La Medicina del Lavoro è una rivista bimestrale fondata nel 1901 da L Devoto e quindi diretta da L Preti, da EC Vigliani, da V Foà e da PA Bertazzi (Milano). Oggi diretta da A Mutti (Parma), è l'organo ufficiale della Società Italiana di Medicina del Lavoro (SIML) e si propone di formare e aggiornare tutte le figure coinvolte nella prevenzione e cura delle malattie professionali. Lingua: Italiano/Inglese Periodicità: Bimestrale (6 numeri all’anno) Formato: 20 x 27 cm ISSN: 0025-7818 eISSN: 2532-1080 La Medicina del Lavoro è recensita su: Index Medicus/MEDLINE; Embase/Excerpta Medica; the Elsevier BioBASE, Abstracts on Hygiene; Industrial Hygiene Digest; Securitè et Santè au Travail Bit-CIS; Sociedad Iberoamericana de Informaciòn Cientifica (SIIC); Science Citation Index Expanded (SciSearch); Journal Citation Report/Science Edition; ISI Web of Science; Scopus, PubMed/Medline 0.978 NUOVO IMPACT FACTOR (ultimo aggiornamento giugno 2019)
All Journal's articles are Open Access papers distributed under the terms of the Creative Commons Attribution License CC BY-NC 4.0 Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Reproductions with commercial intent will require written permission and payment of royalties.
Artificial Intelligence in Occupational Medicine: Upholding Disciplinary Integrity and Editorial Standards
Copyright (c) 2026 Antonio Mutti https://creativecommons.org/licenses/by-nc/4.0
Artificial Intelligence in Occupational Health Surveillance: Evaluating AI-Assisted ILO Classification of Radiographs of Pneumoconioses
Background: 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. Methods: 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. Results: 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. Conclusion: 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.
ILO International Classification of Radiographs of Pneumoconioses
Copyright (c) 2026 Antonio Baldassarre, Martina Padovan, Alessandro Palla, Augusto Quercia, Rita Leonori, Stefano Dugheri, Nicola Mucci, Veronica Traversini https://creativecommons.org/licenses/by-nc/4.0
Reference Values for Maximal Isometric Handgrip and Pinch Strength in Healthy Italian Adults Without Occupational Biomechanical Overload
Background: Handgrip strength (HGS) and pinch strength are key indicators of hand function with relevant clinical and ergonomic implications. In Italy, normative reference values based on combined measurements of grip and pinch strength in healthy adults not exposed to upper-limb biomechanical overload are currently lacking. The primary aim of this cross-sectional study was to provide descriptive reference values for HGS and three pinch types, stratified by sex and age group, in a healthy Italian adult population (18–65 years) not exposed to occupational biomechanical overload. The secondary aim was to investigate the influence of sex, age, body mass index (BMI), and hand dominance, as well as the relationships among strength measures. Methods: A total of 813 participants (319 men and 494 women) were evaluated. Measurements were performed using a calibrated Baseline® hand dynamometer and pinch gauge according to the standardized protocol of the American Society of Hand Therapists (ASHT). Results: Men showed higher strength values than women across all measures. The association between body mass index (BMI) and strength was more pronounced and consistent in women than in men, reaching statistical significance only for selected pinch measures in males. Strength values showed a non-linear distribution across age groups, with peak levels observed between 30 and 49 years in men and between 40 and 49 years in women. Hand dominance showed a selective effect in both sexes, influencing specific pinch tasks but not handgrip strength. Conclusions: This study provides the first national joint normative dataset for intergrip and pinch strength in healthy Italian adults aged 18–65 years not exposed to occupational biomechanical overload. These findings may support clinical and occupational assessments and contribute to the development of broader Italian normative reference tables.
handgrip strength; pinch strength; reference values; occupational health; biomechanical load
Copyright (c) 2026 Emma Sala, Nicola Riolfi, Alessandro De Bellis, Andrea Bisioli, Cesare Tomasi, Francesco Romagnoli, Giuseppe De Palma https://creativecommons.org/licenses/by-nc/4.0
Alcohol Consumption at Work in Construction Workers Employed in Small Italian Companies
Background: 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. Results: 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. Conclusions: 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.
AUDIT-C; construction workers; occupational health surveillance; alcohol use; risk perception; workplace sa-fety; injury prevention
Copyright (c) 2026 Ivan Borrelli, Luca Fontana, Antongiulio Perrotta, Paolo Zita, Mauro Fedele, Ivo Iavicoli https://creativecommons.org/licenses/by-nc/4.0
Self-Reported Non-Auditory Effects of High Sound Pressure Levels Exposure in Academic Musicians in Uruguay
Background: While hearing loss is the most emblematic effect of exposure to high sound pressure levels, it is not neither the first nor the only one. This article explores self-reported effects of exposure to high sound pressure levels among a population of 306 academic musicians (singers, choir members and instrumentalists) in Uruguay. Methods: A special anamnesis form was prepared for use in interviews of each of the participants. The collected information was anonymized and processed. Some interesting results were found, both through direct processing and PCA analysis. Results: Most participants reported several non-auditory effects. These were classified by sex, age, and role (singer or instrumentalist, voice type, or played instrument). Conclusions: Among the reported effects, the most prevalent were muscle contractures, fatigue/tiredness, difficulty sleeping, and noise sensitivity, followed by arthralgia and headaches. The most frequent effects in women were muscle contracture (86%), followed by tiredness/fatigue, noise susceptibility, and tinnitus. The most frequent effects in men were muscle contracture (68%), followed by tinnitus, noise susceptibility, and irritability after musical activity. It was possible to establish some “effects profiles” according to instrument and gender. For example, woodwind players experience muscle contracture, tinnitus, post-musical activity irritability, noise susceptibility, and decreased performance, while soprano singers have a higher prevalence of muscle contracture, tiredness/fatigue, noise sensitivity, difficulty sleeping, arthralgia, digestive disorders, headache, tinnitus, and vertigo. They are the second most affected category of musicians, according to their effect profile.
Copyright (c) 2026 Alice Elizabeth González, Fernando Tomasina, Julián D. Ortiz Umaña, Lady Carolina Ramírez, Bettina Tellechea, Adriana Pisani https://creativecommons.org/licenses/by-nc/4.0
Copyright (c) 2026 La Redazione https://creativecommons.org/licenses/by-nc/4.0
Occupational Exposure to Inhalation Anesthetics in Operating Room and Adverse Health Outcomes: A Systematic Review
Summary: 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.
Volatile anaesthetics; Operating room; Exposure; Adverse health effects; Systematic review
Copyright (c) 2026 Andrea Caronna, Katia Vitale, Laura Ciccariello, Andrea De Giorgi, Sergio Gazzanelli, Lidia Ricci, Matteo Vitali, Carmela Protano https://creativecommons.org/licenses/by-nc/4.0
General and Toxicologic Aspects of Occupational Fatalities in the Metropolitan Area of Lyon From 2000 to 2020, a Retrospective Study
Over the past two decades, fatal workplace accidents have accounted for between 300,000 and 400,000 deaths a year worldwide. The aim of this study was to investigate the general characteristics and the toxicological profile of work-related deaths. A descriptive retrospective study was carried out on occupational-related deaths occurred in the Lyon metropolitan area from 2000 to 2020 from the autopsy reports of the University Institute of Legal Medicine. A total of 476 cases of work-related deaths were identified, of which 91% were men. The median age was 48 years, 44% of the deaths were due to cardiac origin, 34% to mechanical accidents and 18% to suicide. 16 homicides were also recorded. The cause of death differed significantly between socio-professional categories: suicide was the main cause of death among managers & intellectual occupations (50%), cardiovascular death among non-manual elementary workers (53%), manual elementary workers (49%) and craftsmen, shop keepers & business owners (33%), and physical accidents among farmers (50%) and manual elementary workers (48%). The main cause of death varied by sector: physical accidents in construction (61%), cardiovascular events in transportation and storage (67%) and manufacturing (51%). 27% (n = 130) tested positive for at least one psychoactive substance, including 75 for alcohol, 43 for sedative anxiolytics and 33 for cannabis. These results may help occupational health professionals to design policies and campaigns to prevent deaths among the workers concerned. Specific studies to assess the proportion of fatal accidents attributable to the use of alcohol, cannabis or benzodiazepines could contribute to reducing work-related deaths.
Copyright (c) 2026 Céline Lamouroux, Guillaume Pouliquen, Emmanuel Fort, Marie Epain, Florent Marfaing, Barbara Charbotel, Laurent Fanton https://creativecommons.org/licenses/by-nc/4.0
Breathing the Job: Impaired Pulmonary Function in Hairdressers due to Occupational Chemical Exposure
Background: Hairdressers are occupationally exposed to harmful factors in the working environment and many cosmetic products. During the professional use of these products, there is exposure to many irritating, allergic, and carcinogenic chemicals, mainly through the skin and respiratory tract, and it is known that these occupational exposures are much more frequent and long-lasting than personal exposures. Hairdressing is one of the occupational groups with a high risk of respiratory diseases. In this study, we aimed to determine the extent to which the hairdressing profession affects respiratory functions. Methods: The present study included 50 people who had worked in hairdressing for at least three years, especially with hair products, had not been diagnosed with respiratory disease before this job, and did not smoke, and 50 healthy people with similar demographic characteristics. All respiratory complaints and sociodemographic information of the hairdressers were determined. Pulmonary function tests (PFTs) were performed on hairdressers and a healthy group, including FEV1, FVC, PEF, and FEV1/FVC ratio. Results: In the present study, we found that the hairdressing profession significantly increased the risk of respiratory symptoms. In addition, the increase in working hours as a hairdresser was associated with increased respiratory complaints, while hairdressers showed a statistically significant decrease in PFT values compared to the healthy group. Conclusions: Exclusion of smoking in our study reveals the occupational exposure more clearly. Our study provides additional evidence of a possible significant association between chemical exposure and increased respiratory symptom prevalence and decreased lung function.
Copyright (c) 2026 Zeliha Demir Giden, Elif Demir, Ramazan Giden, Hasret Yağmur Sevinç Akın https://creativecommons.org/licenses/by-nc/4.0
Headaches in Hospital Nurses - Authors' Reply
Copyright (c) 2026 Carla Scorza, Fulvio Scorza, Josef Finisterer, Elif Reyhan Sahin, Gabriele d'Ettorre, Andrea Baldassarre, Roberta Tornese https://creativecommons.org/licenses/by-nc/4.0
Diagnostic Utility of Serum Krebs von den Lungen-6 (KL-6) and Surfactant Protein-D (SP-D) Levels in Hypersensitivity Pneumonitis
Background: This study aimed to investigate the diagnostic and prognostic values of serum Krebs von den Lungen-6 (KL-6) and ve Surfactant Protein-D (SP-D) levels in patients with hypersensitivity pneumonitis (HP). Methods: Serum samples were collected from patients diagnosed with HP and from a healthy control group. KL-6 and SP-D levels were measured using the ELISA method. HP cases were further compared according to fibrotic and non-fibrotic subgroups, as well as whether they were receiving treatment or not. The relationships between respiratory function tests (DLCO, FEV₁, FVC) and biomarker levels were examined. Results: Both KL-6 (median 5.95 ng/ml vs 5.4 ng/ml, p<0.001) and SP-D (median 14.87 ng/ml vs 14.72 ng/ml, p<0.05) levels were significantly higher in HP patients than in the control group. In non-fibrotic HP patients, KL-6 levels were higher than in the fibrotic group (median 6.07 ng/ml vs 5.62 ng/ml, p<0.05), while no significant difference was observed for SP-D (p=0.71). KL-6 levels were significantly higher in untreated cases compared to treated cases (median 6.30 ng/ml vs 5.65 ng/ml, p<0.01), while the difference in SP-D was not significant (p=0.26). Conclusion: KL-6 emerges as a sensitive biomarker in the diagnosis of HP, assessing of disease activity, and monitoring treatment response. SP-D, although reflecting inflammatory processes, seems to be have limitations in evaluating fibrotic progression.
Copyright (c) 2026 Asuman Aslan Kara, Adem Koyuncu, Gülden Sarı, Tuğçe Şahin Özdemirel, Berna Akıncı Özyürek, Cebrail Şimşek https://creativecommons.org/licenses/by-nc/4.0
Where Are We Going by Applying AI Tools? Are We Going to Lose Our Jobs?
Copyright (c) 2025 Antonio Mutti https://creativecommons.org/licenses/by-nc/4.0
Effectiveness of Occupational Health Promotion Programs on Cardiometabolic risk factors: A Systematic Review and Three-Level Meta-Analysis
Background: This study aimed to evaluate the effectiveness of workplace-based health promotion programs targeting cardiometabolic risk factors. Methods: We conducted a systematic review and three-level random-effects meta-analysis following PRISMA guidelines, covering studies published from January 2019 to September 2024. Eligible studies included randomized controlled trials (RCTs) and quasi-experimental (QE) designs assessing workplace interventions to reduce cardiometabolic risks in adult workers. Twelve outcomes were considered. Subgroup analyses and meta-regressions were performed to explore sources of heterogeneity. Certainty of evidence was evaluated using GRADE assessment tool. Results: Forty-four studies (30 RCTs, 14 QE) involving 49,813 participants were included. Significant improvements were found in nine of twelve outcomes. These included reductions in BMI (–0.61kg/m²; [–0.93; –0.29]), body weight (–2.43kg; [–3.48; –1.38]), waist circumference (–3.46cm; [–5.21; –1.71]), body fat (–1.58%; [–2.40; –0.76]), systolic (–3.75mmHg: [–5.67; –1.82]) and diastolic (mmHg; [-3.58; -1.29]) blood pressure, LDL cholesterol (–5.9 mg/dL; [–11.6; –0.12]), and an increase in HDL cholesterol (2.76 mg/dL; [0.42; 5.09]). All significant outcomes were supported by moderate-to-high certainty evidence except LDL cholesterol, which was rated very low. Non-significant results were observed for total cholesterol, triglycerides and FBG. High heterogeneity was observed. Pre-existing health conditions, author and duration of intervention partially explained between-study heterogeneity. Conclusions: Workplace health promotion programs were associated with improvements in various cardiometabolic health indicators. Greater effectiveness was observed in interventions targeting high-risk populations, delivered by physicians or qualified health professionals, and implemented over shorter durations. Findings support the integration of such programs into occupational health policies and broader public health strategies. Future research should optimize intervention designs, extend follow-up, and consider integrated approaches to maximize long-term benefits.
Copyright (c) 2025 Alessandro Godono, Veruscka Leso, Ettore Paradisi, Elisa Carena, Maria Vittoria Picciaiola, Anna Schneider-Kamp, Catalina Ciocan, Fabrizio Bert, Franco Veglio, Paolo Boffetta, Ivo Iavicoli https://creativecommons.org/licenses/by-nc/4.0
Prevalence and Multivariate Impact of Musculoskeletal Disorders on General Health, Occupational Fatigue, and Productivity in an Industrial Workforce
Background: Musculoskeletal disorders represent a leading occupational health challenge in heavy‐industry settings, yet their combined impact on workers’ general health, fatigue, and productivity remains underexplored. This study aims to quantify the relationship between multisite musculoskeletal symptom burden and key health and performance outcomes among copper‐industry employees. Methods: A cross-sectional survey of 585 workers used the Standardized Nordic Musculoskeletal Questionnaire, the 28-item General Health Questionnaire, the SOFI-20 fatigue inventory, and the HPQ-26 productivity survey. Spearman’s rank correlation was used to examine bivariate relationships, and multivariable linear regression models adjusting generally for demographic, work-related, and psychosocial factors were employed to estimate the independent effect of the number of painful sites on health, fatigue, and productivity outcomes. Results: Fifty-seven percent of workers reported pain in at least one region during the preceding 12 months, with an average of 2.6 painful sites per person (standard deviation 2.4). The number of painful sites showed a moderate positive correlation with poorer general health scores (ρ = 0.43, p < 0.001) and higher fatigue scores (ρ = 0.53, p < 0.001), and a moderate negative correlation with productivity ratings (ρ = –0.30, p < 0.001). In adjusted regression analyses, each additional painful site was associated with a 1.9-point worsening in general health score (95% CI 1.5 to 2.2), an 8.4-point increase in fatigue score (95% CI 7.3 to 9.6), and a 1.6-point decrease in productivity score (95% CI –2.0 to –1.2), all with p-values < 0.001. Conclusions: There is a clear dose–response relationship between the number of painful anatomical sites and declines in health, increases in fatigue, and reductions in productivity among copper-industry workers. To address this multifaceted impact, interventions should integrate ergonomic workstation design, task rotation, optimized break schedules, and comprehensive health-promotion services targeting both physical and psychosocial risk factors.
Copyright (c) 2026 Alireza Choobineh, Mohammad Karami, Yaser Sahranavard, Mohammad Reza Fakhraei, Fatemeh Ghanbari Mohammad, Fatemeh Alibeygian, Somayeh Hossainie Nasab, Azam Alizadeh, Mina Shahbazi, Reza Tahmasebi https://creativecommons.org/licenses/by-nc/4.0
The Micronucleus Test for Occupational Safety
Although less commonly used than internal dose indicators, biological effect indicators can be valuable for Risk Assessment. Among the numerous biomarkers used to date, those that indicate DNA damage could be especially useful for occupational safety, as they predict the risk of carcinogenesis. The most common among these assays is the micronucleus test. Unfortunately, this test cannot be performed on human erythrocytes; to apply it to lymphocytes, it requires invasive blood sampling, limiting its use to scientific research. We have developed a new method that enables the micronucleus test to be conducted in a rapid, non-invasive, and cost-effective manner. The test is performed on immature erythrocytes (reticulocytes) in human blood smears collected via a finger prick and stained with Acridine Orange. This new protocol allows the micronucleus test to be applied to human blood samples in a manner compatible with occupational safety procedures.
Copyright (c) 2026 Ion Udroiu, Claudia Giliberti, Antonella Sgura https://creativecommons.org/licenses/by-nc/4.0
Human Biomonitoring of Butylated Hydroxytoluene (BHT) in Germany: Methods, Exposure Levels, and Health-Based Interpretation
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.
Copyright (c) 2025 Christoph Schmidtkunz, Isabell Schönrath, Aline Murawski, Katja Küpper, Nora Lemke, Till Weber, Gabriele Leng, Marike Kolossa-Gehring https://creativecommons.org/licenses/by-nc/4.0
From Subjects to Partners: Rethinking Research Methodologies through Citizen Science
The article will first introduce a general definition of Citizen Science (section 1), followed by an excursion of its foundations and of the different understandings and ways of applying it, with examples drawn from diverse research and policy areas (section 2). It will then focus more closely on the field of health and the environment (section 3), including occupational medicine (subsection 3.1), community response to environmental risks (section 3.2), biomonitoring (sub-section 3.3), and human biomonitoring (subsection 3.4). Section 4 will address some of the advantages (section 4.1) and challenges (section 4.2) of adopting CS in research and policy. Finally, section 5 will trace the legislative and normative background of participatory approaches and points to the challenges ahead.
Citizen Science, participation, integration, inter-disciplinarity, trans-disciplinarity, occupational medicine, biomonitoring, human biomonitoring.
Copyright (c) 2025 Bruna De Marchi https://creativecommons.org/licenses/by-nc/4.0
Cognitive Effects of Aluminum Exposure in Cement Factory Workers: A Mini-Mental State Examination (MMSE) Assessment
Background: 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. Methods: 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. Results: 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). Conclusion: 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.
Copyright (c) 2026 Fatma Bozdağ, Sultan Pınar Çetintepe, Mümüne Bozdağ Kiraz, Sevgi Suna Karatay-Rassmus, Mustafa Necmi İlhan https://creativecommons.org/licenses/by-nc/4.0
Investigation of the Association Between COVID-19 and Hepatitis B Vaccination Among Healthcare Workers: A Cross-Sectional Study in Turkey
Backgrounds: Vaccination is a cornerstone of public health. While COVID-19 vaccination became globally prioritized during the pandemic, Hepatitis B immunization has remained a mandatory occupational requirement in Turkey, particularly among healthcare workers (HCWs). This study evaluated Hepatitis B immunization and factors associated with COVID-19 vaccination among Turkish HCWs. Methods: A retrospective cross-sectional study was conducted between February 1 and August 15, 2024, at Mersin City Training and Research Hospital. Employees and trainee students who underwent periodic health examinations were included. Participants were grouped as physicians, non-physician HCWs, and non-healthcare professionals. Data included demographics, vaccination history, hematological and biochemical parameters, and clinical characteristics. Logistic regression identified factors associated with COVID-19 vaccination status. Results: Of 4,048 participants, 92.1% received at least one COVID-19 vaccine dose and 90.0% were vaccinated against Hepatitis B. Physicians demonstrated the highest coverage for both vaccines. Male gender (OR=1.37, 95% CI: 1.04–1.80), non-physician HCW status (OR=2.51, 95% CI: 1.33–4.75), non-healthcare professional status (OR=2.99, 95% CI: 1.55–5.77), and behaviorally linked elevated platelet count (OR=1.54, 95% CI: 1.04–2.28) were independently associated with COVID-19 non-vaccination. A prior history of Hepatitis B vaccination showed a strong protective effect against COVID-19 non-vaccination (OR=0.30, 95% CI: 0.23–0.40). Conclusions: Vaccine uptake varied across occupational groups, with physicians achieving the highest rates. Prior compliance with mandatory Hepatitis B vaccination was positively associated with COVID-19 vaccine acceptance, emphasizing the role of previous immunization behavior in new vaccine adoption. Occupational health policies integrating vaccination counseling and follow-up are essential to improve coverage among non-physician HCWs.
Copyright (c) 2026 Seval Müzeyyen Ecin, Abdulsamet Sandal https://creativecommons.org/licenses/by-nc/4.0
Work-Related Accidents and Their Predictors Among Delivery Drivers in Egypt: A Cross-Sectional Study
Background: 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. Methods: 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. Results: 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). Conclusions: 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.
Copyright (c) 2026 Omnia A. M. Yousef, Mohamed El-Helaly, Adel El-Wehedy, Khadija A. F. Denewar https://creativecommons.org/licenses/by-nc/4.0
Occupational Risk for Headache Disorders in Female Registered Nurses. A Retrospective Study
Background: Prevention of headache disorders (HDs) among healthcare workers in hospital settings remains a challenge for organizations and employees worldwide. The goals of the present retrospective study were both to analyze the 1-year prevalence of any primary HDs among female registered nurses (RNs) employed in hospital settings and to investigate the relationship between occupational risk factors and HDs. Methods: We analyzed the occupational medicine database of RNs employed in a large hospital. The sample included 975 female RNs; the diagnostic criteria were based on the International Classification of Headache Disorders, 3rd edition (beta version). Results: One-year prevalence of any HD was 45.9%; tension-type headache (TTH) was the most commonly reported headache type (by 25.6% of participants), followed by migraine (17.5%). No association was found between the different headache types and work schedules; TTH was linked to age ≥40 years (OR=1.91; 95% CI=1.41-2.72), duration of service ≥15 years (OR=1.61; 95% CI=1.24-2.38), and number of night shifts >5 per month (OR=1.71; 95% CI=1.09-2.68). A high level of WRS was a significant predictor of TTH. Conclusions: We found a link between TTH and modifiable risk factors at both the individual and organizational levels. These findings suggest interventions in occupational settings to minimize the occurrence of TTH among RNs. Policy-makers and employers should implement preventive measures to reduce the incidence of HDs among RNs by minimizing modifiable risk factors associated with increased occupational risk.
Headache disorder; Shift-work; Work-related stress;
Copyright (c) 2025 Gabriele d'Ettorre; Roberta Tornese; Andrea Baldassarre https://creativecommons.org/licenses/by-nc/4.0
Evaluation of the Hearing Function in the Orchestra Professional Musicians of the Teatro alla Scala in Milan
Background: This study was conducted to determine whether occupational exposure to high sound levels, typical of an opera orchestra, can cause hearing loss. Methods: 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. Results: 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. Conclusions: 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.
Opera; Music; Orchestral Professional Musicians; Musicians Hearing Threshold; Hypoacusis; Hearing Disorders; Occupational Workers; Noise-Induced Hearing Loss
Copyright (c) 2025 Terenzio Cassina, Alessia Tomasin, Orietta Calcinoni, Umberto Ambrosetti, Eliana Filipponi, Valeria Castelli, Riccardo Bianchin, Valentina Teodorani, Laura Magnoni, Leonardo Braga, Linda Parati, Federica Di Berardino https://creativecommons.org/licenses/by-nc/4.0
Call for Applications for the Enrico C. Vigliani Award
La SIML – Società Italiana di Medicina del Lavoro è lieta di annunciare l’apertura delle candidature per il prestigioso Premio Vigliani, riconoscimento annuale riservato a giovani ricercatori che si siano distinti per l’impegno e la qualità della propria attività scientifica nel campo della Medicina del Lavoro. SCADENZE IMPORTANTI Candidatura: data limite 31 agosto 2025, ore 18 COMUNICAZIONE DEL VINCITORE: 15 settembre 2025 Premiazione ufficiale: 1 ottobre 2025, Bologna – 87° Congresso Nazionale SIML Scarica il PDF per saperne di più...
The Silent Strain: Grip Strength, and Wrist/Hand Musculoskeletal Disorders among Meat Cutters
Background: Meat cutters are a working group engaged in awkward posture, repetitive motion, and forceful exertion in wrists/hands. This study was conducted a) to examine the prevalence of musculoskeletal symptoms among Iranian meat cutters, b) to assess the wrist musculoskeletal disorders risk assessment and hand grip strength. Methods: Ninety-five male meat cutters in Iran (≥ 1 year tenure) completed a demographic/occupational questionnaire, the Nordic Musculoskeletal Questionnaire (NMQ), and the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Ergonomic risk was assessed via the ACGIH-TLV hand activity method, and maximum hand-grip force was measured. Results: With 69.5% reporting point prevalence and 70.5% reporting period prevalence of wrist/hand musculoskeletal symptoms, the study indicated that meat cutters had a significant prevalence of these symptoms. Most participants demonstrated mild to moderate severity in self-reported wrist symptoms while retaining asymptomatic functional status. The ACGIH-HAL assessment indicated most participants operated at or above the action level (AL), suggesting potential ergonomic risks. Moreover, The ACGIH-HAL ratio had a weak negative association with hand grip strength (β = − 0.0071, p = 0.12). Conclusions: These findings highlight the ergonomic challenges associated with meat-cutting tasks.
Copyright (c) 2026 Hamid Jahangiri, Fatemeh Ghasemi, Mojgan Zoaktafi, Hamid Salmani Nodooshan, Mohebat Vali, Hadi Daneshmandi https://creativecommons.org/licenses/by-nc/4.0
Workplace Violence and Patient Management Time in the Emergency Department: An Observational Study
Background: 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. Objective: 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.Methods: 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. Results: 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. Conclusion: 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.
Copyright (c) 2025 Chiara Di Giorgio, Isabella Cucchi, Marco Mendola, Maria Cristina Costa, Fabio Tonelli, Elisa Turchet, Matteo Marrazzo, Paolo Carrer https://creativecommons.org/licenses/by-nc/4.0
Strength and Perceived Effort in Repetitive Upper-Limb Tasks: An OCRA Method Analysis of 900 Workers
Background: Work-related musculoskeletal disorders pose a significant burden on the population. The OCRA method plays a key role in assessing the risk associated with repetitive actions of the upper limbs. In this method, muscular force is evaluated based on the rate of perceived effort (RPE) reported by the worker, which can introduce subjective bias into the assessment. This study aims to determine whether testing the worker’s handgrip strength can improve the accuracy of the force assessment in the OCRA method. Methods: Handgrip strength was measured during the risk assessment process following the OCRA method. Data were divided into specific percentile ranks based on age, gender, height, and handedness. Results: 903 workers from 43 different Italian companies were surveyed. There was a significant difference in handgrip strength percentiles stratified by report of an RPE > 2 and those without (p = 0.047). Additionally, significant differences were found in perceived effort rates (based on the OCRA method) among workers with different levels of stratified handgrip strength (dominant hand: p = 0.04, non-dominant hand: p = 0.02). Conclusions: Workers performing repetitive upper limb actions at various strength levels experience different perceived effort rates during tasks. These findings suggest that measuring handgrip strength is a crucial component of risk assessments using the OCRA method. To date, this study's sample size is among the largest for this evaluation method; we believe these results could be a significant step forward in improving the risk assessment process for biomechanical overload
Copyright (c) 2025 Stefano Gobbo, Valentina Bullo, Francesco Favro, Davide Pavan, Beatrice Doro, Alessandro Bortoletto, Giuseppe De Palma, Emma Sala, Stefano Mattioli, Andrea Di Blasio, Marco Bergamin https://creativecommons.org/licenses/by-nc/4.0
Occupational Asthma Due to Subtilisin: The Power of Specific Inhalation Challenge
We report the first confirmed case in Italy of occupational asthma caused by subtilisin in a healthcare worker involved in cleaning surgical instruments. The diagnosis was confirmed through a specific inhalation challenge (SIC) performed one year after the last exposure and after stopping inhaled corticosteroid therapy. An immediate reaction was observed after three minutes of exposure to diluted Neogiozym ™, with a 30% decrease in FEV1. This case highlights the diagnostic importance of SIC even for high-molecular-weight (HMW) agents and emphasizes the need to reconsider occupational asthma as a complex, evolving disease influenced by both host and environmental factors. The patient exhibited a Type-2-high phenotype despite negative skin prick tests and normal IgE levels, reinforcing the value of dynamic, multi-marker assessment in occupational endotyping. This case supports the broader use of SIC in occupational settings where allergen-specific IgE testing is limited.
Copyright (c) 2025 Filippo Liviero, Laura Fabris, Marco Biasioli, Francesco Favretto, Paola Mason https://creativecommons.org/licenses/by-nc/4.0
Steady-State Auditory Evoked Potentials in Workers Exposed to Occupational Noise
Background: The present study aims to investigate neural synchrony, as measured by Auditory Steady State Response (ASSR), in individuals with normal hearing who are exposed and not exposed to occupational noise, thereby providing insights into hidden hearing loss within the central auditory nervous system, and justifying the importance of exploring auditory neural function in populations at risk. Methods: A cross-sectional study involved 30 noise-exposed individuals in the Study Group and 30 unexposed individuals in the Control Group, all paired by an average age of 35 years. The following procedures were performed on all individuals: clinical and occupational history, meatoscopy, immitanciometry, pure tone audiometry, speech audiometry, and ASSR (40Hz). We analyzed the audiometric hearing thresholds at frequencies of 1 kHz and 4 kHz, the electrophysiological thresholds estimated by ASSR, and the comparison of the differences between them: the thresholds estimated by ASSR and the audiometry thresholds. The data were analyzed using both descriptive and inferential statistics. P-values ≤ 0.05 were considered significant. Results: When comparing hearing thresholds at 1 kHz and 4 kHz between groups, we found significant differences, with the SG showing higher hearing thresholds than the CG bilaterally. No significant differences were seen in the electrophysiological thresholds estimated by ASSR, nor in the comparison between the ASSR-estimated threshold and the psychoacoustic hearing threshold groups. Conclusions: The results of this study suggest that workers exposed to occupational noise did not show detectable changes in neural synchrony in the midbrain, thalamus, or primary auditory cortex when compared to individuals without occupational noise exposure.
Copyright (c) 2025 Mariana Keiko Kamita, Clayton Henrique Rocha, Liliane Aparecida Fagundes Silva, Alessandra Giannella Samelli, Carla Gentile Matas https://creativecommons.org/licenses/by-nc/4.0
Longitudinal Changes in Work Ability, Well-Being, and Psychosocial Risk Factors Among Older Workers: The ProAgeing Study
Background: As the workforce ages, older employees face increasing challenges in adapting to changing job demands, including technological advances and ongoing occupational risks such as shift work and physically demanding tasks. Work ability is a reliable indicator of older workers’ capacity to meet both physical and mental requirements of their jobs. The ProAgeing study, a multicenter investigation specifically focused on workers over 50 years old, examined long-term patterns in work ability, perceived health, and psychosocial risk factors, along with their interactions across this demographic. Methods: Participants completed self-reported questionnaires at baseline and after one year, including the Work Ability Index (WAI), technostress, sleep quality, perceived stress, health, and psychosocial risk factors. A first-difference linear regression model was used to assess predictors of changes in WAI. Subgroup analyses examined differences across occupational roles (bank employees, administrative employees, and manual workers). Results: Of the 470 workers enrolled, 356 (76%) completed the follow-up. A significant decline in average WAI score was observed over 12 months (-1.2 points, p<0.001), mainly in subscales related to work demands and physical illness. Technostress levels slightly decreased, suggesting adaptation over time. Bank employees showed less favorable trends than manual workers, indicating that digitalization and higher job demands significantly affected employees’ well-being, especially older workers. Improvements in perceived health and reduced stress mostly contributed to enhanced work ability. Conclusions: These findings highlight the importance of targeted interventions to enhance health and lower stress among aging workers, supporting their well-being and subsequently their work ability.
Copyright (c) 2025 Alice Fattori, Teresa Barnini, Anna Comotti, Pasquale Bufano, Marco Laurino, Simone Russo, Luca Ferrari, Catalina Ciocan, Matteo Bonzini https://creativecommons.org/licenses/by-nc/4.0
Neurosensory Response of the Hand and Foot to Vibration Exposure
Background: This study investigated the vibrotactile perception threshold (VPT) changes in the fingers and toes of twenty-eight healthy subjects (15 males and 13 females aged 20 to 62 years) exposed to hand- and foot-transmitted vibration. Methods: The VPT was measured before and after the exposure of the hands and feet to 5 minutes of triaxial white noise pseudorandom vibration. The post-vibration VPT was measured immediately after and 15 minutes after the end of the exposure to assess the temporary threshold shift (TTS) of vibration perception. The effects of the anatomical district (index finger and big toe), measurement time (before and after vibration exposure), test frequency (8, 31.5, and 125 Hz), age group (Under30s and Over 40s), and gender (male and female) on the changes in VPT were investigated. Results: The findings revealed that the index finger and the big toe exhibited comparable profiles in the vibrotactile sensitivity at the low-middle vibration frequencies and in the recovery of the perception threshold after vibration exposure. The big toe showed a higher perception threshold than the index finger, and the difference increased with the test frequency. In addition to vibration frequency, age and skin temperature influenced the results of VPT and TTS measurements. Conclusions: The findings of this study can contribute to outlining alternative frequency weighting functions for the neurosensory response of the hand and foot to vibration exposure, and to update the current guidelines for evaluating human vibration exposure.
Copyright (c) 2025 Flavia Marrone, Nicole Sanna, Julio Sánchez García , Federico Ronchese, Enrico Marchetti, Angelo Tirabasso, Massimo Bovenzi, Marco Tarabini https://creativecommons.org/licenses/by-nc/4.0