Influence of night-shift and napping at work on urinary melatonin, 17-ß-estradiol and clock gene expression in pre-menopausal nurses.

Night-workers experience disruption of the sleep-wake cycle and light at night which may increase breast cancer risk by suppressing the nocturnal melatonin surge, resulting in higher levels of circulating estrogens. Night-work may also deregulate peripheral clock genes which have been found to be altered in breast cancer. This study investigated urinary 6-sulfatoxymelatonin (aMT6s), serum 17-beta-estradiol levels in premenopausal shift nurses at the end of the night-shift compared to a control group of daytime nurses. Peripheral clock gene expression in lymphocytes were also investigated. All participants were sampled in the follicular phase of the menstrual cycle. The effect of nurses’ ability to take a short nap during the night-shift was also explored. The shift-work group had significantly lower aMT6s levels than daytime nurses independently of a nap. Night-shift napping significantly influences 17-beta-estradiol levels resulting in higher outcomes in nurses who do not take a nap compared to napping group and daytime workers. Peripheral clock genes expression investigated was not significantly different among the groups. Our findings suggest that shift nurses experience changes in aMT6s levels after a night-shift. Napping habits influence 17-beta-estradiol levels at the end of a night-shift. These findings might be related to the increased cancer risk reported in night-shift workers and suggest that a short nap during night-shifts may exert a positive effect.

[Biological risk and health care workers: analysis of the effects of work chronobiology on the immune system]. / Rischio biologico ed operatori sanitari: analisi dell'interferenza tra cronobiologia lavorativa e sistema immunitario.

BACKGROUND: Healthcare workers may be exposed to a variety of biological hazards. Although many studies have shown that some immunological alterations were related to work stress and sleep disorders, few studies investigated effects of shiftwork on the immunological system. OBJECTIVES: The aim of the study was to compare the immune status of a group of nurses on shiftwork with that of nurses working only day shifts. METHODS: A total of 138 nurses were evaluated at baseline and after a year of follow-up, via tests for perceived stress, daytime sleepiness, number of lymphocytes and subpopulation of CD3+, CD4+, CD8+-CD57+, CD19+ and CD56+, cytotoxic activity and lympho-prolferative response of NK cells, serum concentrations of IL-1beta, IL-6, INFgamma and TNFalpha. RESULTS AND CONCLUSION: No significant alterations of any of the studied parameters were found both at baseline and after a year of follow-up. The biological hazards for nurses do not seem to be increased by shiftwork.

[Role of waist circumference in the diagnosis of metabolic syndrome and assessment of cardiovascular risk in shift workers]. / Importanza della circonferenza vita per la diagnosi di sindrome metabolica e per la valutazione del rischio cardiovascolare nei lavoratori turnisti.

BACKGROUND: Shift work is associated with coronary heart disease (CHD). Metabolic syndrome (MS) is associated with an increased risk of cardiovascular disease (CVD). An association between shift work and MS has been reported in some studies. OBJECTIVE: The purpose of this study was to compare the criteria of the National Cholesterol Education Panel (NCEP), revised NCEP (NCPEP-R) and International Diabetes Federation (IDF) metabolic syndrome criteria for the diagnosis of MS, also to explore how metabolic risk factors for CVD differ between shift workers and day workers in a cohort of Italian workers. METHODS: The study population consisted of 552 workers (361 men, 191 women; mean age 40.4 years) and included 262 healthcare providers (130 rotating shift nurses and 132 day nurses), 204 forestry workers and 86 factory workers. Fasting blood sugar level, HDL-cholesterol, triglycerides, blood pressure, and waist circumference were measured. RESULTS: Healthcare providers had greater waist circumference (p< 0.01), serum triglycerides (p< 0.01) and fasting plasma glucose (p< 0.001) compare with the other worker categories. In comparison with day workers, rotating shift nurses had greater waist circumference (p<0.001), higher serum triglycerides (p< 0. 001) and fasting plasma glucose (p< 0.05), and lower concentrations of HDL cholesterol (p<0.01) The prevalence of MS according to NCEP criteria was 8.3%, according to NCEP-R criteria 9.3% and 12% according to IDF criteria. No significant association between MS and shift work was found. Abdominal obesity and high serum triglycerides was significantly associated with shift work after adjusting for age, sex, smoking, alcohol consumption and job seniority, with an OR of 2.74; 95% CI: 1.43-5.26 for high serum triglycerides and an OR of 1.81; 95% CI: 1.0-3.2 for abdominal obesity assessed according to IDF criteria. No significant association with NCEP and NCEP-R criteria was observed. CONCLUSIONS: The data show greater prevalence of cardiovascular risk factors among healthcare providers. Shift work was significantly associated with high triglycerides and abdominal obesity using IDF criteria. Measurement of waist circumference is a simple and non-invasive method to use in the evaluation of metabolic risk factor for CVD.

[Fast stress evaluation in nurses]. / La valutazione rapida dello stress negli infermieri.

The aim of the study was to assess subjective stress to 92 nurses by administering the Rapid Stress Assessment (RSA) Scale, a self-rated tool. The self-administered test, easily understandable, which is quickly drawn up and which allows a quick scooring, appears to be suitable to select subjects deserving a thorough specialistic investigation. The test itself becomes therefore a useful professional means for the occupational health physician, who has to evaluate the workers' psychic and physical attitude.

[Study of a population exposed to occupational stress: correlation among psychometrics tests and biochemical-immunological parameters]. / Studio di una popolazione esposta a stress occupazionale: correlazione tra tests psicometrici e parametri biochimico-immunologici.

A longitudinal study was carried out to evaluate the effect of psycho-physical and occupational stress on some biochemical and immunological parameters. The study was aimed to the identification of new and reliable method for the identification of subjects at high risk of occupational stress. 101 nurses which were working at several departments were enrolled. A blood sample was collected from all subjects after have filled the questionnaires at the time T0 and at the followed time points of 4 months (T1), 8 months (T2) and 12 months (T3). The self-reported questionnaires were: Rating Scale for Rapid Stress Assessment (VRS), General Health Questionnaire to 12 items (GHQ-12) Multidimensional Scale of Perceived Social Support (MSPSS) and a questionnaire on the occupational satisfaction (SOD). Haemachrome glycaemia, homocysteine, cortisol, lymphocyte numbers and their subtypes (CD4, CD8, CD19, NK CD56, NK CD57), NK activity and inflammatory cytokines were evaluated. A high reliability has been found between the psychometric tests. Correlations between biochemical and immunological variables were performed by Pearson coefficients and multiple regression analysis. Subjects with elevated value of stress evaluated as VRS and GHQ-12 score showed an altered immune response. A reduction of NK CD57 and IL-6 content better characterize the occupational satisfaction.

[Hymenoptera stings in forestry department agents: evaluation of risk]. / Punture di imenotteri negli agenti del corpo forestale dello stato: valutazione del rischio.

BACKGROUND: In sensitized subjects Hymenoptera stings may provoke the awakening of mediated systemic reactions of I type IgE, which can sometimes be serious. Considering the type of work performed activity and the high frequency of reported hymenoptera sting episodes, a sample of 206 Forestry Department agents was surveyed who worked outside urban areas in the Marche Region. OBJECTIVES: The aim of the study was to analyse the prevalence of stings and their possible systemic reactions, as well as to evaluate the type of occupational risks involved. METHODS: A total of 206 agents were examined and questioned about the number of stings suffered during work and about the kind of subsequent skin and systemic reactions; they were then classified according to the method proposed by H.L. Mueller. RESULTS: 179 agents reported having suffered from hymenoptera stings and, of these, 53 subjects (29,6%) remembered that one episode at least occurred during work. Among 175 operators (98%), 4 had a regular reaction, with appearance of a generalized urticaria and uneasiness. In the remaining 4 agents (2%) there was a local extensive reaction, which was not associated with systemic reactions and they were all referred to allergological examination. 19 agents (10,6%) suffered more than 5 stings altogether, but none developed a systemic reaction. 87% of the subjects practised self-medication, 7% reported to the casualty department of the local hospital or to their own doctor, and 6% undertook no cure at all. CONCLUSIONS: Epidemiological studies agree in recognizing that, in the general population, the percentage of systemic reactions after one or more hymenoptera stings varies from 0,15% to 3,3%. In categories of workers occupationally at risk, the prevalence of systemic reactions varies from 4,5% to 26%. The prevalence of systemic reactions in Forestry Department agents was 2%, which is similar to the prevalence in the general population. Therefore, rather than occupational risk, there appeared to be a generic risk made more serious by working conditions for Forestry Department agents due to their possible exposure to hymenoptera stings. The occupational health physician needs to monitor these events, due to the fact that frequent exposure to stings, above all occurring within a short period of time (less than two months) favours an increase in the tendency to develop systemic reactions, with a more serious prognosis, especially when working in isolated conditions.

[Usefulness of a questionnaire and RAST in screening of health care workers allergic to latex]. / Utilità del questionario e del RAST nello screening di operatori sanitari allergici al lattice.

BACKGROUND: The prevalence of latex mediated IgE allergy in health care workers varies, according to the various studies, from 0.5% to 16. 7%. The onset of latex allergy involves aspects concerning the worker's health, the need for job transfer and possible retraining. In any case, the use of latex gloves in health care environments cannot be discarded, since they offer more efficacious protection from biological agents, compared to gloves of different materials. OBJECTIVES: Our objectives were to verify the prevalence of latex allergy in a sample of 515 health care workers and evaluate the usefulness of RAST and a questionnaire especially organized to identify potentially allergic subjects, at the same time limiting the number of false positive and false negative results. METHODS: 515 health care workers of the ASUR Zone7-Ancona local health unit accepted to answer to a questionnaire and to undergo a RAST testfor latex. Those with positive responses to the questionnaire or to RAST were later invited to undergo further allergological tests (prick and prick by prick). The questionnaire was revised according to the results obtained, thus increasing its positive predictiveness. RESULTS: Prevalence of latex allergy in our sample was 1, 7%, positive predictiveness of RAST was rather low (31.3%), but increased considerably if combined with the modified questionnaire (62.5%). The Prick by Prick test gave more specific results than the Prick test. CONCLUSIONS: The proposed questionnaire can reduce the number of false positive workers needing to undergo further allergological tests and may be usefully applied in the screening of latex mediated IgE allergy in health care workers.

[Guidelines for health surveillance of health care workers exposed to biological risks set up by the Italian Society for Occupational Health and Industrial Hygiene: application in health facilities of the Regional Health Administration--District No. 7, Ancona]. / Rischio biologico per i lavoratori della sanità: applicazione delle Linee Guida SIMLII nella ASUR--Zona Territoriale 7 di Ancona.

BACKGROUND: Evidence Based Medicine and the need to achieve better management of health budgets call for verification and, if necessary, revision of the criteria used in Occupational Health, in order to ensure appropriate measures as regards protection of health at the workplace. In December 2003, the Marche Region initiated a process of reform of the regional health service, which will be completed in two years, and will provide a new regional health organization that will improve the quality and appropriateness of health services available to the population. The reform also involves the Occupational Health Services responsible for prevention activities for 20,000 health care workers employed in regional public health facilities. The need was strongly felt to set up a network that would meet the health needs of health care workers, by adopting a common language among occupational health physicians, by eliminating reported criticism, which is due not only to lack of communication between different structures and profiles, but also to the different methods of approach, evaluation and management of occupational risks. OBJECTIVES AND METHODS: From a historical point of view, the health sector has the biggest as regards prevention of biological risk. Therefore, with a view to harmonizing actions and approach among occupational health physicians in the evaluation of this risk, the publication by the Italian Society for Occupational of Health and Industrial Hygiene of Guidelines for health surveillance of health care workers exposed to biological risks, produced by the working group under the leadership of Prof. Lorenzo Alessio, was considered to offer an interesting opportunity to verify the reproducibility of methods and the quality of results, as applied to health facilities under the Regional Health Administration in Ancona (District No. 7). RESULTS AND CONCLUSION: The Guidelines fully confirmed the need to plan activities, starting from analysis of epidemiological and occupational data, thus assuring good results both in terms of efficacy and efficiency of the health surveillance programme used. This method also assures a high level of appropriateness of medical measures as regards the "safety" target, at the same time avoiding waste and poor management of human and economic resources, which were till now caused by differences in methods used in assessment of biological risk.