques to minimize interference (control of the microclimate, use of electrodes resistant to shocks and water) was reccomnded, so too the adherence to the Evidence Based Care reduces the risk of complications and guides professional action in the best possible way.

Workplace violence among healthcare workers, a multicenter study in Italy.

OBJECTIVES: The purpose of this study is to assess the prevalence and determinants of workplace violence and the sociodemographic risk factors associated. STUDY DESIGN: This was a multicenter cross-sectional study. METHODS: The study was performed using self-compiled Italian version of the World Health Organization's questionnaire on workplace violence online by filling in a Google form. The survey was opened from May 2018 to March 2020 and lasted 5-10 min. RESULTS: The sample consists of 3659 healthcare workers, of which 2525 (69%) are females, 1446 (39.5%) are nurses, and 2029 (55.5%) are health workers from northern Italy. The most frequent age group of the sample is 50-54 years (16.7%). A total of 366 (10%) healthcare workers are victims of physical aggression at work in the last 12 months, of which 6.3% with a weapon. The risk of being a victim of physical aggression at work in the last 12 months is significantly associated with the following independent variables: male gender (odds ratio [OR] 1.72, 95% confidence interval [CI]: 1.36-2.17), work in southern Italy (OR 1.59, 95% CI: 1.10-2.28), and being a nurse (OR 2.56, 95% CI: 2.01-3.25). The risk of being a victim of physical aggression at work with a weapon in the last 12 months is significantly associated with work in southern Italy (OR 9.33, 95% CI: 3.83-22.73). A total of 1723 (47.1%) of healthcare workers declare to be a victim of verbal aggression at work in the last 12 months. The risk of being a victim of verbal aggression at work in the last 12 months is significantly associated with the following independent variables: work in northern Italy (adjusted OR [aOR] 1.54, 95% CI: 1.32-1.81), work in southern Italy (aOR 3.68, 95% CI: 2.90-4.68), and be more than 55 years old (aOR 0.73, 95% CI: 0.63-0.85). CONCLUSIONS: The study underlines that the problem of verbal and physical aggression against healthcare workers is still central and is a further starting point for research. The prevalence of violence is difficult to assess because violent incidents are underreported or unreported. The results of the study suggest that increased awareness is needed to develop effective control strategies at the individual, hospital, and national levels to prevent aggression and improve the conditions of victims.

Lifestyle and Life Expectancy Questionnaire: validation and assessment in an Italian sample.

Background: The objective of this study was to evaluate the relia-bility and validity of the lifestyle (Miller-Smith) and life expectancy (Schneider) questionnaires in the Italian setting in order to make this instrument available for the determination of lifestyle and hope level in the different domains of everyday life. Method: Before testing their psychometric properties, the original versions of the two questionnaires, lifestyle (Miller-Smith) and life expectancy (Schneider), were translated into the Italian language. We tested the instrument's psychometric properties on a sample of 18 patients over 60 years old with Alzheimer's disease in the Sapienza University of Rome teaching hospital, policlinico Umberto 1. Internal consistency was considered to assess the reliability of the results across items within the adopted scale by using Cronbach's α coefficient. Using Kolmogorov-Smirnov's test, the normality distribution was evaluated to guarantee the applicability of a parametric or non-parametric test. The software used to analyze data was SPSS version 26 for Windows. Results: According to the outcome of our statistical analysis, the lifestyle scale showed high overall internal consistency, and the Cron-bach's α coefficient for the total 20-item scale was 0.80 in the Italian population. On the other hand, using the 12-item questionnaire about life expectancy resulted in a high overall internal consistency of 0.93, according to the Cronbach's alpha test. Conclusions: The outcome of our study shows that the Italian versions of the lifestyle (Miller-Smith) and life expectancy (Schneider) questionnaires demonstrated good psychometric properties and good characteristics of factorial validity for future epidemiological studies aimed at evaluating lifestyle and lifestyle expectancy in the Italian population and can as well be used in clinical practice and research.

I-PHAN Study - Use of E-learning modules to Promote Physical activity and wellness among Nurses in order to improve mental and physical health: A research protocol for a randomized controlled trial.

AIM: To develop and test the effectiveness of an E-learning program for promoting physical activity (PA) and wellness among nurses. BACKGROUND: Restrictions during the coronavirus (COVID-19) pandemic drastically changed many people's lives. Maintaining a healthy lifestyle is an everyday challenge faced by the general popula-tion. Nurses are one of the health care professionals who are typically well-educated in taking care of patients. There are studies that show that night shifts, extended shifts, and obesity have a correlation with the prevalence of acute low back pain among female nurses. PA is the key factor in the prevention and treatment of many chronic diseases, resulting in an improvement in the quality of life. The impact of social media and technology on our lives is undeniable in the modern era. DESIGN: This study will be a single-centre, single-blind, randomi-zed controlled trial executed on an E-learning platform to provide the control and intervention groups with a distance learning program. Par-ticipants will be randomly assigned to either the control or intervention group. Participants in the control group will only sign up for module 1 of the PA modules, which only comprises information on PA and health promotion. On the other hand, the participants in the intervention group are expected to carry out 3 modules of exercises at home three days a week for a total duration of 8 weeks. The exercises will be performed at moderate intensity (5-6 on the Borg CR10 Scale). ETHICAL ISSUES: This trial will comply with the declaration of Helsinki 1975, as revised in 2000. Informed written consent will be obtained from the participants. The Sapienza University of Rome, institutional ethics committee and review board approval will be requested for this study. CONCLUSION: Establishing an online PA program with good quality, such as a high level of convenience in access and use, simplified, easy to practice, and made available on social media, can minimize the difficulties faced previously in the implementation of an online PA program for nurses, and may enhance the health and wellbeing of many nurses in healthcare institutions.

Non-adherence to Mediterranean diet and synergy with lifestyle habits in the occurrence of breast cancer: a case-control study in Italy.

OBJECTIVE: The aim of this study was to assess the synergistic effect of non-adherence to the Mediterranean Diet (MD) and lifestyle habits on the occurrence of breast cancer (BC). PATIENTS AND METHODS: A case-control study was carried out from September 2018 to February 2019 at the Teaching Hospital "Umberto I" in Rome. A Food Frequency Questionnaire was used for assessing the level of adherence to MD, the IPAQ Questionnaire to measure physical activity, and AUDIT-C to estimate alcohol consumption. The possible interaction between risk factors was tested using the synergism index. RESULTS: A total of 94 cases and 88 controls were enrolled (median age 55.8 for cases and 57.9 for controls). The MD Score over 6 was associated with low odds of having breast cancer (OR = 0.29; 95% CI: 0.12-0.69). There is a clear indication for the additivity and synergism between non-adherence to MD and many risk factors on the occurrence of BC: current smoker (S = 2.02; 95% CI 0.62-8.07), physical inactivity (S = 2.14; 95% CI 0.71 2-8.28) and alcohol consumption (S = 3.02; 95% CI 0.91-12.95). CONCLUSIONS: Primary prevention of BC can benefit from intervention targeting nutritional and lifestyle factors that act synergistically.

Which is the best communication strategy, based on anti-tobacco ads, to impress teenagers? A multicenter cross-sectional study.

BACKGROUND: Well-planned mass-media campaigns can increase health literacy and raise awareness about the consequences of tobacco use. This study aims to evaluate the emotions and opinions of adolescents about several anti-tobacco spots delivered by the mass media over the world. STUDY DESIGN: Cross-sectional study. METHODS: The study was conducted in Italy in 2016-2017 among students aged 13-17 years. Students expressed their emotions and opinions about seven anti-tobacco spots from all over the world on different topics and styles. RESULTS: 499 students attended. The video "Sponge" was found to be the most impressive (30.2%) and what they would have chosen if they had been responsible for campaign launched by the Minister of Health (40.5%). The "Icons" spot ranged second, with 19.2% and 17.4%, respectively. CONCLUSIONS: In summary, this study showed that the communication strategies most effective, according to the students interviewed, are those that give clear messages with a scientific profile or that discover the false stereotypes, as in the video "Icons". However, further research is needed to investigate the effectiveness of TV campaigns against smoking, in terms of habits and knowledge in young people.

Results of the Italian project 'GiochiAMO' to improve nutrition and PA among children.

BACKGROUND: Prevalence of overweight and obesity during childhood is still elevated in high-income countries. GiochiAMO is a health promotion program that uses knowledge-based education and games to teach healthy nutrition and physical activity among children (6-8 years old). METHODS: This study was a single arm field trial. Second and third grade classes of primary school attended an oral presentation about nutrition and physical activity and then were involved in three game sessions. Two multiple-choice questionnaires were administered at the beginning and at the end of the trail. The following scores were measured: nutrition behavior score (NTs), physical activity behavior score (PAs) and delta score (Ds). Wilcoxon, T-test and Mann Whitney were used to perform the univariate analysis. RESULTS: A total number of 74 and 76 children participated in the physical activity and nutrition interventions. NTs was 4.17 (SD: 2.23) before and 5.03 (SD: 2.79) after the intervention (P = 0.005). PAs was 27.4 (SD: 9.6) before and 30.5 (SD: 10.7) after the intervention (P = 0.003). No significant differences were obtained comparing males and females for all scores. Ds was 0.86 for nutrition and 3.1 for physical activity. Univariate analysis of Delta scores obtained no significant differences. CONCLUSIONS: The present results confirm the effectiveness of 'GiochiAMO' to change nutrition and physical activity behavior.

Diffusion of the Italian social media campaign against smoking on a social network and YouTube.

INTRODUCTION: Recently, the Italian Ministry of Health developed a health prevention campaign against tobacco smoking entitled "Ma che sei scemo? Il fumo fammale" (Are you stupid? Smoking is bad). The aim of this study was to evaluate the diffusion of the ministerial campaign by analyzing data from two web platforms, Facebook and YouTube. METHOD: The study evaluated the dissemination of the campaign using the number of users reached, interactions and the interaction index (interactions/users reached) on the web platform Facebook and YouTube. A qualitative analysis of the text comments left by the users was also carried out. RESULT: The average number of interactions on Facebook was 6,087 and 400 for YouTube while the total views were 356,967 for Facebook and 174,763 for YouTube. The interaction index was very low for both platforms, between 0 and 1%. A total number of 156 comments were obtained on Facebook and 37 on YouTube, most of which were negative, or comments not related to the campaign. CONCLUSIONS: The Italian campaign had low diffusion on the web platforms investigated. Evidence-based public health interventions can play a central role in the prevention field but must be based on elements of scientific effectiveness. Further research should analyze the effects of social media campaigns on direct health related outcomes.

The PRECEDE-PROCEED model as a tool in Public Health screening: a systematic review.

OBJETCTIVE: The aim of this systematic review was to summarize the scientific literature concerning the use of the Precede-Proceed model (PPM) applied to educational programs and health screenings contextsV. STUDY DESIGN: Systematic review. METHODS: The search process was based on a selection of publications listed in Medline and Scopus. The keywords used were "Precede-Proceed" AND ("screening" OR "educational programs"). Studies included in the systematic review were subdivided into those applying the model in a screening context, and those applying it within educational programs. RESULTS: Twenty-seven studies were retrieved, mostly performed in the USA and, generally, the promoting center was the University. In the context of cancer screening, the PPM model was most of all applied to Mammography Screening (5 of 13 studies in cancer screening), and Cervical Cancer Screening (5 of 13). Another three studies within the cancer field investigated Menopause-Inducing Cancer Treatments, Oral cancer prevention, and cancer screening in general. In the remaining studies, the model was applied in various screening areas, particularly chronic and degenerative diseases. There were many different study designs, most of which cross-sectional (8), though several RTCs (8) and focus groups (5) were also found. For the cross-sectional studies the methodological quality varied between 3/10 and 9/10, whilst for the RCTs it ranged from 2/5 to 3/5. CONCLUSIONS: The PPM provides an excellent framework for health intervention programs especially in screening contexts, and could improve the understanding of the relationship between variables such as knowledge and screening. Given the complexity of a behavioral change process, certain important predisposing factors could be measured in future studies, and during health intervention planning.

Is there an association between Stevens-Johnson Syndrome and vaccination? A systematic review.

AIMS AND BACKGROUND: It is essential to make sure that vaccines are safe, effective, and of good quality. In the past years, there have been some reports of adverse effects regarding vaccination. One of these adverse effects is the development of Stevens-Johnson syndrome. Stevens-Johnson syndrome is a rare, severe, skin disorder, that usually occurs after medication. In Europe, its estimated incidence is of 2-3 cases/million population/year. Therefore, the aim of this study was to investigate, through a systematic review, the association between vaccination and the development of Stevens-Johnson syndrome. MATERIALS AND METHODS: We performed a systematic review using PubMed, Scopus and Web of Science databases. We included studies dated between January 2000 and February 2018. The main selection criterion was the reporting of the disease, following vaccination. RESULTS: Ten studies were selected, from a total of 391 studies. Of these, 5 were case reports, 3 were cohort studies and 2 were case-control. All the studies were regarding cases of Stevens-Johnson syndrome after vaccination. The selected studies reported cases following vaccines such as influenza vaccine, smallpox, anthrax and tetanus vaccine, MMR vaccine, varicella vaccine, DTaP-IPV vaccine or rabies vaccine. None of the cohort studies reported statistically significant associations between vaccination and the syndrome. In the case-control studies, it was not observed significant increased risk for the Stevens-Johnson syndrome following the administration of vaccines. Regarding the case reports, there was not sufficient evidence to form a positive association between these two factors, and more studies are needed. CONCLUSIONS: In this review it was not possible to establish a positive relation between vaccination and the development of Stevens-Johnson syndrome.

Return to work after kidney transplant: a systematic review.

BACKGROUND: Renal transplant is the gold standard treatment for patients with end-stage renal disease. Employment after transplant is an important marker of recovery and a key component of general well-being with important social implications. AIMS: To evaluate employment status after renal transplant and to investigate facilitators of and barriers to return to work for renal transplant patients. METHODS: We searched PubMed, Scopus and the Cochrane Library in March 2019 using the following algorithms: 'return to work' AND kidney AND transplant. Eligible studies were selected by two independent researchers. Quality assessment was performed using the following tools: International Narrative Systematic Assessment (INSA) and Newcastle-Ottawa Scale (NOS) for cross-sectional and cohort studies. RESULTS: The review included 18 papers: 10 cross-sectional studies, 6 cohort studies and 2 narrative reviews. The weighted mean percentage for return to work within 1 year was 39.4% (95% CI 39.3-39.6%). Employment status was influenced by modifiable and non-modifiable factors, such as pre-transplant employment, sociodemographic characteristics, clinical conditions and comorbidities, operative technique (invasive or not), type of transplants (living donor or cadaver), pre-transplant dialysis, psychosocial support, educational level and participation in education programmes. CONCLUSION: Return to work after kidney transplant is a dynamic process influenced by numerous factors. It is vital to implement multidimensional interventions focused on rehabilitation and influencing modifiable factors to improve return to work after kidney transplant. This systematic review updates knowledge in the field of transplant and of disability management.

Effectiveness of a training course on smoking cessation knowledge and behaviour for health profession students: the SISMA project.

INTRODUCTION: University students are at risk of starting smoking or continuing and increasing the consumption of tobacco products. The aim of the study was to assess the impact of the training course, Sisma Project, about smoking in healthcare degree courses, in terms of knowledge, behaviour and to evaluate the course. METHODS: SISMA project was a pre- post study about an intervention delivered to healthcare profession students about smoking and smoking cessation. It had a before-after design and was an online optional course available on the eLearning platform Moodle 2. The course was structured in four lessons of sixty minutes, a debate among experts and a final test of evaluation. The McNemar test was used to measure the effectiveness of Sisma on smoking behaviour of students after the intervention. Students rated the course assigning a score from one to ten, and expressed free comments about point of strength and weakness of Sisma project. RESULTS: The participants were 365 students, 28.5% males and 71.5% females, most were nursing 194 (53.2%) and dental hygienists students 105 (28.8%). Current smokers were 161 (44.1%) before and 142 (38.9%) after the course, there was statistical significant difference in smoking status after attending the course (p < 0.001). Students evaluated the course giving a high score with a mean of 8.13 (SD: 1.1); the main points of strength were the content (33.2%), the structure (15.6%) and knowledge given by the course (12.6%). The main point of weakness were the online structure 62 (37%), problem related to length and time 17 (10%) and the final test 15 (9%). DISCUSSION: Given the central role health professionals play in patient care, students need to be aware and trained in tobacco cessation techniques. Our results indicate that smoking behaviour significantly changed after attending a university course for smoking cessation and students appreciated its contents and structure.

Smoking E-CigaRette and HEat-noT-burn products: validation of the SECRHET questionnaire.

BACKGROUND: The nicotine market has rapidly evolved with the emergence of newer forms of smoking device that have been expanded worldwide, such as electronic cigarettes (eCig) which heat a solution (e-liquid) to create vapour and heat-not-burn (HNB) tobacco products, which heats tobacco at a temperature below the point of combustion. Their use is increasing at an alarming rate; it is believed it will surpass the use of traditional cigarettes in next 5 years, mostly among never-smokers and young people. OBJECTIVE: There are not many studies investigating knowledge and behaviour about heat tobacco products (HTP) among teenagers, so the aim of this study is to validate the SECRHET questionnaire (Smoking E-CigaRette and HEat-noT-burn products) on knowledge and behaviour on cigarette and HTP among youth. METHODS: The study was conducted in February and March 2019 inside Sapienza University of Rome and high school Giulio Cesare of Rome. A self-administered anonymous questionnaire was performed to investigate smoking habits and measures knowledge about HTP among Italian teenagers. OUTCOMES: A sample of 60 students took part in the validation of the questionnaire. The overall Cronbach's alpha was 0,635, corresponding to a sufficient reliability. CONCLUSIONS: There is little or no data on consumption or perceptions of HTP products among youth and evidence suggests the usefulness of a standardized and validated questionnaire available to monitoring of awareness, interest in trying and prevalence of use of these novel products among young people.

A cross sectional study on the vocal handicap index applied to a sample of teachers in nurseries and primary school.

BACKGROUND: Acoustic pollution is generally analysed in relation to the risks for the hearing apparatus, omitting the extra-auditory effects, such as the damage that the noise can cause to the speaker's voice and listening to the learning of the vocal message. These damages are mainly found in school environments among teachers. OBJECTIVE: A cross-sectional study was carried out to verify the influence that the noise of the classrooms can have on the physical and mental health of the teachers examined. METHODS: This study involved four schools of Rome, for a total of 60 teachers, who were interviewed via online questionnaires, which consisted of a socio-demographic data section and 3 other sections: Vocal Handicap Index (VHI), SF-12, Job Content Questionnaire. RESULTS: 50 responses were received. 68% of teachers exceeded the normative value of 2.83 and perceived a disorder of the voice, and only 32% had a value lower than the standard considered (mean=7.34; median=5). The medians of MCS12 and PCS12 scores (52.9 and 54.2) were very close to those of the general population, as well as the distribution of the scores obtained from the Job Content Questionnaire. Furthermore, there was a direct association between the VHI-10 score and the age (B=0.321 p=0.016), the marital status (B=0.345 p= 0.009), and an indirect association with the MCS12 (B=-0.283 p=0.033). CONCLUSIONS: In general, the teachers examined are exposed in the classrooms to a high acoustic climate (median=75 dB) and, consequently, to a vocal effort during the didactic activities. Although it has not been possible to verify whether teachers with a high vocal disturbance were in the classrooms with a worse acoustic climate, the descriptive analyses provide a solid basis for further studies on the association between noise pollution and vocal effort.

Work-related stress and cortisol levels: is there an association? Results of an observational study.

OBJECTIVE: Chronic exposure to work-related stress (WRS) stimulates the hypothalamic-pituitary-adrenal (HPA) axis to increase glucocorticoid secretion, including cortisol, and these hormones can be measured both in serum and urine. The Health Safety Executive Toolkit (HSE) questionnaire is used to assess WRS risk objectively. The scope of our study is to investigate whether serum or urinary cortisol levels could be used as alternative objective indicators of WRS, specifically in those subjects who are chronically exposed to it. PATIENTS AND METHODS: 130 patients (75 males and 55 females, mean age 47.7 ± 11.3 years) were evaluated at a specialized Centre for Secondary Hypertension, where both their serum (8 AM) and 24-hours urinary cortisol were measured and they were asked to complete two questionnaires: one questionnaire to collect data about their socio-demographic and job characteristics, and the HSE questionnaire to evaluate WRS. RESULTS: Multiple linear regression analysis showed an association of urinary cortisol with several variables: tobacco smoke (ß = 69.6; p = 0.003); female gender (ß = -37.3; p = 0.041); exposure to physical risks (ß = 51.8; p = 0.032); control score (ß = -22.7; p = 0.039); role score (ß= 39.3; p = 0.020). Age was the only variable associated with serum cortisol levels (ß = -3.6; p = 0.042). CONCLUSIONS: Urinary cortisol levels, but not serum levels, are associated with variables linked to WRS (score control and role) and to socio-demographic variables, namely gender and tobacco smoke. Thus, urinary cortisol can be considered a useful and non-invasive biological indicator to quantify WRS.

Returning to work after breast cancer: A systematic review of reviews.

BACKGROUND: Due to improvements in breast cancer diagnosis and treatment, the healthcare system faces a growing number of cancer survivors. Breast cancer survivors experience many difficulties when returning to work, including discrimination at work and lack of support by employers and colleagues. OBJECTIVE: To point out the knowledge in literature up to date about return to work (RTW) after breast cancer, the factors influencing it and the interventions to facilitate it. METHODS: A literature search was conducted in January 2017 using the databases Medline (PubMed) and Scopus. Studies were included if they analyzed the problem of RTW in women treated for breast cancer. RESULTS: Twenty-six articles met the inclusion criteria. The studies were divided into four themes: factors facilitating or impeding RTW; interventions to enhance RTW; lived experiences of RTW; economic aspects related to cancer survivors and RTW. CONCLUSIONS: The heterogeneity of the interventions suggests the need for a better definition of the concept of RTW. To compare interventions, studies should use a rigorous approach and better outcome measures should be identified to evaluate RTW.

Counseling intervention to improve quality of life in patients with pre-existing acute myocardial infarction (AMI) or chronic obstructive pulmonary disease (COPD): a pilot study.

BACKGROUND: In the light of diagnostic and therapeutic advances, patients with a previous myocardial infarction or with a diagnosis of chronic obstructive pulmonary disease are vulnerable and need continuous monitoring over time. These pathological frameworks have a strong impact on the economy and on the status of the population and require effective and low-cost solutions. AIMS: The objective of this clinical trial is to evaluate the efficacy in the short term of a telephone counseling intervention to modify the lifestyles of these two patient populations. METHODS: In May 2015, all the patients included in the study underwent a questionnaire to evaluate their eating and smoking habits and their quality of life. After randomization in two groups, the intervention group received telephone counseling related to the correct lifestyles. The control group did not undergo any intervention. In September-October 2015, the same initial questionnaire was administered to evaluate changes in patients' behavior. RESULTS: 64 patients were included in the study: 34 were assigned to the intervention group and 30 to the control group. The outcomes evaluated were: quality of life, assessment of eating habits and smoking status. After the telephone counseling, the intervention group (34 persons) showed a significant improvement in the score of adherence to the Mediterranean diet (p = 0.01) and a significant reduction in the percentage of smokers (p = 0.01) compared to the population that did not receive any intervention (30 persons). On the other hand, the changes related to the quality of life questionnaire were not significant. CONCLUSIONS: A single telephone counseling intervention is effective in modifying the lifestyles of patients with a previous myocardial infarction or diagnosed with chronic obstructive pulmonary disease in the short term, reducing their risk profile.