Healthy People in Healthy Workplace: Philosophy and Practice of Workplace Health Promotion (WHP)

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European Monitoring Plans for the management of Outbreak of Crimean Congo Haemorrhagic Fever (CCHF)

The Crimean Congo Haemorrhagic Fever (CCHF) is a viral infection caused by the CCHF virus (CCHFV), a member of the family Bunyaviridae, genus Nairovirus

Invecchiamento nel settore sanitario italiano: dalle criticità alle soluzioni possibili

L’età media della popolazione generale e al contempo della popolazione lavorativa è in continuo e progressivo aumento, soprattutto in alcuni settori lavorativi, come ad esempio quello della sanità, caratterizzato da lavoratori prevalentemente di genere femminile e con età media elevata. Vi è pertanto necessità di programmi di intervento come linee guida e buone prassi che consentano di migliorare le condizioni di salute e di sicurezza, ad esempio evitando gli incidenti o favorendo il rientro al lavoro dopo malattia o infortunio. Soluzioni organizzative ed ergonomiche vanno ricercate ed incentivate per garantire lavoratori sani, attivi e produttivi all’interno di luoghi di lavoro sicuri.The average age of the general population and at the same time of the working population is increasing continuously and progressively, especially in certain sectors of work, such as health care one, with predominantly female workers with a high average age. There is a need for action programmes such as guidelines and good practices to improve health and safety conditions, for example by avoiding accidents or facilitating return to work after illness or injury. Organizational and ergonomic solutions must be encouraged to ensure healthy, active and productive workers in safe workplaces

Kratkotrajni učinci izloženosti niskim koncentracijama didušikova oksida u anesteziologa

The aim of this study was to assess whether a sample of 37 anaesthetists occupationally exposed only to N2O showed any deterioration in vigilance and/or mood. The anaesthetists were examined with three neurobehavioural tests (Simple Reaction Time and Colour Word Vigilance to measure the vigilance and Mood Rating Scale to evaluate the level of stress and arousal) and underwent N2O biological monitoring (to correlate the test results with the N2O exposure) on the first and on the last day of the work week, before and after work in the operating room. No significant relationship was found between the biological monitoring and the test results. The only significant statistical difference was found between the beginning and the end of each workday in the arousal level, regardless of the result of the biological monitoring.Cilj je ovoga ispitivanja bio utvrditi do kakvih promjena budnosti i raspoloženja dolazi u 37 anesteziologa profesionalno izloženih didušikovu oksidu. Promjene u budnosti ispitane su s pomoću zadatka jednostavnog vremena reagiranja i zadatka pozornosti, a promjene u raspoloženju s pomoću skale procjene različitih raspoloženja. Mjerenja su izvršena na početku i na kraju prvog i zadnjeg radnog dana u tjednu, a mjerenja didušikova oksida u urinu izvršena su samo na kraju radnog vremena prvoga i posljednjeg radnog dana u tjednu. Nije utvrđena povezanost između rezultata biološkog monitoringa i psihologijskog ispitivanja. Konzistentne statistički značajne razlike utvrđene su jedino u subjektivnim procjenama budnosti na početku i na kraju radnog dana

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

[The new methodology to produce instruments for updating occupational physician proposed by Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII)]

Starting from the experience of last five years, during which 24 guide liens about the most important aspects of Occupational Physician activity have been produced, the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII) delegated a specific working group for updating the methodology to be adopted for guide lines and other instruments for improving and standardizing the current activity in our professional field. SIMLII produced in the context of the specific Education and Accreditation Programme for occupational physicians prepared from 2002 25 guide lines or other informative instruments on the most important and controversial themes in which our discipline is involved. They were considered and treated to meet the need to improve and standardise activities and to modify the current approach of occupational physicians and aimed not only at improving the effectiveness of preventive actions but also at constantly adopting rigorous methodologies based where possible on evidence based or on consensus procedures. The Directive of SIMLII was firmly convinced about the opportunity-necessity to critically evaluate the experience carried out during the last years, at the light of the National Program for Guide Lines edited By Italian National Health Institute since 2002 and which concerns preparation, dissemination, updating, implementation of guide lines in Medicine. The guide lines were defined as rational critical effective aid addressed to professionals and patients for health services organization. Relevant was the new Framework Act for the occupational safety and health (Decreto legislativo 81/08) too signed by the President of the Italian Republic on April 9, 2008, which for the first time includes and defines in a legislative act the different possible instruments (technical normative, good practices, guide lines). In this paper we present the new methodology defined by our Society for producing the different kind of instruments such as guide lines, consensus conference reports, technology assessments, good practices statements guide lines focusing as the main aspects those related to definitions, argument choice, working group and coordinator identification, producing methods, evidence evaluation, grading, quality evaluation using AGREE method, dissemination procedure, the conflict of interest and the possible use for distance formation procedure focusing the recommendations that take a practical-applicative approach